Nur677 final exam study guide 2025-2026
Ears, eyes, nose, and throat (eent)
Ears
Chapter 66, “inner ear disturbance”
1. A patient is suspected of having vestibular neuritis. Which finding on physical
examination is consistent with this diagnosis?
1. Facial palsy and vertigo
2. Fluctuating hearing loss and tinnitus
3. Spontaneous horizontal nystagmus
4. Vertigo with changes in head position
Ans: c
Many patients with vestibular neuritis will exhibit spontaneous horizontal or rotary
nystagmus, away from the affected ear. Facial palsy with vertigo occurs with ramsay
hunt syndrome, caused by herpes zoster. Fluctuating hearing loss with tinnitus is
common in meniere’s disease. Tinnitus may occur with vestibular neuritis but hearing
loss does not occur. Patients with benign paroxysmal positional vertigo will exhibit
vertigo associated with changes in head position.
2. A patient reports several episodes of acute vertigo, some lasting up to an hour,
associated with nausea and vomiting. What is part of the initial diagnostic workup for
this patient?
1. Audiogram
2. Auditory brainstem testing
3. Electrocochleography
4. Vestibular testing
Ans: a
An audiogram and magnetic resonance imaging (mri) are part of basic testing for meniere’s
disease. The other testing may be performed by an otolaryngologist after referral.
1. Which symptoms may occur with vestibular neuritis? (select all that apply.)
1. Disequilibrium
2. Fever
3. Hearing loss
4. Nausea and vomiting
5. Tinnitus
,Ans: a, d, e
Vestibular neuritis can cause severe vertigo, disequilibrium, nausea, vomiting, and tinnitus, but
not fever or hearing loss.
Chapter 175, “dizziness and vertigo”
1. A patient reports a recurrent sensation of spinning associated with nausea and vomiting.
Which test will the provider order to confirm a diagnosis for this patient?
1. Electroencephalogram (ecg)
2. Holter monitoring and electrocardiogram
3. Neuroimaging with computerized tomography (ct)
4. The hallpike-dix positioning maneuver
Ans: d
This patient has symptoms consistent with a vestibular lesion, so the provider will order
a hallpike-dix positioning maneuver to evaluate vestibular function. If seizure activity is
suspected, an
Electroencephalogram will be ordered. Holter monitoring and ecg are used if patients
report syncope or lightheadedness. Neuroimaging with ct is used when patients possibly
have a central lesion which would present with difficulty balancing.
2. An older adult patient reports sensations of being off balance when walking but does
not experience dizziness. The provider will refer this patient to which specialist for
further evaluation?
A. Audiologist
B. Cardiologist
C. Neurologist
D. Otolaryngologist
Ans: c
This patient has problems of balance without dizziness, suggestive of a central neural lesion and
should be referred to a neurologist. Patients with vertigo are likely to have vestibular
dysfunction and would be referred to an otolaryngologist and possibly an audiologist if hearing
is affected. Patients with syncope or lightheadedness are more likely to have an underlying
cardiac disorder and would be referred to a cardiologist.
,Eyes
Chapter 52, “evaluation of the eyes”
1. A provider performs an eye examination during a health maintenance visit and notes a
difference of 0.5 mm in size between the patient’s pupils. What does this finding
indicate?
1. A relative afferent pupillary defect
2. Indication of a difference in intraocular pressure
3. Likely underlying neurological abnormality
4. Probable benign, physiologic anisocoria
Ans: d
A difference in diameter of less than 1 mm is usually benign. Afferent pupillary defects
are paradoxical dilations of pupils in response to light. This does not indicate differences
in intraocular pressure. A difference of more than 1 mm is more likely to represent an
underlying neurological abnormality.
2. A patient comes to clinic with diffuse erythema in one eye without pain or history of
trauma. The examination reveals a deep red, confluent hemorrhage in the conjunctiva
of that eye. What is the most likely treatment for this condition?
1. Order lubricating drops or ointments.
2. Prescribe ophthalmic antibiotic drops.
3. Reassure the patient that this will resolve.
4. Refer to an ophthalmologist.
Ans: c
Most subconjunctival hemorrhage, occurring with trauma or valsalva maneuvers, will
self-resolve and are benign. Lubricating drops are used for chemosis. Antibiotic eye
drops are not indicated. Referral is not indicated.
1. During an eye examination, the provider notes a red-light reflex in one eye but not the
other. What is the significance of this finding?
1. Normal physiologic variant
2. Ocular disease requiring referral
, 3. Potential infection in the “red” eye
4. Potential vision loss in one eye
Ans: b
The red reflex should be elicited in normal eyes. Any asymmetry or opacity suggests
ocular disease, potentially retinoblastoma, and should be evaluated immediately.
Chapter 53, “cataracts”
1. A primary care provider may suspect cataract formation in a patient with which finding?
1. Asymmetric red reflex
2. Corneal opacification
3. Excessive tearing
4. Injection of conjunctiva
Ans: a
An asymmetric red reflex may be a finding in a patient with cataracts. Corneal opacification,
excessive tearing, and corneal injection are not symptoms of cataracts.
1. Which are risk factors for development of cataracts? (select all that apply.)
1. Advancing age
2. Cholesterol
3. Conjunctivitis
4. Smoking
5. Ultraviolet light
Ans: a, d, e
Most older adults will developncautarrsacitsn. Sgmtobk.incgoamnd uv light exposure hasten
the development of cataracts. Cholesterol and conjunctivitis are not risk factors.
Chapter 57, “dry eye syndrome”
A patient experiencing chronically dry eyes reports having a foreign body sensation, burning,
and itching. A schirmer test is abnormal. What is the suspected cause of this patient’s
symptoms based on this test finding?
Ears, eyes, nose, and throat (eent)
Ears
Chapter 66, “inner ear disturbance”
1. A patient is suspected of having vestibular neuritis. Which finding on physical
examination is consistent with this diagnosis?
1. Facial palsy and vertigo
2. Fluctuating hearing loss and tinnitus
3. Spontaneous horizontal nystagmus
4. Vertigo with changes in head position
Ans: c
Many patients with vestibular neuritis will exhibit spontaneous horizontal or rotary
nystagmus, away from the affected ear. Facial palsy with vertigo occurs with ramsay
hunt syndrome, caused by herpes zoster. Fluctuating hearing loss with tinnitus is
common in meniere’s disease. Tinnitus may occur with vestibular neuritis but hearing
loss does not occur. Patients with benign paroxysmal positional vertigo will exhibit
vertigo associated with changes in head position.
2. A patient reports several episodes of acute vertigo, some lasting up to an hour,
associated with nausea and vomiting. What is part of the initial diagnostic workup for
this patient?
1. Audiogram
2. Auditory brainstem testing
3. Electrocochleography
4. Vestibular testing
Ans: a
An audiogram and magnetic resonance imaging (mri) are part of basic testing for meniere’s
disease. The other testing may be performed by an otolaryngologist after referral.
1. Which symptoms may occur with vestibular neuritis? (select all that apply.)
1. Disequilibrium
2. Fever
3. Hearing loss
4. Nausea and vomiting
5. Tinnitus
,Ans: a, d, e
Vestibular neuritis can cause severe vertigo, disequilibrium, nausea, vomiting, and tinnitus, but
not fever or hearing loss.
Chapter 175, “dizziness and vertigo”
1. A patient reports a recurrent sensation of spinning associated with nausea and vomiting.
Which test will the provider order to confirm a diagnosis for this patient?
1. Electroencephalogram (ecg)
2. Holter monitoring and electrocardiogram
3. Neuroimaging with computerized tomography (ct)
4. The hallpike-dix positioning maneuver
Ans: d
This patient has symptoms consistent with a vestibular lesion, so the provider will order
a hallpike-dix positioning maneuver to evaluate vestibular function. If seizure activity is
suspected, an
Electroencephalogram will be ordered. Holter monitoring and ecg are used if patients
report syncope or lightheadedness. Neuroimaging with ct is used when patients possibly
have a central lesion which would present with difficulty balancing.
2. An older adult patient reports sensations of being off balance when walking but does
not experience dizziness. The provider will refer this patient to which specialist for
further evaluation?
A. Audiologist
B. Cardiologist
C. Neurologist
D. Otolaryngologist
Ans: c
This patient has problems of balance without dizziness, suggestive of a central neural lesion and
should be referred to a neurologist. Patients with vertigo are likely to have vestibular
dysfunction and would be referred to an otolaryngologist and possibly an audiologist if hearing
is affected. Patients with syncope or lightheadedness are more likely to have an underlying
cardiac disorder and would be referred to a cardiologist.
,Eyes
Chapter 52, “evaluation of the eyes”
1. A provider performs an eye examination during a health maintenance visit and notes a
difference of 0.5 mm in size between the patient’s pupils. What does this finding
indicate?
1. A relative afferent pupillary defect
2. Indication of a difference in intraocular pressure
3. Likely underlying neurological abnormality
4. Probable benign, physiologic anisocoria
Ans: d
A difference in diameter of less than 1 mm is usually benign. Afferent pupillary defects
are paradoxical dilations of pupils in response to light. This does not indicate differences
in intraocular pressure. A difference of more than 1 mm is more likely to represent an
underlying neurological abnormality.
2. A patient comes to clinic with diffuse erythema in one eye without pain or history of
trauma. The examination reveals a deep red, confluent hemorrhage in the conjunctiva
of that eye. What is the most likely treatment for this condition?
1. Order lubricating drops or ointments.
2. Prescribe ophthalmic antibiotic drops.
3. Reassure the patient that this will resolve.
4. Refer to an ophthalmologist.
Ans: c
Most subconjunctival hemorrhage, occurring with trauma or valsalva maneuvers, will
self-resolve and are benign. Lubricating drops are used for chemosis. Antibiotic eye
drops are not indicated. Referral is not indicated.
1. During an eye examination, the provider notes a red-light reflex in one eye but not the
other. What is the significance of this finding?
1. Normal physiologic variant
2. Ocular disease requiring referral
, 3. Potential infection in the “red” eye
4. Potential vision loss in one eye
Ans: b
The red reflex should be elicited in normal eyes. Any asymmetry or opacity suggests
ocular disease, potentially retinoblastoma, and should be evaluated immediately.
Chapter 53, “cataracts”
1. A primary care provider may suspect cataract formation in a patient with which finding?
1. Asymmetric red reflex
2. Corneal opacification
3. Excessive tearing
4. Injection of conjunctiva
Ans: a
An asymmetric red reflex may be a finding in a patient with cataracts. Corneal opacification,
excessive tearing, and corneal injection are not symptoms of cataracts.
1. Which are risk factors for development of cataracts? (select all that apply.)
1. Advancing age
2. Cholesterol
3. Conjunctivitis
4. Smoking
5. Ultraviolet light
Ans: a, d, e
Most older adults will developncautarrsacitsn. Sgmtobk.incgoamnd uv light exposure hasten
the development of cataracts. Cholesterol and conjunctivitis are not risk factors.
Chapter 57, “dry eye syndrome”
A patient experiencing chronically dry eyes reports having a foreign body sensation, burning,
and itching. A schirmer test is abnormal. What is the suspected cause of this patient’s
symptoms based on this test finding?
