EENT 1: The Audio PANCE and PANRE Board Review Podcast Topic Specific Review Episode 33

Welcome to episode 33 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I continue to cover topic specific PANCE and PANRE review from the Academy course content following the NCCPA™ content blueprint.

This week we will be covering 10 topic specific EENT board review questions.

Eyes, Ears Nose and Throat accounts for 9% of your PANCE/PANRE board exam.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full EEMT review includes over 111 EENT specific questions and is available to all members of the PANCE and PANRE Academy.

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You can listen to the latest episode, take an interactive quiz and download your results below.

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EENT PANCE and PANRE Podcast Quiz

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Question 1

A 4 year-old child presents with a rapid onset of high fever and extremely sore throat. Which of the following findings are suggestive of the diagnosis of epiglottitis?

A	Croupy cough and drooling
B	Thick gray, adherent exudate Hint: Thick gray adherent exudate is suggestive of diphtheria.
C	Beefy red uvula, palatal petechiae, white exudate Hint: Beefy red uvula, palatal petechiae, and white exudate are findings suggestive of streptococcal pharyngitis.
D	Inflammation and medial protrusion of one tonsil Hint: Inflammation with medial protrusion of the tonsil is suggestive of a peritonsillar abscess.

Question 1 Explanation:

A croupy cough with drooling in a patient who appears very ill is consistent with epiglottitis. Examining the throat is contraindicated, unless the airway can be maintained.

Question 2

Which of the following are normal findings in a Weber test?

A	The tympanic membrane is movable with pneumatic otoscopy. Hint: A movable tympanic membrane indicates there is no effusion, and is not the Weber test.
B	The tympanic membrane is pearly gray with a sharp cone of light with apex at the umbo. Hint: The tympanic membrane is evaluated by direct observation with an otoscope, and is not the Weber test.
C	Sound is heard equally in both ears when a vibrating tuning fork is placed on the mid forehead.
D	Air conduction is greater than bone conduction when a vibrating tuning fork is moved from the mastoid bone to close to the ear canal. Hint: A normal Rinne test means that tuning fork vibration is heard longer through the air than the bone.

Question 2 Explanation:

A normal Weber test means there is no lateralization of sound perception when a vibrating tuning fork is placed on the mid forehead.

Question 3

Which of the following is diagnosed by use of the cover/uncover test?

A	Adie's pupil Hint: Adie's pupil is a sluggish pupil reaction to light and accommodation, evaluated by papillary reaction to light.
B	Strabismus
C	Glaucoma Hint: Tonometry is used to measure intraocular pressure to evaluate for glaucoma.
D	Myopia Hint: Myopia is evaluated by using a Snellen chart.

Question 3 Explanation:

The cover/uncover test is used to diagnose strabismus.

Question 4

A 45 year-old male complains of loss of hearing in his left ear. He also complains of ringing in the ear, and has had occasional dizziness. On exam, there is unilateral left-sided sensorineural hearing loss and a diminished corneal reflex. Neuro exam is otherwise normal. TMs are normal, and canals are clear. Neck is supple, without adenopathy. Oropharynx is normal. Of the following, the best diagnostic study to identify the cause of this patient's complaints is

A	auditory brainstem evoked response. Hint: See B for explanation.
B	gadolinium-enhanced MRI.
C	acoustic reflex testing. Hint: See B for explanation.
D	vestibular testing. Hint: Vestibular testing is not a useful screening test for acoustic neuromas.

Question 4 Explanation:

MRI has replaced auditory brainstem evoked response and acoustic reflex testing in the evaluation of patients for acoustic neuromas

Question 5

A 23 year-old graduate student presents with sudden onset of severe dizziness, with nausea and vomiting for the past couple of hours. She denies hearing loss or tinnitus. She has had a recent cold. Which of the following is the most likely diagnosis?

A	Ménière's disease Hint: Ménière's disease is associated with hearing loss, tinnitus, and vertigo that lasts from seconds to hours.
B	Vestibular neuronitis
C	Benign positional vertigo Hint: Benign positional vertigo occurs with changes in position, especially rapid movements of the head. Nausea may occur, but vomiting is not significant.
D	Vertebrobasilar insufficiency Hint: Vertebrobasilar insufficiency is usually accompanied by brain stem findings, such as diplopia, dysarthria, or dysphagia, and is not common in this age group.

Question 5 Explanation:

Vestibular neuronitis or labyrinthitis presents with vertigo, nausea, and vomiting, but not hearing loss or tinnitus. It is related to viral URIs, and develops over several hours, with symptoms worse in the first day, with gradual recovery over several days.

Question 6

A 4 year-old boy presents with purulent, foul-smelling nasal discharge for three days. He has not had any other symptoms of respiratory illness, cough, wheeze, or fever. His activity level and appetite has been normal. On exam, he is afebrile. TM's have normal light reflex, canals are clear. Left nare is clear; there is considerable amount of purulent exudate from the right nare, and a bright reflection of light is noticed. Oropharynx is without inflammation or exudate. Neck is supple, without lymphadenopathy. Lungs are clear, with equal breath sounds and no wheezing. Heart has regular rhythm without murmurs. Which of the following is the most likely diagnosis?

A	Viral URI Hint: Viral URI does not present with foul-smelling nasal discharge.
B	Acute sinusitis Hint: Acute sinusitis may present with purulent nasal discharge, but the observation of a bright light reflection suggests a foreign body.
C	Allergic rhinitis Hint: Allergic rhinitis is seasonal, associated with sneezing and other allergy-related symptoms.
D	Nasal foreign body

Question 6 Explanation:

Nasal foreign body is suggested by unilateral nasal obstruction or discharge.

Question 7

A 59 year-old male complains of "flashing lights behind my eye" followed by sudden loss of vision, stating that it was "like a curtain across my eye." He denies trauma. He takes Glucophage for his diabetes mellitus and atenolol for his hypertension. He has no other complaints. On funduscopic exam, the retina appears to be out of focus. Which of the following is the most likely diagnosis?

A	Central retinal vein occlusion Hint: Central retinal vein occlusion causes painless, variable loss of vision. Exam shows retinal hemorrhages in all quadrants and edema of the optic disk.
B	Retinal artery occlusion Hint: Retinal artery occlusion presents with sudden, painless loss of vision. Exam shows pale retina with normal macula, seen as a cherry-red spot.
C	Retinal detachment
D	Hyphema Hint: Hyphema is usually associated with trauma, and is a collection of blood in the anterior chamber.

Question 7 Explanation:

Patients with retinal detachment frequently complain of flashes of light or floaters that occur during traction on the retina as it detaches. This is followed by loss of vision. In small detachments, the retina may appear out of focus, but with larger detachments, a retinal fold may be identified.

Question 8

A 64 year-old woman complains of headache and left eye pain for about a day. She says it started yesterday as a dull ache and now is throbbing. She also complains of nausea and vomiting, which she attributes to the popcorn she ate at the movie theater yesterday afternoon. On exam, the left pupil is mid-dilated and nonreactive. The cornea is hazy. A ciliary flush is noted. Which of the following is the most likely diagnosis?

A	Migraine headache Hint: Migraine headache does not present with eye findings.
B	Temporal arteritis Hint: Temporal arteritis presents with headache and systemic symptoms of fever, myalgias, anorexia, and tenderness over the temporal artery.
C	Acute glaucoma
D	Retinal artery occlusion Hint: Retinal artery occlusion presents with sudden, painless, severe loss of vision. There are no systemic symptoms.

Question 8 Explanation:

Acute glaucoma often presents with abdominal complaints that may delay diagnosis. Findings of ciliary flush, mid-dilated and nonreactive pupil, and hazy cornea in a patient with severe eye pain are consistent with acute angle closure glaucoma.

Question 9

The most reliable sign of acute otitis media (AOM) is

A	bulging of the tympanic membrane. Hint: Bulging and air bubbles behind the TM represent OM with effusion.
B	loss of tympanic membrane mobility.
C	reddening of the tympanic membrane. Hint: Reddening of the eardrum is not reliable as it may be due to crying or other vascular changes.
D	air bubbles behind the tympanic membrane. Hint: See A for explanation.

Question 9 Explanation:

Loss of tympanic membrane mobility during pneumoinsufflation is the most reliable sign for diagnosing acute otitis media.

Question 10

A patient presents with eye pain and blurred vision. Snellen testing reveals vision of 20/200 in the affected eye and 20/20 in the unaffected eye. Fluorescein staining reveals the presence of a dendritic ulcer. Which of the following is the most likely diagnosis?

A	Viral keratitis
B	Fungal corneal ulcer Hint: Fungal corneal ulcers have an indolent course with intraocular infection being common but fluorescein staining is negative for a dendritic pattern.
C	Acanthamoeba keratitis Hint: Acanthamoeba keratitis has a waxing and waning course over several months and has no fluorescein staining in a dendritic pattern.
D	Bacterial corneal ulcer Hint: Bacterial corneal ulcers can progress aggressively resulting in corneal perforation. Fluorescein staining does not occur in a dendritic pattern.

Question 10 Explanation:

Herpes Simplex virus is a common cause of dendritic ulceration noted on fluorescein staining.

Question 11

Small grayish vesicles and punched-out ulcers in the posterior pharynx in a child with pharyngitis is representative of which organism?

A	Epstein-Barr virus Hint: Epstein-Barr virus presents with enlarged tonsils with exudates and petechiae of the palate.
B	Group C Streptococcus Hint: Group C Streptococcus presents with a red pharynx and enlarged tonsils with a yellow, blood tinged exudates
C	Coxsackievirus
D	Gonorrhea Hint: Neisseria gonorrhea of the pharynx may be asymptomatic

Question 11 Explanation:

Coxsackievirus presents with small grayish vesicles and punched-out ulcers in the posterior pharynx.

There are 11 questions to complete.

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