Chapter 13: Ears, Nose, and Throat

Ball: Seidel’s Guide to Physical Examination, 9th Edition

1. Mr. Sprat is a 21-year-old patient who complains of nasal congestion. He admits to using

recreational drugs. On examination, you have noted a septal perforation. Which of the

following recreational drugs is commonly associated with nasal septum perforation?

a. Heroin

b. Cocaine

c. PCP

d. Ecstasy

Long-term cocaine snorting causes ischemic necrosis of the septal cartilage and leads to

perforation of the nasal septum.

2. A 5-year-old child presents with nasal congestion and a headache. To assess for sinus

tenderness, you should palpate over the:

a. sphenoid and frontal sinuses.

b. maxillary and frontal sinuses.

c. maxillary sinuses only.

d. sphenoid sinuses only.

Only the maxillary and the frontal sinuses are accessible for physical examination; however, the young
child does not develop frontal sinuses until 7 to 8 years of age.

3. Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear

drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize

the otoscope against the head while using the other hand to:

a. pull the auricle down and back.

b. hold the speculum in the canal.

c. distract the infant.

d. stabilize the chest.

The nurse should use the other hand to pull the auricle down and back in an effort to straighten the
upward curvature of the canal.
4. Mrs. Donaldson is a 31-year-old patient who is pregnant. In providing Mrs. Donaldson with healthcare
information, you will explain that she can expect to experience:

a. more nasal stuffiness.

b. a sensitive sense of smell.

c. drooling.

d. enhanced hearing.

Physiologic changes of pregnancy include nasal stuffiness, a decreased sense of smell, impaired hearing,
epistaxis, and a sense of fullness in the ears.

5. You are performing hearing screening tests. Who would be expected to find difficulty in

hearing the highest frequencies?

a. A 7-year-old

b. An 18-year-old

c. A 30-year-old

d. A 50-year-old

Sensorineural hearing loss begins after 50 years of age, initially with losses of high-frequency sounds and
then progressing to tones of lower frequency.

6. Mr. Spencer presents with the complaint of hearing loss. You specifically inquire about

current medications. Which medications, if listed, are likely to contribute to his hearing loss?

a. Chlorothiazide

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b. Acetaminophen

c. Salicylates

d. Cephalosporins

Ototoxic medications include aminoglycoside, salicylates, furosemide, streptomycin, quinine, ethacrynic

7. To approximate vocal frequencies, which tuning fork should be used to assess hearing?

a. 100 to 300 Hz

b. 200 to 400 Hz

c. 500 to 1000 Hz
d. 1500 to 2000 Hz

Use of a 500- to 1000-Hz tuning fork approximates vocal frequencies.

8. You are using a pneumatic attachment on the otoscope while assessing tympanic membrane

movement. You gently squeeze the bulb but see no movement of the membrane. Your next

action should be to:

a. remove all cerumen from the canal.

b. change to a larger speculum.

c. squeeze the bulb with more force.

d. insert the speculum to a depth of 2 cm.

To see tympanic movement when using the pneumatic attachment, there should be a seal around the
speculum to block outside air. In this manner, the normal tympanic membrane moves as a result of
pressure changes from the insufflator bulb. A soft rubber speculum is recommended to establish the
seal.

9. When conducting an adult otoscopic examination, you should:

a. position the patient’s head leaning toward you.

b. grasp the handle of the otoscope as you would a baseball bat.

c. select the largest speculum that will fit in the canal.

d. ask the patient to keep his or her eyes closed.

When conducting an adult otoscopic examination, select the largest speculum that will comfortably fit in
the patient’s ear. When you are conducting an adult otoscopic examination,

the patient’s head should be positioned toward the opposite shoulder. Hold the handle of the otoscope
between the thumb and index finger, supporting it on the middle finger. There is no reason for the
patient to keep her or his eyes shut.

10. Bulging of an amber tympanic membrane without mobility is usually associated with:

a. middle ear effusion.

b. healed tympanic membrane perforation.

c. impacted cerumen in the canal.

d. repeated and prolonged crying cycles.

An amber color, with bulging of the tympanic membrane and without mobility or redness, usually
indicates the presence of fluid in the middle ear.
11. When hearing is evaluated, which cranial nerve is being tested?

a. III

b. IV

c. VIII

d. XII

Cranial nerve VIII, the vestibulocochlear nerve, is associated with hearing.

12. Speech with a monotonous tone and erratic volume may indicate:

a. otitis externa.

b. hearing loss.

c. serous otitis media.

d. sinusitis.

Speech with a monotonous tone and erratic volume may indicate hearing loss.

13. You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized to the
unaffected ear; for the Rinne test, air conduction-to-bone conduction ratio is less than 2:1. You interpret
these findings as suggestive of:

a. a defect in the inner ear.

b. a defect in the middle ear.

c. otitis externa.

d. impacted cerumen.

These results are consistent with a sensorineural hearing loss, a defect in the inner ear. Otitis externa
and impacted cerumen are conditions of the external ear that can cause conductive hearing problems.

14. Nasal symptoms that imply an allergic response include:

a. purulent nasal drainage.

b. bluish gray turbinates.

c. small, atrophied nasal membranes.

d. firm consistency of turbinates.

Nasal symptoms that imply an allergic response include bluish gray or pale pink nasal turbinates that are
swollen and boggy and a transverse crease at the junction between the cartilage and bone of the nose.
 15. You are interviewing a parent whose child has a fever, is pulling at her right ear, and is irritable. You
ask the parent about the child’s appetite and find that the child has a decreased appetite. This additional
finding is more suggestive of:

a. acute otitis media.

b. otitis externa.

c. serous otitis media.

d. middle ear effusion.

Anorexia is an initial symptom of acute otitis media.

16. A hairy tongue with yellowish brown to black elongated papillae on the dorsum:

a. is indicative of oral cancer.

b. is sometimes seen following antibiotic therapy.

c. usually indicates vitamin deficiency.

d. usually indicates anemia.

Recent antibiotic use can turn the tongue yellow-brown to black and make it appear hairy. Oral cancer
involves lesions. A smooth red tongue with a slick appearance may indicate a niacin or vitamin B12
deficiency. Pallor usually indicates anemia.

17. To inspect the lateral borders of the tongue, you should:

a. ask the patient to extend the tongue outward.

b. insert the tongue blade obliquely against the tongue.

c. lift the tongue upward with gloved fingers.

d. pull the gauze-wrapped tongue to each side.

To inspect the lateral borders of the tongue, you should wrap the tongue with a piece of gauze and then
pull the tongue to each side for inspection.

18. For best results, an otoscopic and oral examination in a child should be:

a. conducted at the beginning of the assessment.

b. done after inspection.

c. performed at the end of the examination.

d. performed before palpation.

Because young children often resist an otoscopic and oral examination, it may be wise to postpone
these procedures until the end, after you have gained some trust.
1. Mr. Akins is a 78-year-old patient who presents to the clinic with complaints of hearing loss. Which are
changes in hearing that occur in older adults? (Select all that apply.)

a. Results from cranial nerve VII

b. Slow progression

c. Loss of high frequency

d. Bone conduction heard longer than air conduction

e. Sounds may be garbled, difficult to localize

f. Unable to hear in a crowded room

Age-related hearing loss is associated with degeneration of hair cells in the organ of Corti, loss of cortical
and organ of Corti auditory neurons, degeneration of the cochlear conductive membrane, and decreased
vascularity in the cochlea. Sensorineural hearing loss first occurs with high-frequency sounds and then
progresses to tones of lower frequency. Loss of high-frequency sounds usually interferes with the
understanding of speech and localization of sound. Conductive hearing loss may result from an excess
deposition of bone cells along the ossicle chain, causing fixation of the stapes in the oval window,
cerumen impaction, or a sclerotic tympanic membrane.

2. Which signs and symptoms occur with a sensorineural hearing loss? (Select all that apply.)

a. Air conduction shorter than bone conduction

b. Lateralization to the affected ear

c. Loss of high-frequency sounds

d. Speaks more loudly

e. Disorder of the inner ear

f. Air conduction longer than bone conduction

The signs and symptoms of sensorineural hearing loss include loss of high-frequency sounds, speaks
more loudly, disorder of the inner ear, air conduction longer than bone conduction, and lateralization to
the unaffected ear.

1. When you ask the patient to identify smells, you are assessing cranial nerve __. I

The first cranial nerve, the olfactory nerve, is tested when you ask a patient to identify

different smells