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Mosby’s Ch.11 & 12 H&PExam2

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What is the pathways of tears?
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1. Produced in lacrinal glands & accessory lacrimal glands 2. cover the cornea 3. drain out the punctum in medial eyelids 4. flow down canaliculi into lacrimal sac 5. drain down nasolacrimal duct into the nose at the inferior meatus
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What is the structure that protects the eyes from foreign bodies?
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conjunctiva
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Tears flow over the cornea and drain via the lacrimal sac into the…
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nasal meatus
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Contraction of which eye structure controls the amount of light that reaches the retina?
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Iris
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Contraction or relaxation of the ciliary body:
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changes lens thickness
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The sensory network of the eye is the:
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retina
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Term infants have a visual acuity of about:
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20/400
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At what age does an infant usually develop the ability to distinguish color?
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6 months
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An increased level of lysozyme in the tears will occur normally during which life stage?
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Pregnancy
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A pregnant woman in her third trimester tells you that her vision has been a little blurred and she thinks she needs to get new contact lenses. You should advise her to:
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wait until several weeks after delivery to get new lenses.
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Which of the following is a relatively benign condition that may occur during pregnancy or labor?
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Subconjunctival hemorrhage; bleeding underneath the conjunctiva
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When does the lens usually become more rigid and the ciliary muscle of the iris become weaker?
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Around 45 years of age
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A condition that typically develops by the age of 45 is:
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Presbyopia; eye develops a progressively diminished ability to focus on near objects
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Whats is an ominous finding in infants?
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White pupils on photographs
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What is a genetic eye disorder that should be included in the history and physical, under family history, for all members of the affected families?
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Retinal Cancer
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The Rosenbaum card is used to measure:
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near vision
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When measuring visual acuity, you are assessing cranial nerve:
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CN 2: Optic Nerve
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Measurement of near vision should be tested:
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in each eye separately.
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Mr. C.’s visual acuity is 20/50. This means that he:
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can read letters while standing 20 feet from the chart that the average person could read at 50 feet.
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Peripheral vision can be estimated by means of which test?
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Confrontation
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The criterion for adequacy of a patient’s visual field is:
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correspondence with the visual field of the examiner.
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Periorbital edema is a sign of?
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Abnormality
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Xanthelasma may suggest that the patient has an abnormality of:
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lipid metabolism
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Mrs. S. is a 69-year-old woman who presents for a physical examination. On inspection of her eyes, you note that the left upper eyelid droops, covering more of the iris than does the right. This is recorded as _____ on the _____.
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ptosis; left
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Ptosis may be secondary to:
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paresis of a branch of CN III Oculomotor
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What is the condition called when the eyelid is turned away, or everted, from the globe?
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Ectropion
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Entropion implies that the lid is:
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turned inward
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A condition in which the eyelids do not completely meet to cover the globe is called:
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lagophthalmos
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Inspection of the tarsal conjunctiva should be performed:
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when a foreign body may be present
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An allergy can cause the conjunctiva to have a:
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cobblestone pattern
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An abnormal growth of conjunctiva extending over the cornea from the limbus is known as:
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a pterygium
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A pterygium is more common in people heavily exposed to:
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ultraviolet light.
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Mr. B. was admitted from the emergency department and you are completing his physical examination. His pupils are 2 mm bilaterally and you notice that they fail to dilate when the penlight is moved away. This is characteristic in patients who are or have been:
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on opioid drugs (morphine)
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When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient to respond by:
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brisk blinking
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You observe pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for:
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accomodation
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Mydriasis is an accompaniment of:
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coma
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The inequality of pupillary size is called?
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anisocoria
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When inspecting the region of the lacrimal gland, what do you palpate?
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in the are between the arch of the eyebrow and the upper lid
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You note dark, rust-colored pigment just anterior to the insertion of the medial rectus muscle in an 80-year-old woman. Which action is appropriate?
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Record the finding in the patient’s record
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Examination to assess for extraocular muscle imbalance is conducted by?
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having the patient follow your finger through planes
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When there is an imbalance found with the corneal light test, you should then perform the _____ test.
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cover-uncover
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To see retinal details in a myopic patient, you will need to do what?
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turn your ophthalmoscope to a minus lens
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The unit of measurement in describing lesion size and location on the fundus is the:
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disc diameter
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Ask the patient to look directly at the light of the ophthalmoscope when you are ready to examine the:
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macula
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After focusing on a blood vessel in the retina with your ophthalmoscope, you attempt to locate the optic disc. You should:
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follow the vessel as it converges into larger vessels
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After completion of your ophthalmoscopic examination, you record that the AV ratio is 1:2. This indicates that the:
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arterioles are narrowed
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If a patient has early papilledema, the examiner will be able to detect:
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dilated retinal veins
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Cupping of the optic disc may be a result of?
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glaucoma
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Drusen bodies are most commonly a consequence of?
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aging
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When drusen bodies are noted to be increasing in number or in intensity of color, the patient should be further evaluated with a(n)?
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Amsler grib
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Cotton wool spots are most closely associated with?
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Hypertension
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The Keith-Wagner-Barker system group IV is characterized by the development of?
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papilledema
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Which of the following may be suggestive of Down syndrome?
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Prominent epicanthal folds
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To differentiate between infants who have strabismus and those who have pseudostrabismus, use the?
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corneal light reflex
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You are attempting to examine the eyes of a newborn. To facilitate eye opening, you would first?
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dim the room lights
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White specks scattered in a linear pattern around the entire circumference of the iris are called?
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Brushfield spots
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Opacities of the red reflex may indicate the presence of?
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cataracts
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The Snellen E chart is appropriate for initial visual acuity in what age child?
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3 years
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When assessing the vision of a 4-year-old girl, you find that she has 20/50 vision in the right eye and 20/30 vision in the left eye. This child should be evaluated first for?
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amblyopia
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You normally expect a child to achieve 20/20 vision by age ____ years.
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6
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What maneuver can be done to reduce systemic absorption of cycloplegic and mydriatic agents when examining a pregnant woman if the examination is mandatory?
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Use nasolacrimal occlusion after instillation
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Episcleritis may indicate?
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an autoimmune disorder
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The most common cause of exophthalmos is?
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Graves disease
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Horner syndrome is manifested by?
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ipsilateral miosis and mild ptosis
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Dot hemorrhages, or microaneurysms, and the presence of hard and soft exudates are most commonly seen in?
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diabetic retinopathy
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Changes seen in proliferative diabetic retinopathy are the result of?
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anoxic stimulation
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Bone spicule pigmentation is a hallmark of?
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retinitis pigmentosa
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An initial sign of retinoblastoma in an infant is?
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cat’s eye reflex
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Retinal hemorrhages in an infant require investigation for?
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child abuse
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In adults, the length of the external auditory canal is _____ cm.
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2.5
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The middle ear contains the?
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umbo and malleus
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The middle ear is normally filled with?
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air
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The hair cells of Corti and membrane of Corti?
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stimulate the eighth cranial nerve
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The organ of Corti is a coiled structure located inside the?
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cochlea in the inner ear
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Which ear structure is responsible for equalizing atmospheric pressure when swallowing, sneezing, or yawning?
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Eustachian tube
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The structures that lie along the lateral wall of the nasal cavity near the facial cheek are the _____ sinuses.
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Maxillary
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A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness you should palpate over the?
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Maxillary sinuses only
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A 30-year-old woman presents with rapid swelling beneath her jaw that suddenly appears while she is eating. The swelling is mildly painful but is not hot or red. You suspect Wharton salivary duct stones and proceed to palpate?
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under the tongue along each side of the frenulum
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An infant’s auditory canal, when compared with an adult’s, is?
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short and curved upward
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When examining an infant’s middle ear, the practitioner should use one hand to stabilize the otoscope against the head while using the other hand to?
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pull the auricle down and back
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The eruption of permanent teeth most commonly begins with?
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lower central incisors
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The pregnant woman can expect to experience?
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more nasal stuffiness
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During what developmental stage are hoarseness, voice-cracking, and a persistent cough a common finding?
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Pregnancy
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Hearing tends to deteriorate after 50 years of age because of?
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degeneration of the hair cells of the organ of Corti
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You are performing hearing screening tests. Difficulty in hearing the highest frequencies would be expected in the ___ year old.
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50 (or the oldest age available)
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Mr. S. 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?
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Salicylates
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Mr. W., age 25, has recovered recently from an upper and lower respiratory infection. He describes a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented within which section of his history?
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Past medical data
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A newborn whose serum bilirubin is greater than 20 mg/100 mL risks later…
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Hearing loss
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Which ethnicity has the highest rate of oral cancers?
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African American ancestry
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To approximate vocal frequencies, which tuning fork should be used to assess hearing?
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500 to 1000 Hz
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You are using a pneumonic 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 do what?
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change to a rubber speculum.
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An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or?
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renal disorders
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When conducting an adult otoscopic examination, you should?
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select the largest speculum that will fit in the canal
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Normal tympanic membrane color is?
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pearly gray
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Bulging of an amber tympanic membrane without mobility is most often associated with?
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middle ear effusion
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In the presence of otitis externa, tympanic membrane perforation, or myringotomy tubes you should?
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avoid instilling fluids
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When hearing is evaluated, which cranial nerve is being tested?
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VIII ~ Vestibulochlear
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Speech with a monotonous tone and erratic volume may indicate?
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hearing loss
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Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test for?
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lateralization of sound
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To perform the Rinne test, place the tuning fork on the?
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mastoid bone
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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 was less than 2:1. You interpret these findings as suggestive of:
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a defect in the inner ear
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Nasal symptoms that imply an allergic response include?
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bluish gray turbinates
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When you ask the patient to identify smells, you are assessing which cranial nerve?
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I Olfactory
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Pallor of the lips and mucous membranes is one sign of?
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anemia
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A smooth red tongue with a slick appearance may indicate?
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niacin or vitamin B12 deficiency
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White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are?
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aphthous ulcers (canker sores)
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A hairy tongue with yellowish brown to black elongated papillae on the dorsum?
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is sometimes seen following antibiotic therapy
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To inspect the lateral borders of the tongue, you should?
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pull the gauze-wrapped tongue to each side
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A 6-month-old who can hear well can be expected to?
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turn his or her head toward the source of sound
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Which variation may be an expected finding in the ear examination of a newborn?
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Diffuse light reflex
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For best results, an otoscopic and oral examination in a child should be?
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performed at the end of the examination
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What pediatric patient complaint would you refer immediately to the emergency department?
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The drooling patient with muffled voice and stridor
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Which abnormality is common during pregnancy?
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Hypertrophy of the gums
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Expected physical changes associated with older adults include?
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bristly hairs in the vestibule
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Intense pain with movement of the pinna is most closely associated with?
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otitis externa
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Severe vertigo, tinnitus, and progressive hearing loss are characteristic of?
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Ménière disease
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Which of the following recreational drugs is commonly associated with nasal septum perforation?
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Cocaine
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Evidence-based practice suggests that the strongest predictor of sinusitis is?
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any combination of: 1. Maxillary toothache 2. dull or opaque sinus transilluminations 3. ineffective decongestants and colored nasal drainage 4. purulent nasal secretions
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You are interviewing a parent whose child has fever, is batting 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?
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acute otitis media
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The term hyperopic means?
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far sighted
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The term myopic means?
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near sighted
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When in life does myopia occur?
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at any age
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When in life does a stigmatism develop?
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at any age
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Which cranial nerve is involved in accommodation?
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CN IV Trochlear Nerve
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Legal blindness is considered what visual acuity?
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20/200