ENT and Eye Assessment and Management Principles Practice Questions

30 multiple-choice questions on Assessment and management principles for paramedic and EMT students, from Chapter 20 (Diseases of the Eyes, Ears, Nose, and Throat). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. When assessing a patient with an EENT complaint, what is your first priority?

   1. A. Visual acuity
   2. B. Hearing testing
   3. C. Dental exam
   4. D. Airway patency
   Show answer

   Answer: D. Airway patency

   Many EENT conditions, such as epiglottitis, angioedema, deep neck infections, and facial trauma, can threaten the airway. Assess and protect the airway first.

2. A 4-year-old recently arrived from a country with low vaccine coverage. She has a fever, a very sore throat and a gray coating on her tonsils. Which history item matters most?

   1. A. Whether she has food allergies
   2. B. Whether she has had ear tubes
   3. C. Whether her vaccines are up to date
   4. D. Whether she has had strep throat before
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   Answer: C. Whether her vaccines are up to date

   Vaccination history changes the likely causes: an unvaccinated child with a gray membrane on the tonsils raises concern for diphtheria, and missed Hib doses raise concern for epiglottitis, both of which can obstruct the airway and need droplet precautions and early notification. Food allergies, ear tubes and a past strep infection do not explain a gray membrane or change the precautions she needs.

3. A patient with an eye complaint wears glasses. How should visual acuity be tested?

   1. A. With one lens removed
   2. B. With the glasses on
   3. C. Without the glasses
   4. D. Only by light perception
   Show answer

   Answer: B. With the glasses on

   Test acuity with corrective lenses if the patient normally wears them, to measure best corrected vision.

4. What is appropriate pain management for a patient with a painful eye injury?

   1. A. Ice pressed firmly on the eye
   2. B. Analgesia per protocol
   3. C. Topical anesthetic for home use
   4. D. No pain relief until the ED
   Show answer

   Answer: B. Analgesia per protocol

   Systemic analgesics and, where permitted, topical anesthetics for irrigation are appropriate per protocol, and pain control also reduces straining that raises eye pressure. Ice pressed firmly on the eye puts pressure on the globe, topical anesthetic for home use delays healing and masks injury, and withholding pain relief until the ED is not needed.

5. Why should patients with serious eye injuries be kept calm and reassured?

   1. A. Vision loss is very frightening
   2. B. Reassurance treats retinal tears
   3. C. Anxiety lowers eye pressure
   4. D. It prevents conjunctivitis
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   Answer: A. Vision loss is very frightening

   Bilateral eye covering leaves patients unable to see, which is frightening. Explain each step, keep physical contact, and tell them what is happening.

6. Which patient with an eye complaint needs the fastest transport?

   1. A. Sudden painless vision loss 1 hour ago
   2. B. A painless lump in the eyelid for weeks
   3. C. A red patch on the white after coughing
   4. D. An itchy, crusted eye in a child
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   Answer: A. Sudden painless vision loss 1 hour ago

   Sudden painless loss of vision in one eye suggests central retinal artery occlusion, an eye stroke in which the retina can survive only a few hours, so it needs rapid transport to a stroke or eye-capable center. A painless lump in the eyelid for weeks is a chalazion, a red patch on the white after coughing is a subconjunctival hemorrhage, and an itchy, crusted eye in a child is conjunctivitis, all of which are not time critical.

7. A patient has a red eye. Which findings suggest a serious condition rather than simple conjunctivitis?

   1. A. Mild itching with clear discharge
   2. B. Decreased vision and severe pain
   3. C. Bilateral watery tearing
   4. D. Crusting of lids in the morning
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   Answer: B. Decreased vision and severe pain

   Red-eye red flags include decreased vision, severe pain, photophobia, abnormal pupil, and a cloudy cornea, which suggest glaucoma, iritis, keratitis, or trauma.

8. When documenting a dental injury, which detail is most useful?

   1. A. Name and phone of the patient's dentist
   2. B. Teeth involved and time elapsed
   3. C. History of braces as a child
   4. D. Whether the gums are pink
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   Answer: B. Teeth involved and time elapsed

   Document which teeth are injured, how they are injured, how avulsed teeth were stored, and the time since injury, which affects reimplantation success. The dentist's contact details and a history of braces can be noted later, but they do not guide immediate care or the chance of saving the tooth.

9. A patient with a facial injury and possible basilar skull fracture needs supplemental oxygen. Which device is most appropriate?

   1. A. Nasopharyngeal airway with cannula
   2. B. Nasal cannula inserted deep
   3. C. Nonrebreather mask
   4. D. Nasal CPAP
   Show answer

   Answer: C. Nonrebreather mask

   A face mask avoids the nasal passages. NPAs and nasal devices may be avoided when basilar skull or midface fractures are suspected.

10. You are documenting a chemical splash to one eye. How should you record which eye is injured?

    1. A. Use the abbreviation OD or OS
    2. B. Use R or L in a circle
    3. C. Describe it as the bad eye
    4. D. Spell out right or left eye
    Show answer

    Answer: D. Spell out right or left eye

    Abbreviations such as OD, OS and OU are on the ISMP list of error-prone abbreviations because they are easily confused with each other and with ear abbreviations, which can lead to treatment of the wrong side. Spell out 'right eye' or 'left eye.' Circled letters can be misread or lost when copied, and describing it as 'the bad eye' does not identify a side.

11. A patient says he cannot hear well on his left side after a blast nearby. Which quick field check helps compare his hearing between ears?

    1. A. Shine a light into each ear canal
    2. B. Ask him to read a printed card
    3. C. Check his pupils for reaction
    4. D. Rub fingers by one ear at a time
    Show answer

    Answer: D. Rub fingers by one ear at a time

    Rubbing your fingers or whispering a few words beside one ear at a time while he covers the other gives a rough side-to-side comparison of hearing, which helps document a deficit after a blast. Shining a light into the ear canal shows blood or a torn eardrum but does not measure hearing, a printed card tests vision, and pupil checks do not test hearing.

12. You transported a child with red, watery eyes from contagious viral conjunctivitis. Which step best prevents spread to your crew and the next patient?

    1. A. Wearing an N95 respirator
    2. B. Changing the stretcher sheets
    3. C. Giving the child antibiotic drops
    4. D. Hand hygiene and wiping surfaces
    Show answer

    Answer: D. Hand hygiene and wiping surfaces

    Viral conjunctivitis, often from adenovirus, spreads through hands and contaminated surfaces and can survive for days on equipment. Wash or sanitize hands, avoid touching your own eyes, and disinfect surfaces the patient touched. An N95 respirator does not address contact spread, changing sheets alone leaves other surfaces contaminated, and antibiotic drops do not treat a virus.

13. A patient has a chemical splash to the eyes and is wearing contact lenses. What is the correct approach?

    1. A. Leave lenses in throughout
    2. B. Irrigate only after ED arrival
    3. C. Irrigate; remove lenses if easy
    4. D. Remove lenses before any irrigation
    Show answer

    Answer: C. Irrigate; remove lenses if easy

    Do not delay irrigation to remove contact lenses. Remove them if easily done, since they can trap chemicals against the cornea.

14. Which intervention is appropriate for a patient with vertigo and vomiting?

    1. A. Walking to the ambulance
    2. B. Oral fluids during transport
    3. C. Rapid head movements
    4. D. Antiemetic per protocol
    Show answer

    Answer: D. Antiemetic per protocol

    Antiemetics per protocol, a position of comfort, minimal head movement, and assisting with ambulation reduce symptoms and fall risk.

15. When covering both eyes for a penetrating eye injury, what should you tell the patient?

    1. A. That vision will return soon
    2. B. To keep looking around
    3. C. Why both eyes are covered
    4. D. Nothing, to avoid anxiety
    Show answer

    Answer: C. Why both eyes are covered

    Explaining that covering both eyes reduces eye movement and further damage helps the patient cooperate and reduces anxiety.

16. A 55-year-old with a scratched eye forgot her glasses and can read only large print with that eye. How can you tell whether the blur is from her uncorrected vision rather than the injury?

    1. A. Have her look through a pinhole
    2. B. Test both eyes together
    3. C. Shine a light to check the pupil
    4. D. Ask her to describe the colors she sees
    Show answer

    Answer: A. Have her look through a pinhole

    Looking through a small pinhole, such as one punched in a card, removes most of the blur caused by needing glasses. If her acuity improves through the pinhole, the blur is mainly from her uncorrected vision; if it does not, the injury is more likely the cause. Testing both eyes together hides a one-sided problem, a pupil check does not measure acuity, and asking about colors does not separate the two causes.

17. Both eyes of a factory worker were splashed with a cleaning chemical. You need to irrigate both eyes at once during transport. Which setup works well?

    1. A. A nasal cannula over the nose bridge
    2. B. A nonrebreather mask filled with saline
    3. C. A bag-valve mask over both eyes
    4. D. An IV line taped into one eye
    Show answer

    Answer: A. A nasal cannula over the nose bridge

    A nasal cannula connected to IV tubing and a bag of saline can be laid over the bridge of the nose so the two prongs drip into the inner corners of both eyes, giving continuous irrigation that flows outward. A nonrebreather mask filled with saline or a bag-valve mask over both eyes would not deliver a steady flow and could press on the eyes, and an IV line taped into one eye treats only that eye.

18. During a 3-hour transfer of a sedated, intubated patient, you notice her eyelids are partly open and the exposed corneas look dry. What should you do?

    1. A. Leave them open so you can check pupils
    2. B. Rinse them with alcohol pads
    3. C. Keep the eyes moist and the lids closed
    4. D. Press firmly on the lids with gauze
    Show answer

    Answer: C. Keep the eyes moist and the lids closed

    Sedated and paralyzed patients lose their blink and lid closure, so the cornea dries and can ulcerate within hours. Keep the lids gently closed with tape or a moist cover, use lubricant per protocol and lift the lid briefly to check the pupils. Leaving the eyes open lets the cornea dry, alcohol pads would burn the eye, and firm pressure on the lids presses on the globe.

19. After 20 minutes of irrigating an alkali splash to the eye, your service carries pH test strips. How should they guide your care?

    1. A. Stop once the pH strip turns color
    2. B. Use them to choose an acid to neutralize it
    3. C. Test the saline bag instead of the eye
    4. D. Irrigate until the eye pH is near normal
    Show answer

    Answer: D. Irrigate until the eye pH is near normal

    If pH paper is available, touching it to the inside of the lower lid after a pause in irrigation shows whether chemical remains. Alkali can keep seeping out of the tissues, so irrigation continues until the pH is near normal (about 7.0 to 7.5). Stopping once the strip changes color is meaningless because it always shows some color, neutralizing with an acid causes heat and more injury, and testing the saline bag tells you nothing about the eye.

20. Why is reassessment important during transport of a patient with a throat infection?

    1. A. Airway status can change quickly
    2. B. To re-examine the throat often
    3. C. To check the pupils every minute
    4. D. To decide on oral antibiotics
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    Answer: A. Airway status can change quickly

    Swelling from infections such as epiglottitis or Ludwig's angina can progress rapidly. Frequent reassessment of airway, breathing, SpO2, and mental status catches deterioration early. Repeated throat exams with a tongue blade can trigger obstruction and should be avoided, antibiotics are chosen at the hospital, and pupil checks every minute add nothing in a throat infection.

21. Two patients from a fireworks injury have similar eye injuries. One of them is already blind in his other eye. How does this affect your priorities?

    1. A. It raises his priority for care
    2. B. It makes no difference
    3. C. He needs less care since he adapted to blindness
    4. D. The patient with two good eyes comes first
    Show answer

    Answer: A. It raises his priority for care

    A serious injury to the only seeing eye threatens total blindness, so that patient has a higher priority for rapid transport and specialist care, and the injured eye must be protected carefully. It does make a difference, prior blindness in one eye does not mean he needs less care, and the patient with two good eyes still needs full care but has less to lose from one injury.

22. Which patient with an EENT complaint is most appropriate for rapid transport to a trauma center?

    1. A. Isolated nasal fracture with a stable airway
    2. B. Avulsed tooth, otherwise well
    3. C. Midface fracture with airway compromise
    4. D. Corneal abrasion from debris
    Show answer

    Answer: C. Midface fracture with airway compromise

    Midface fractures with airway compromise are life threatening and need trauma center resources. An isolated nasal fracture with a stable airway, an avulsed tooth in an otherwise well patient and a corneal abrasion need prompt care but not trauma center resources.

23. A patient reports blurred vision after a minor fender bender with no eye trauma. Which additional cause should you evaluate?

    1. A. Dental caries
    2. B. Dry socket
    3. C. Head injury or stroke
    4. D. Seasonal allergies
    Show answer

    Answer: C. Head injury or stroke

    New visual changes after trauma or with neurologic symptoms may indicate head injury or stroke. Perform a neurologic exam.

24. A patient has right ear pain with a normal-appearing ear and canal. Which possible source should be considered?

    1. A. Referred pain
    2. B. Otitis externa
    3. C. Cerumen impaction
    4. D. A ruptured eardrum
    Show answer

    Answer: A. Referred pain

    Ear pain can be referred from the teeth, TMJ, tonsils, pharynx, or larynx because of shared nerve pathways. Otitis externa, impacted wax and a ruptured eardrum would all be visible on looking into the canal, which is normal here.

25. Which is the best way to evaluate whether a patient with facial trauma has a malocclusion?

    1. A. Ask about the bite
    2. B. Test tongue movement
    3. C. Check lower lip sensation
    4. D. Tap each tooth for pain
    Show answer

    Answer: A. Ask about the bite

    Patients usually notice when their bite feels off. Malocclusion suggests mandible or maxillary fracture. Numbness of the lower lip can accompany a mandible fracture but does not show how the teeth meet, tongue movement tests a cranial nerve, and tapping teeth checks for a tooth injury rather than the bite.

26. A child with a throat infection is drooling, anxious, and sitting upright. What should you do with the parent?

    1. A. Keep the parent with the child
    2. B. Have the parent lay the child flat
    3. C. Separate them to keep calm
    4. D. Ask the parent to wait outside
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    Answer: A. Keep the parent with the child

    A calm parent reduces the child's distress, which helps prevent airway obstruction from crying and agitation.

27. Wet cement splashed into a worker's eye, and gritty particles are visible under the lower lid. What is the best initial approach?

    1. A. Wait for the cement to dry, then pick it out
    2. B. Remove the particles and irrigate
    3. C. Patch the eye and transport without rinsing
    4. D. Add vinegar to neutralize the cement
    Show answer

    Answer: B. Remove the particles and irrigate

    Cement contains lime, a strong alkali, and gritty particles trapped under the lids keep releasing it. Gently remove visible particles with a moist swab, lift the lids and irrigate for a long time. Waiting for the cement to dry prolongs the burn, patching without rinsing traps the alkali against the eye, and adding vinegar to neutralize it causes heat and more injury.

28. A 75-year-old is confused after a fall at home. Both pupils are 2 mm and react sluggishly. Her respirations are 16 and regular, and her SpO2 is 97%. Her medication list includes pilocarpine eye drops for glaucoma. How should you interpret her pupils?

    1. A. Proof of an opioid overdose
    2. B. Likely from her eye drops
    3. C. Evidence of brain herniation
    4. D. A reason to give naloxone now
    Show answer

    Answer: B. Likely from her eye drops

    Pilocarpine is a glaucoma drop that constricts the pupils, so small, sluggish pupils in a patient using it are likely from her eye drops, and the confusion after a fall still needs a full assessment for head injury, glucose and stroke. Small pupils alone are not proof of an opioid overdose, brain herniation typically causes a dilated pupil on one side rather than two small ones, and naloxone is given for opioid-related breathing depression, which she does not have with regular respirations of 16.

29. For a patient with sudden painless vision loss and stroke risk factors, which destination consideration is appropriate per many protocols?

    1. A. A Level I trauma center
    2. B. Next-day eye clinic visit
    3. C. Nearest optometry office
    4. D. A stroke-capable facility
    Show answer

    Answer: D. A stroke-capable facility

    Central retinal artery occlusion is time sensitive and is treated like a stroke in many systems. Transport to a facility with stroke or ophthalmology capability. A trauma center is not the right resource without injury, and waiting for a next-day eye clinic or an optometry office loses the few hours in which the retina can recover.

30. Which is the best field documentation for a patient's ear drainage after trauma?

    1. A. Diagnosis of basilar fracture
    2. B. Glucose strip result
    3. C. Suspected cause of leak
    4. D. Color, amount, and side
    Show answer

    Answer: D. Color, amount, and side

    Document objective findings such as which ear, the color (clear or bloody), the amount, and any halo sign, rather than a definitive diagnosis. Glucose strips are unreliable for detecting CSF, especially when blood is mixed in, and a guessed cause is an interpretation rather than an objective finding.