MCQ Quiz-Otolaryngologic

MCQ Quiz: Otolaryngology

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Otolaryngologic (Ear, Nose, and Throat) conditions are among the most common reasons patients seek care in a community pharmacy. From seasonal allergies and sinus infections to earaches and sore throats, pharmacists need a strong foundation in this area to provide effective self-care recommendations and manage prescription therapies. This quiz for PharmD students will test your knowledge of the pathophysiology, treatment guidelines, and key counseling points for these prevalent conditions.

1. A patient complains of a runny nose, sneezing, and itchy, watery eyes that occur every spring. This is the classic presentation of:

  • Acute bacterial sinusitis
  • The common cold (viral rhinitis)
  • Allergic rhinitis
  • Influenza

Answer: Allergic rhinitis

2. What is the first-line pharmacotherapy for a patient with persistent, moderate-to-severe allergic rhinitis?

  • An oral decongestant.
  • A first-generation oral antihistamine.
  • An intranasal corticosteroid.
  • A mast cell stabilizer.

Answer: An intranasal corticosteroid.

3. A key counseling point for a patient starting an intranasal corticosteroid like fluticasone is that:

  • It provides immediate relief of symptoms within minutes.
  • It needs to be used consistently every day for maximum effect, which may take several days to a week to become noticeable.
  • It should only be used on an as-needed basis for acute symptoms.
  • The most common side effect is drowsiness.

Answer: It needs to be used consistently every day for maximum effect, which may take several days to a week to become noticeable.

4. A patient is looking for an oral antihistamine that is least likely to cause sedation. Which of the following would be the best recommendation?

  • Diphenhydramine
  • Chlorpheniramine
  • Loratadine
  • Doxylamine

Answer: Loratadine

5. First-generation antihistamines like diphenhydramine have strong __________ properties, leading to side effects like dry mouth, blurred vision, and urinary retention.

  • Anticholinergic
  • Adrenergic
  • Dopaminergic
  • Serotonergic

Answer: Anticholinergic

6. Oral decongestants like pseudoephedrine and phenylephrine should be used with caution in patients with which condition?

  • Asthma
  • Eczema
  • Uncontrolled hypertension
  • Hypothyroidism

Answer: Uncontrolled hypertension

7. A child presents with a bulging, red tympanic membrane and ear pain following a viral upper respiratory infection. This is the classic presentation of:

  • Otitis externa (swimmer’s ear)
  • A foreign body in the ear
  • Acute Otitis Media (AOM)
  • Cerumen impaction

Answer: Acute Otitis Media (AOM)

8. The most common bacterial pathogens responsible for Acute Otitis Media are Streptococcus pneumoniae, Haemophilus influenzae, and:

  • Staphylococcus aureus
  • Pseudomonas aeruginosa
  • Moraxella catarrhalis
  • Escherichia coli

Answer: Moraxella catarrhalis

9. What is the first-line antibiotic of choice for a child with Acute Otitis Media who has not recently taken antibiotics?

  • Azithromycin
  • Ceftriaxone
  • Amoxicillin
  • Ciprofloxacin

Answer: Amoxicillin

10. “Watchful waiting” or observation for 48-72 hours is an appropriate initial strategy for AOM in which patient population?

  • All infants under 6 months of age.
  • A child over 2 years of age with non-severe, unilateral AOM.
  • Any child with a perforated eardrum.
  • A child with a high fever and severe ear pain.

Answer: A child over 2 years of age with non-severe, unilateral AOM.

11. A patient complains of facial pain/pressure, purulent nasal discharge, and congestion for the past 12 days. This is suggestive of:

  • The common cold.
  • Allergic rhinitis.
  • Acute bacterial rhinosinusitis.
  • A migraine headache.

Answer: Acute bacterial rhinosinusitis.

12. The vast majority of acute rhinosinusitis cases are _________ in origin, and antibiotics are not indicated.

  • Bacterial
  • Fungal
  • Viral
  • Allergic

Answer: Viral

13. A patient has a sore throat, fever, and a positive rapid antigen detection test (RADT). This confirms a diagnosis of:

  • Viral pharyngitis
  • Mononucleosis
  • Group A Streptococcal (GAS) pharyngitis
  • Laryngitis

Answer: Group A Streptococcal (GAS) pharyngitis

14. The primary goal of treating Streptococcal pharyngitis with an antibiotic is to:

  • Reduce the duration of symptoms.
  • Prevent the complication of acute rheumatic fever.
  • Prevent the spread to others.
  • All of the above.

Answer: All of the above.

15. What is the first-line antibiotic treatment for Streptococcal pharyngitis in a patient with no penicillin allergy?

  • Doxycycline
  • Penicillin or amoxicillin
  • Levofloxacin
  • Metronidazole

Answer: Penicillin or amoxicillin

16. Otitis Externa, or “swimmer’s ear,” is an infection of the external auditory canal. The treatment typically involves:

  • Oral antibiotics.
  • A topical antibiotic ear drop, often with a corticosteroid.
  • Watchful waiting.
  • An oral decongestant.

Answer: A topical antibiotic ear drop, often with a corticosteroid.

17. A pharmacist counseling a patient on the use of an intranasal corticosteroid should instruct them to aim the spray:

  • Straight back towards the septum.
  • Towards the outer wall of the nostril, away from the septum.
  • Upwards towards the bridge of the nose.
  • Directly at the floor of the nose.

Answer: Towards the outer wall of the nostril, away from the septum.

18. The “common cold” is a viral infection of the upper respiratory tract. The most appropriate recommendation for a patient is:

  • A 5-day course of amoxicillin.
  • Symptomatic care with analgesics, decongestants, and hydration.
  • A high-dose inhaled corticosteroid.
  • An antiviral agent like oseltamivir.

Answer: Symptomatic care with analgesics, decongestants, and hydration.

19. A patient is using an intranasal decongestant spray (e.g., oxymetazoline) every day for the past month. They are at risk for developing:

  • A severe nosebleed.
  • Rhinitis medicamentosa (rebound congestion).
  • A sinus infection.
  • Anosmia (loss of smell).

Answer: Rhinitis medicamentosa (rebound congestion).

20. A key counseling point for a patient using antibiotic ear drops is to:

  • Instill the drops while standing up straight.
  • Warm the bottle in their hands before use to avoid dizziness.
  • Fill the entire ear canal with the solution.
  • Expect immediate relief of pain.

Answer: Warm the bottle in their hands before use to avoid dizziness.

21. In which practice setting is a pharmacist most likely to be involved in a “test and treat” program for influenza or strep throat?

  • Hospital ICU
  • Nuclear Pharmacy
  • Community Pharmacy
  • Managed Care Organization

Answer: Community Pharmacy

22. A pharmacist using the SCHOLAR-MAC acronym to assess a patient’s symptoms is practicing a key part of:

  • The patient care process for self-care recommendations.
  • The dispensing process.
  • The billing process.
  • The inventory management process.

Answer: The patient care process for self-care recommendations.

23. A patient with allergic rhinitis also has benign prostatic hyperplasia (BPH). Which medication should be used with caution?

  • Loratadine
  • Fluticasone
  • Diphenhydramine (due to anticholinergic effects).
  • Montelukast

Answer: Diphenhydramine (due to anticholinergic effects).

24. A key difference between the common cold and influenza is that influenza:

  • Never causes a fever.
  • Has a more abrupt onset with more severe systemic symptoms like fever and myalgia.
  • Is caused by a bacteria.
  • Cannot be prevented with a vaccine.

Answer: Has a more abrupt onset with more severe systemic symptoms like fever and myalgia.

25. A patient with a penicillin allergy who has strep throat could be treated with which of the following?

  • Amoxicillin
  • Penicillin VK
  • A macrolide like azithromycin or a cephalosporin (depending on allergy severity).
  • Augmentin

Answer: A macrolide like azithromycin or a cephalosporin (depending on allergy severity).

26. The use of a “neti pot” or saline nasal irrigation can be a useful non-pharmacologic therapy for:

  • Acute otitis media.
  • Allergic rhinitis and sinusitis.
  • Hearing loss.
  • Tinnitus.

Answer: Allergic rhinitis and sinusitis.

27. A key leadership practice for a pharmacist wanting to start a new allergy management service is to:

  • Create a business plan outlining the need, services, and financial model.
  • Assume the service will be immediately profitable.
  • Hire a new technician.
  • Order a large supply of antihistamines.

Answer: Create a business plan outlining the need, services, and financial model.

28. A pharmacist’s knowledge of __________ is critical for recommending the correct dose of an OTC analgesic for a child’s ear pain.

  • Biostatistics
  • Pharmaceutical calculations (weight-based dosing)
  • Medicinal chemistry
  • Health policy

Answer: Pharmaceutical calculations (weight-based dosing)

29. A “difficult conversation” for a pharmacist might involve:

  • Explaining to a parent why an antibiotic is not needed for their child’s viral sore throat.
  • Handing a patient a routine refill.
  • Taking a patient’s insurance information.
  • Recommending a brand of tissues.

Answer: Explaining to a parent why an antibiotic is not needed for their child’s viral sore throat.

30. The ultimate goal of managing otolaryngologic conditions in the pharmacy is to:

  • Ensure patients receive the most expensive medications.
  • Provide safe and effective care, whether through self-treatment recommendations or referral to a physician.
  • Sell as many OTC products as possible.
  • Diagnose all conditions without a physician’s input.

Answer: Provide safe and effective care, whether through self-treatment recommendations or referral to a physician.

31. The “anticholinergic” side effect profile of first-generation antihistamines makes them potentially inappropriate for use in which patient population, according to the Beers Criteria?

  • Pediatric patients
  • Pregnant patients
  • Geriatric patients
  • Young adults

Answer: Geriatric patients

32. The mechanism of action of montelukast involves:

  • Blocking histamine-1 receptors.
  • Stabilizing mast cells.
  • Blocking leukotriene receptors.
  • Stimulating beta-2 receptors.

Answer: Blocking leukotriene receptors.

33. The service of “deprescribing” might be considered for a patient on long-term daily use of:

  • An intranasal corticosteroid for severe allergies.
  • An oral decongestant for chronic congestion.
  • A second-generation antihistamine.
  • Saline nasal spray.

Answer: An oral decongestant for chronic congestion.

34. From a “human factors” perspective, the availability of dozens of different combination cough and cold products can lead to:

  • Simplified patient decision-making.
  • Patient confusion and the risk of therapeutic duplication or unintentional overdose.
  • A lower cost for all products.
  • A reduction in medication errors.

Answer: Patient confusion and the risk of therapeutic duplication or unintentional overdose.

35. A key “policy” issue that has advanced pharmacy practice in this area is:

  • The expansion of pharmacists’ scope of practice to include “test and treat” services.
  • The reclassification of all decongestants to prescription-only.
  • The removal of all antihistamines from the market.
  • A mandate for all pharmacies to be open 24/7.

Answer: The expansion of pharmacists’ scope of practice to include “test and treat” services.

36. A pharmacist’s understanding of “health disparities” is relevant because:

  • Conditions like asthma and allergies can be more prevalent or severe in minority children living in urban environments.
  • All patient populations are affected by these conditions equally.
  • It is not relevant to otolaryngology.
  • Access to care is the same for everyone.

Answer: Conditions like asthma and allergies can be more prevalent or severe in minority children living in urban environments.

37. When providing care to a patient with a “disability” who has allergic rhinitis, a pharmacist may need to:

  • Adapt their counseling on how to use a nasal spray if the patient has limited manual dexterity.
  • Assume the patient cannot use a nasal spray.
  • Speak only to the patient’s caregiver.
  • Recommend a more complex regimen.

Answer: Adapt their communication and selection on how to use a nasal spray if the patient has limited manual dexterity.

38. The use of an “Electronic Health Record” (EHR) can improve care by:

  • Alerting a prescriber if they order an antibiotic for a patient with a documented history of an allergy to that class.
  • Making it harder to access a patient’s medication history.
  • Hiding a patient’s allergy information.
  • Increasing the number of transcription errors.

Answer: Alerting a prescriber if they order an antibiotic for a patient with a documented history of an allergy to that class.

39. A “forging ahead” mindset in community pharmacy involves:

  • Viewing common otolaryngologic complaints as opportunities to provide valuable clinical services, not just product sales.
  • Referring all patients with a cough or cold to their physician.
  • Focusing only on dispensing speed.
  • Resisting the expansion of pharmacy services.

Answer: Viewing common otolaryngologic complaints as opportunities to provide valuable clinical services, not just product sales.

40. A key “human resources” consideration for a pharmacy offering test and treat services is:

  • Ensuring all staff are properly trained and have demonstrated competency in performing the CLIA-waived tests.
  • The brand of computer used by the staff.
  • The pharmacy’s holiday party schedule.
  • The number of parking spaces available.

Answer: Ensuring all staff are properly trained and have demonstrated competency in performing the CLIA-waived tests.

41. The use of a “negotiation” framework would be helpful when:

  • A pharmacist is discussing with a parent the evidence-based reasons for “watchful waiting” for their child’s ear infection.
  • A patient is picking up a routine refill.
  • A pharmacist is ringing up a sale.
  • A pharmacist is checking in a medication order.

Answer: A pharmacist is discussing with a parent the evidence-based reasons for “watchful waiting” for their child’s ear infection.

42. A “first response” to a child with a suspected foreign body in their ear should be:

  • To attempt to remove it with a cotton swab.
  • To refer the patient to a healthcare provider for safe removal.
  • To pour water in the ear canal.
  • To ignore it.

Answer: To refer the patient to a healthcare provider for safe removal.

43. A pharmacist’s knowledge of “toxicology” is important when a parent asks about the safety of:

  • Multiple different OTC cold products for their young child, to prevent overdose.
  • A saline nasal spray.
  • A single dose of ibuprofen.
  • A throat lozenge.

Answer: Multiple different OTC cold products for their young child, to prevent overdose.

44. A key leadership practice is creating a workflow that allows the pharmacist to:

  • Spend more time on patient assessment and counseling for otolaryngologic conditions, rather than just on technical tasks.
  • Stay behind the counter at all times.
  • Focus only on inventory.
  • Avoid patient interaction.

Answer: Spend more time on patient assessment and counseling for otolaryngologic conditions, rather than just on technical tasks.

45. Which of the following is an “alarm symptom” for a sore throat that would warrant a referral?

  • Mild scratchiness.
  • Difficulty breathing or significant drooling.
  • A sore throat that lasts for one day.
  • A post-nasal drip.

Answer: Difficulty breathing or significant drooling.

46. A “business plan” for a new allergy management service would need to include which of the following elements?

  • A market analysis of the local need for the service.
  • A description of the services offered (e.g., education, product recommendation, referral).
  • A financial plan.
  • All of the above.

Answer: All of the above.

47. The “services” a modern pharmacy provides for otolaryngologic conditions have expanded beyond dispensing to include:

  • Health screenings.
  • Point-of-care testing.
  • Patient education and self-care management.
  • All of the above.

Answer: All of the above.

48. An “analytics and reporting system” could be used in a pharmacy to:

  • Track the number of flu tests performed and the percentage of positive results.
  • Identify patients who may be overusing intranasal decongestants.
  • Monitor the effectiveness of an allergy promotion.
  • All of the above.

Answer: All of the above.

49. The “regulation” of pseudoephedrine sales is a policy designed to prevent:

  • The overuse of decongestants.
  • The illicit manufacturing of methamphetamine.
  • The sale of the product to minors.
  • The pharmacy from making a profit.

Answer: The illicit manufacturing of methamphetamine.

50. The ultimate goal of a pharmacist’s involvement in managing otolaryngologic conditions is to:

  • Ensure the safe, effective, and appropriate use of both self-care and prescription therapies.
  • Diagnose all ear, nose, and throat diseases.
  • Perform surgical procedures for these conditions.
  • Increase the sales of all OTC products.

Answer: Ensure the safe, effective, and appropriate use of both self-care and prescription therapies.

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