(Bates)
Regional Examinations: General Survey, Vital Signs, and Pain.
The Older Adult. Head and Neck. Eyes
Ears and Nose
Throat and Oral Cavity
1) Which statement best defines diabetic retinopathy to a patient you are
discharging?
a) Clouding of the eye lens due to prolonged hyperglycemia.
b) A complication at the microvascular level of diabetes that affects the
retina, which may lead to sudden vision loss.
c) Redness and yellow discharge from one eye.
d) Loss of control of blinking on one eye and complaints of dry eyes.
Answer B
Diabetic retinopathy may present with complaints of blurred vision, cobwebs, black
spots, or sudden loss of vision (Gantioque, 2026, slide 36).
A) Clouding of the lens is glaucoma. C) Redness with yellow discharge is conjunctivitis.
D) This complaint will have other physical findings other than vision, which is specifically
Bell’s Palsy.
2) A 21-year-old athletic male presented to the college health clinic with a sore
throat, fever, and generalized fatigue for 10 days. During the physical exam,
tonsillar exudates were present, and cervical lymph nodes were enlarged. What
is the most important educational teaching to include before discharging this
patient?
a) You can safely continue your usual activities, including school, while
finishing your antibiotics.
b) Continue taking over the counter tylenol or ibuprofen to control fever and
finish antibiotics
c) Because this condition is not contagious, you do not need to make any
changes to your love life.
d) You should remain on strict bed rest and refrain from any high-impact or
contact physical activities.
Answer D
High risk for ruptured spleen due to mononucleosis (Mayoclinic, 2026; Bickley et al.,
2021, p. 1797-1798)
A) The patient is an athlete and should remain on bed rest until the treatment regimen is
completed and cleared by the college clinic clinician. B) Antibiotics do not work on a
viral infection. Follow up blood work with CBC with differential and monitor lymphocyte
count (Gantioque, 2026, slide 138). C) The patient should avoid kissing, remain on strict
bed rest, and be educated that the disease is highly contagious (Gantioque, 2026, slide
141).
3) A 55-year-old male arrived in the emergency room with a complaint of waking up
with a dry eye on the right side and unilateral facial drooping on the right side.
Patient has denied extremity weakness, with minor slur and no visual changes.
During the examination, the nurse practitioner noted unilateral forehead folds
when the patient was asked to raise his eyebrows, and noted that one eyelid did
not fully open or close. What plan of action would the nurse practitioner
consider?
a) Complete a last well-known time, take baseline vitals, and activate stroke
protocol per hospital policy.
b) Discharge the patient with antibiotics and refer to the EENT specialist.
c) Consider diagnosis of Bell’s Palsy, treatment plan of corticosteroid and
artificial tears, with a follow-up appointment within 1 week with PCP.
d) Plan for a visual acuity test, Intraocular pressure measurement, and
ultrasound of the affected eye.
Answer C
Physical findings are consistent with unilateral facial palsy involving cranial nerve VII,
affecting both the upper and lower face. The physical examination should confirm intact
motor function of the extremities, as normal extremity strength helps rule out stroke, and
assess how the forehead wrinkles during the examination. (Gantioque, 2026, slide 60;
Bickley et al., 2021, p. 1463).
A) One key physical assessment finding is the presence or absence of forehead
wrinkling during examination. If forehead muscle tone is preserved, activation of the
stroke protocol should be considered. B) Discharging the patient does not address the
chief complaint and poses a significant legal risk due to unsafe discharge without
adequately ruling out differential diagnoses. D) Unilateral facial droop is a higher clinical
priority than a vision assessment. A potential stroke must be ruled out before
addressing visual complaints.
References
Bickley, L. S., Szilagyi, P. G., & Hoffman, R. M. (2021). Bates’ guide to physical
examination and history taking (13th ed.). Wolters Kluwer.
Gantioque, R. (2026). Week 2 EENT Disorders [PowerPoint slides]. Canvas.
[Link]
Mayoclinic. (2026). Mononucleosis – symptoms & causes. Mayo Clinic.
[Link]
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