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Nurse Practitioner:
doi: 10.1097/01.NPR.0000421420.54127.6d
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Tinnitus evaluation in primary care

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INSTRUCTIONS Tinnitus evaluation in primary care

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Tinnitus evaluation in primary care

General Purpose: To provide NPs with information on the assessment and management of tinnitus. Learning Objectives: After reading the preceding article and taking this test, you should be able to: 1. Identify the epidemiology and risk factors for tinnitus. 2. Discuss signs and symptoms, diagnosis, and management of tinnitus.

1. Which statement regarding tinnitus is true?

a. It is more common in women than men.

b. It is often an inherited condition.

c. It is a symptom, not a disease.

d. It affects Hispanics more often than non-Hispanic Whites.

2. The majority of patients with tinnitus report some degree of

a. hearing loss.

b. disability.

c. pulsations.

d. ear pain.

3. Objective tinnitus is

a. the most common form of the condition.

b. perceived only by the patient.

c. audible to the examiner using a stethoscope.

d. often described as whirring or buzzing.

4. An otologic cause of subjective tinnitus is

a. giant cell arteritis.

b. Ménière disease.

c. an acoustic neuroma.

d. meningitis.

5. Intracranial hypertension is most commonly associated with

a. pulsatile tinnitus.

b. otologic tinnitus.

c. sensorineural tinnitus.

d. anatomic/muscular tinnitus.

6. Medications that may cause tinnitus include

a. antiepileptics.

b. vasodilators.

c. antispasmodics.

d. salicylates.

7. The most common form of tinnitus is

a. infection-related.

b. sensorineural.

c. anatomic.

d. medication-related.

8. The most common form of tinnitus is often associated with

a. a patulous Eustachian tube.

b. palatal myoclonus.

c. stapedial muscle spasm.

d. presbycusis.

9. In a patient with an acoustic neuroma, tinnitus usually

a. is bilateral.

b. occurs months after hearing loss.

c. is the initial symptom.

d. occurs when the tumor affects the sixth cranial nerve.

10. Risk factors for tinnitus include all of the following except

a. diabetes.

b. hypotension.

c. smoking.

d. hyperlipidemia.

11. One common cause of sudden onset tinnitus is

a. head trauma.

b. presbycusis.

c. glomus tympanicum.

d. carotid stenosis.

12. Symptoms associated with Ménière disease include

a. relief from tinnitus when lying down.

b. hyperacute hearing.

c. episodic tinnitus.

d. pulsatile tinnitus.

13. In pulsatile tinnitus from a venous etiology, symptom resolution may be achieved with

a. pressure on the contralateral IJV.

b. bending the head toward the chest.

c. turning the head away from the side with the tinnitus.

d. pressure on the ipsilateral IJV.

14. Tinnitus may be caused by a deficiency in vitamin

a. A.

b. B6.

c. B12.

d. C.

15. Which test is used to distinguish air and bone conduction loss?

a. Weber test

b. Rinne test

c. otoacoustic emissions measurement

d. tympanometry

16. Immediate referral to an otolaryngologist is indicated for pulsatile tinnitus in a patient with

a. recent head trauma.

b. episodic tinnitus.

c. tinnitus that resolves by lying down.

d. bilateral tinnitus after noise exposure.

17. An effective strategy to address bothersome tinnitus is

a. white noise generators.

b. biofeedback.

c. acupuncture.

d. electrical stimulation.

18. Pramipexole has been shown to significantly improve

a. sound conduction.

b. depression related to hearing loss.

c. hearing threshold.

d. tinnitus annoyance.

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