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1. A study published in 2013 explored how well physicians follow the 2006 American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF) guidelines for acute otitis externa (AOE). What were its findings?

A. By 2013, physicians were following the guidelines for topical and systemic management of AOE in more than 95% of cases B. By 2013, physicians were following the guideline for differential diagnosis of AOE in only 20% of cases C. By 2013, physicians were still prescribing systemic antibiotics for AOE more than 30% of the time D. By 2013, physicians were prescribing topical ototoxic antibiotics when the patient had a nonintact tympanic membrane in more than 45% of cases

2. Which of the following otic conditions is considered self-treatable:

A. Gradual hearing loss B. Otorrhea C. Otalgia D. Cerumen impaction

3. Which of the following is a common risk factor for AOE:

A. Moisture in the ear B. An episode of the common cold C. Daycare D. Use of pacifiers

4. As a pharmacist, what is the most appropriate step to take if AOE is suspected:

A. Recommend a trial of nonprescription acetic acid drops B. Recommend a physician visit C. Recommend a homemade solution of vinegar and water D. Recommend an earwax removal product

5. The parent of a young child approaches the pharmacist. She has noticed that the child's hearing is impaired. The child does not complain that her ear hurts and there are no other relevant symptoms. The child is not taking any medications and has no other medical condition. Which of the following is most likely:

A. Malignant otitis externa B. Otitis media with effusion C. Acute otitis media D. Acute otitis externa

6. A patient with AOE has a ruptured tympanic membrane. Which of the following is U.S. Food and Drug Administration (FDA)-approved for this situation:

A. Domeboro Otic B. Cortisporin Otic C. Floxin Otic D. Vosol HC

7. Which of the following dermatologic conditions is a risk factor for AOE:

A. Tinea corporis B. Acne C. Common warts D. Seborrheic dermatitis

8. What is the AAO-HNSF recommendation for pain relief for AOE?

A. Oral analgesics prescribed by a physician B. Antipyrine/benzocaine otic drops prescribed by a physician C. Nonprescription acetaminophen recommended by the pharmacist D. Nonprescription otic drops recommended by the pharmacist

9. What is the role of homeopathic products in AOE:

A. Proven safe and effective B. Proven safe, but not effective C. Proven effective, but not safe D. Likely to be safe, but not proven to be effective

10. Which of the following is a safe and effective nonprescription method of preventing AOE when used after swimming in the lake:

A. Ciprodex Otic B. Acetic acid C. Ear drying aid drops D. Earwax removal system

11. A father believes his daughter, 8 years of age, has excessive earwax because she has slightly reduced hearing and a feeling of fullness in the ear. Her pediatrician told them, several years ago, that she tends to produce a lot of earwax and a buildup can occur. He wonders if he should use Mack's Wax Away to help. His daughter has seasonal allergic rhinitis, for which she takes a nonprescription allergy medication. What is the best advice the pharmacist can give?

A. Use Mack's Wax Away as directed on the label B. See a physician because of the age of the child C. See a physician because of her concurrent medical condition D. Recommend an ear-drying system instead, advising him to follow all label directions

12. What is the chain of events that most commonly causes AOE?

A. Cerumen removal, skin break, contact with infected water B. Cerumen impaction, use of alcohol, contact dermatitis C. Moisture in the ear, excessive skin scaling, otic canal occlusion D. Swimming, impaired ceruminokinesis, impacted cerumen

13. A prescription for Ciprodex Otic is prescribed for use 2 times a day. What should the pharmacist do?

A. Dispense as written B. Contact the physician to change the regimen to once a day C. Contact the physician to change the regimen to every 4 hours, as needed, for pain D. Contact the physician to change the instructions for administration to 3 times a day

14. All of the following are modifying factors that affect management of AOE, except:

A. Diabetes mellitus B. A history of chemotherapy C. Immunocompromised status D. Psoriasis

15. In which case would the pharmacist advise a patient to use an otic syringe?

A. To remove topical antibacterial otic drops after 5 minutes of contact time with the otic canal B. To assist with the removal of impacted cerumen after the use of carbamide peroxide otic drops C. To provide gentle suction, assisting with the removal of moisture in the ear after swimming D. To assist with applying topical antibacterial otic drops next to the tympanic membrane

16. Why do some physicians prefer to prescribe ophthalmic antibacterials for otic infections?

A. They have a higher viscosity than otic drops, with correspondingly longer contact times with the otic canal B. Their ingredients are not ototoxic and any may be used with a nonintact tympanic membrane C. They are more comfortable to use because they have a higher pH than otic drops, possibly enhancing compliance D. They are suspensions, which allows them to saturate an ear wick more easily

17. A patient was prescribed Cortisporin Otic for AOE 4 days ago, to be used 3 to 4 times daily. He has noticed that the affected ear is unusually pruritic, much more so than when he went to see his physician. Which of the following is the most likely cause:

A. Rebound inflammation caused by waning efficacy of the hydrocortisone B. A flare of the AOE symptoms, possibly caused by resistant Pseudomonas C. Overgrowth of fungal pathogens, most likely Candida species D. Contact dermatitis caused by the neomycin

18. A patient asks about the use of ear candles to help remove impacted cerumen, for him and for his child, 7 years of age. What should the pharmacist tell him?

A. They are dangerous and ineffective and should be avoided B. They are safe and effective for children and adults C. They are safe for him, but not for his child D. They have been withdrawn from the market and are no longer available

19. What is the best method to cleanse the ears?

A. A Q-tip inserted into the ear until the tip is no longer visible B. A wet washcloth over the finger C. A rigid object, such as a key or paper clip D. An electronic irrigation device set on the lowest setting

20. A patient receiving a prescription for Ciprodex Otic asks how long it will be before his ear stops hurting. Which of the following would be the most accurate and appropriate response from the pharmacist:

A. As soon as the local anesthetic takes effect, within 2 to 3 hours B. Approximately 24 hours C. Approximately 48 to 72 hours D. Approximately 5 to 6 days