A Game of Thrones Chapter Fifty-nine Free Essays

Catelyn As the host trooped down the boulevard through the dark marshes of the Neck and spilled out into the riverlands past, Catelyn’s worries developed. She covered her feelings of dread behind a face kept still and harsh, yet they were there no different, developing with each alliance they crossed. Her days were on edge, her evenings eager, and each raven that flew overhead made her grasp her teeth. We will compose a custom paper test on A Game of Thrones Chapter Fifty-nine or on the other hand any comparative theme just for you Request Now She dreaded for her ruler father, and marveled at his unfavorable quietness. She dreaded for her sibling Edmure, and asked that the divine beings would look out for him on the off chance that he should confront the Kingslayer in fight. She dreaded for Ned and her young ladies, and for the sweet children she had abandoned at Winterfell. But then there was nothing she could accomplish for any of them, thus she made herself put with or without thought of them. You should spare your quality for Robb, she let herself know. He is the just a single you can help. You should be as wild and hard as the north, Catelyn Tully. You should be a Stark for genuine currently, similar to your child. Robb rode at the front of the segment, underneath the fluttering white standard of Winterfell. Every day he would solicit one from his masters to go along with him, so they may present as they walked; he respected each man thusly, demonstrating no top picks, tuning in as his ruler father had tuned in, gauging the expressions of one against the other. He has gained such a great amount from Ned, she thought as she watched him, however has he sufficiently learned? The Blackfish had taken a hundred picked men and a hundred quick ponies and dashed ahead to screen their developments and scout the way. The reports Ser Brynden’s riders brought back did little to console her. Ruler Tywin’s have was as yet numerous days toward the south . . . be that as it may, Walder Frey, Lord of the Crossing, had gathered a power of almost 4,000 men at his mansions on the Green Fork. â€Å"Late again,† Catelyn mumbled when she heard. It was the Trident all finished, damn the man. Her sibling Edmure had called the flags; by rights, Lord Frey ought to have gone to join the Tully have at Riverrun, yet here he sat. â€Å"Four thousand men,† Robb rehashed, more bewildered than irate. â€Å"Lord Frey can't would like to battle the Lannisters without anyone else. Doubtlessly he intends to join his capacity to ours.† â€Å"Does he?† Catelyn inquired. She had ridden forward to join Robb and Robett Glover, his buddy of the day. The vanguard spread out behind them, a moderate moving backwoods of spears and pennants and lances. â€Å"I wonder. Expect nothing of Walder Frey, and you will never be surprised.† â€Å"He’s your father’s bannerman.† â€Å"Some men make their vows more genuinely than others, Robb. What's more, Lord Walder was consistently more amicable with Casterly Rock than my dad would have preferred. One of his children is marry to Tywin Lannister’s sister. That implies little of itself, certainly. Master Walder has sired a considerable number of kids throughout the years, and they should needs wed somebody. Still . . . â€Å" â€Å"Do you think he intends to double-cross us to the Lannisters, my lady?† Robett Glover asked gravely. Catelyn moaned. â€Å"If in all honesty, I question even Lord Frey recognizes what Lord Frey expects to do. He has an old man’s alert and a youthful man’s aspiration, and has never needed for cunning.† â€Å"We must have the Twins, Mother,† Robb said heatedly. â€Å"There is no other path over the stream. You know that.† â€Å"Yes. Thus does Walder Frey, you can make certain of that.† That night they made camp on the southern edge of the lowlands, somewhere between the kingsroad and the stream. It was there Theon Greyjoy brought them further word from her uncle. â€Å"Ser Brynden says to let you know he’s challenged the Lannisters. There are twelve scouts who won’t be detailing back to Lord Tywin at any point in the near future. Or on the other hand ever.† He smiled. â€Å"Ser Addam Marbrand orders their outriders, and he’s pulling back south, consuming as he goes. He knows where we are, pretty much, however the Blackfish promises he won't know when we split.† â€Å"Unless Lord Frey tells him,† Catelyn said forcefully. â€Å"Theon, when you come back to my uncle, disclose to him he is to put his best bowmen around the Twins, day and night, with requests to cut down any raven they see leaving the towers. I need no feathered creatures bringing expression of my son’s developments to Lord Tywin.† â€Å"Ser Brynden has made sure as of now, my lady,† Theon answered with an arrogant grin. â€Å"A barely any more blackbirds, and we ought to have enough to prepare a pie. I’ll spare you their plumes for a hat.† She should have realized that Brynden Blackfish would be well in front of her. â€Å"What have the Freys been doing while the Lannisters consume their fields and loot their holdfasts?† â€Å"There’s been some battling between Ser Addam’s men and Lord Walder’s,† Theon replied. â€Å"Not a day’s ride from here, we discovered two Lannister scouts taking care of the crows where the Freys had hung them up. The majority of Lord Walder’s quality remains massed at the Twins, though.† That drag Walder Frey’s seal without question, Catelyn thought sharply; keep down, pause, watch, face no challenge except if compelled to it. â€Å"If he’s been battling the Lannisters, maybe he intends to hold to his vows,† Robb said. Catelyn was less supported. â€Å"Defending his own territories is a certain something, open fight against Lord Tywin very another.† Robb turned around to Theon Greyjoy. â€Å"Has the Blackfish found some other path over the Green Fork?† Theon shook his head. â€Å"The river’s running high and quick. Ser Brynden says it can’t be forded, not this far north.† â€Å"I must have that crossing!† Robb proclaimed, seething. â€Å"Oh, our ponies may have the option to swim the stream, I assume, however not with defensively covered men on their backs. We’d need to assemble pontoons to shaft our steel over, steerages and mail and spears, and we don’t have the trees for that. Or on the other hand the time. Ruler Tywin is walking north . . . † He balled his hand into a clench hand. â€Å"Lord Frey would be an imbecile to attempt to bar our way,† Theon Greyjoy said with his standard simple certainty. â€Å"We have multiple times his numbers. You can take the Twins in the event that you have to, Robb.† â€Å"Not easily,† Catelyn cautioned them, â€Å"and not in time. While you were mounting your attack, Tywin Lannister would raise his host and ambush you from the rear.† Robb looked from her to Greyjoy, scanning for an answer and discovering none. For a second he looked considerably more youthful than his fifteen years, in spite of his mail and blade and the stubble on his cheeks. â€Å"What would my ruler father do?† he asked her. â€Å"Find a way across,† she let him know. â€Å"Whatever it took.† The following morning it was Ser Brynden Tully himself who rode back to them. He had set aside the overwhelming plate and rudder he’d worn as the Knight of the Gate for the lighter cowhide and-mail of an outrider, yet his obsidian fish despite everything affixed his shroud. Her uncle’s face was grave as he swung down off his pony. â€Å"There has been a fight under the dividers of Riverrun,† he stated, his mouth dismal. â€Å"We had it from a Lannister outrider we abducted. The Kingslayer has decimated Edmure’s host and sent the masters of the Trident pulling in flight.† A virus hand grasped at Catelyn’s heart. â€Å"And my brother?† â€Å"Wounded and taken prisoner,† Ser Brynden said. â€Å"Lord Blackwood and different survivors are under attack inside Riverrun, encompassed by Jaime’s host.† Robb looked touchy. â€Å"We must get over this abhorrent waterway if we’re to have any expectation of alleviating them in time.† â€Å"That won't be effectively done,† her uncle forewarned. â€Å"Lord Frey has pulled his entire quality back inside his strongholds, and his entryways are shut and barred.† â€Å"Damn the man,† Robb swore. â€Å"If the old dolt doesn't yield and let me cross, he’ll leave me no decision yet to storm his dividers. I’ll pull the Twins down around his ears in the event that I need to, we’ll perceive how well he loves that!† â€Å"You sound like a glum kid, Robb,† Catelyn said forcefully. â€Å"A youngster sees an impediment, and his previously thought is to go around it or wreck it. A ruler must discover that occasionally words can achieve what blades cannot.† Robb’s neck blushed at the reproach. â€Å"Tell me what you mean, Mother,† he said docilely. â€Å"The Freys have held the intersection for a long time, and for a long time they have never neglected to correct their toll.† â€Å"What cost? What does he want?† She grinned. â€Å"That is the thing that we should discover.† â€Å"And imagine a scenario in which I don't decide to pay this toll?†. â€Å"Then you had best retreat back to Moat Cailin, send to meet Lord Tywin in fight . . . or on the other hand develop wings. I see no other choices.† Catelyn put her heels to her pony and headed out, leaving her child to contemplate her words. It would not do to cause him to feel as though his mom were usurping his place. Did you instruct him astuteness just as valor, Ned? she pondered. Did you show him how to bow? The burial grounds of the Seven Kingdoms were brimming with valiant men who had never discovered that exercise. It was close to early afternoon when their vanguard came in sight of the Twins, where the Lords of the Crossing had their seat. The Green Fork ran quick and profound here, yet the Freys had spread over it numerous hundreds of years past and developed rich off the coin men paid them to cross. Their extension was a gigantic curve of smooth dim stone, wide enough for two carts to pass side by side; the Water Tower rose from the focal point of the

Notes on American Literature Essay

Significant figures:  ·Sir Walter Raleigh ? explorer, Elizabeth’s I sweetheart, writer, officer, kicked the bucket in Tower of London. A well known English author, artist, squire and adventurer. He was liable for building up the second English state in the New World (after Newfoundland was built up by Sir Humphrey Gilbert almost one year beforehand, August 5 1583) on June 4, 1584, at Roanoke Island in present-day North Carolina. At the point when the third endeavor at settlement fizzled, a definitive destiny of the pilgrims was rarely legitimately discovered.  ·John Winthrop ? legislative head of Massachusetts. driven a gathering of English Puritans to the New World, joined the Massachusetts Bay Colony in 1629 and was chosen their first senator on April 8, 1630. Somewhere in the range of 1639 and 1648 he was removed from governorship and reappointed an aggregate of multiple times. Despite the fact that Winthrop was a regarded political figure, he was scrutinized for his stubbornness (obstinate) with respect to the arrangement of a general get together in 1634. Calvin’s impact:  ·theory of fate, constrained recovery  ·self preliminaries to discover predetermination  ·the just expectation was confidence in God.  ·God’s altruism ? overwhelming effortlessness  ·faith makes everybody great except great deeds without confidence don’t work  ·one ought to follow their predetermination, ex. become a rancher, following fate will make you fruitful, (well off) however you shouldn’t don’t go through cash, contribute it!  ·the sacred demonstration of bringing in cash for God Puritans were sitting tight for signs, they read ? books to read’ (the Bible), deciphered it, deciphered history in their own, Puritan way. Anything could be a sign (climate conditions, Indian assaults, sicknesses, starvation, and so forth ). Puritan confidence:  ·grim, no canvases, no music  ·sermons were critical as they deciphered the Bible Michael Wigglesworth: (1631-1705)  ·wrote The Day of Doom (1662) †his sonnet speaks to puritan thought of the time. Huge numbers of the puritans remembered it and utilized it to get individuals again into the congregation. They utilized it to show youngsters and waiting grown-ups. This was the first â€Å"best seller†, despite the fact that this term wasn’t utilized at this point. It depicts the Day of Judgment and the condemning to discipline in damnation of miscreants and of newborn children who kicked the bucket before submersion. Samuel Danforth: (1626-1674)  ·In 1670, he was welcome to give the yearly political race lesson to the General Assembly, which was a short time later printed as A Brief Recognition of New-England’s Errand into the Wilderness (about transforming nature into human advancement) and is viewed as probably the best case of the â€Å"jeremiad† structure  ·jeremiad messages †clarified things structure the Bible, made setting, it said that future is radiant in light of the fact that we can be better, develop ourselves History translations: Cotton Mather: (1663-1728).  ·Magnalia Christi Americana (about strict improvement of Massachusetts, and other close by provinces in New England from 1620 to 1698); the English title was The Ecclesiastical History of New England (1702)  ·he additionally composed portrayals of the Salem Witch Trials, in which he reprimands a portion of the strategies for the court and endeavors to separate himself from the occasion; record of the break Hannah Dustan, one of the most celebrated to imprisonment story researchers; his total â€Å"catalogus† of the considerable number of understudies that moved on from Harvard College, and story of the establishing of Harvard College itself; and his attestations that Puritan slaveholders ought to accomplish more to change over their captives to Christianity  ·made a legacy, typological approach 08. 10. 2007 Religious writings: †lessons ? instruments of correspondence between the priest and the individuals †philosophical postulation †narratives (chronicled) Mary Rowlandson (1635-7 ? 1678)  ·She was a provincial American lady, who composed a striking depiction of the seven weeks and five days she went through living with Native Americans. Her short book,  ·A Narrative of the Captivity and Restoration of Mrs. Mary Rowlandson (1682), is viewed as an original work in the American artistic sort of bondage accounts. The primary period of gallant period ? initial 30 years, after that a difficult issue happened? experience of transformation, however not every person did it so how to manage their youngsters? 1662 ? Midway Covenant (by Senate in Boston) ? salvation is heredity regardless of whether they didn’t experienced it. seventeenth century was progressively adaptable what prompted incredible strict recovery in the US, abstract marvel, upheaval of strict feelings ? thus writings. George Whitefield ? a rhetorician, minister, spoke to American individuals, activated strict recovery. The Great Awakening: (1735 ? 1750)  ·paradoxical development, they viewed themselves as just evident Puritans yet they were viewed as practically sinful development, their excitement had contrary undertones, individuals figured they ought to be increasingly objective  ·leaders: Jonathan Edwards who composed a fire-and-brimstone message entitled Sinners in the Hands of an Angry God (1741), he had confidence in Protestant creed, he needed individuals to encounter genuine transformation, was against formalâ sermons, he had a sleep inducing method of instructing, speaking to feelings, he had to move and live in wild, kicked the bucket of smallpox. He was a functioning rationalist, attempted to join old religion with Locke’s new way to deal with religion.  ·the development (the Great Awakening) was the last huge second to recapture control by Puritans Edwards versus Franklin ? they lived in a similar time, illumination rivaling the old legacy Franklin was conceived in Boston and he needed to move to Philadelphia ? city of edification, Quakers, city claimed by William Penn. Benjamin Franklin (1706-1790)  ·Autobiography (written in 1771 †1790) - Learning model conduct, proposed model individual, he would react to the excellence of the world, and nature as a living nearness of God, story of narrator’s progress from Boston to Philadelphia, dedicated himself to basic great, he made the most of accomplishment generally (money related in your own eyes and glory in others’ eyes) - 12 decrees, it’s great to mimic Jesus and Socrates (in spite of the fact that Socrates was an agnostic and a suicider)  ·Poor Richard’s Almanac - was a yearly chronological registry distributed by Benjamin Franklin, who received the pen name â€Å"Poor Richard† or â€Å"Richard Saunders† for this reason. The distribution showed up persistently from 1732 to 1758. It was a blockbuster for a flyer distributed in the American states; print runs arrived at 10,000 every year. Franklin, the American creator, legislator, and distributer, made progress with Poor Richard’s Almanac. Chronological registries were exceptionally mainstream books in frontier America, with individuals in the provinces utilizing them for the blend of regular climate gauges, useful family unit indications, puzzles, and different diversions they advertised. Poor Richard’s Almanac was well known for these reasons, and furthermore for its broad utilization of pleasantry, with numerous models got from the work getting by in the contemporary American vernacular. Routed to ranchers (chronicles), valuable data about cultivating, climate, space science, moral exhortation, numerous sayings, (for instance â€Å"God enables the individuals who to help themselves† what is inverse to Puritan theory), Do great papers, settlements writing. Franklin created commonsense method of personal growth step by step and bit by bit to be altogether normal individual. political writing ? banter among Federalists and enemies of Federalists Americans related to Ancient Rome, that’s why the Declaration was conceived. The makers were instructed, they read Greek, Roman works, created feeling of open ethicalness, struggle with the British Crown. Locke, Milton ? enlivened provinces to create belief system to sewer the ties with the Crown + â€Å"no tax collection without representation† Thomas Paine (1737-1809)  ·in 1774 ? came to America as an elderly person, in 1776 he distributed Common sense, an enemy of British book about Britain illicit money related maltreatment, spoke to Americans fearlessness, enough to be free, to shape their fate by assurance, endurance, cerebrums and so forth. The record censured British standard and, through its enormous prevalence, added to animating the American Revolution. Hartford Wits (likewise called the Connecticut Wits) A gathering of American scholars based on Yale University and thrived during the 1780s and 1790s. Generally alumni of Yale, they were traditionalist federalists who assaulted their political rivals with mocking refrain. Individuals included Joel Barlow, Timothy Dwight IV, David Humphreys, John Trumbull, Lemuel Hopkins, Richard Alsop, and Theodore Dwight. Works created by the gathering include: The Anarchiad (distributed in the New Haven Gazette from 1786? 1787) The Political Greenhouse (Connecticut Courant, 1799) The Echo (American Mercury, 1791? 1805) John Trumbull (1756-1843)  ·believed in poetics, feel, chivalrous couplet, parody. Individual from a gathering of specialists who painted significant American verifiable occasions, Trumbull had an insider’s perspective on the War, filling in as a colonel in the Continental Army and helper to Gen. Washington in the American Revolution  ·The Progress of Dullness (1772-1773) †n assault in three sonnets on instructive strategies for his time (three sections: 1. experiences of Tom Brainless, sent to school, he learns â€Å"the craft of preaching,†; 2. Dick Hairbrain, a town coxcomb, the child of an affluent rancher, crazy in dress, void of information, yet significant in swearing and modest disloyalty; 3. Miss Harriet Simper, slim female training, some time ago stylish, and the life of the flirt) Timothy Dwight (1752-1817)  ·continued Wigglesworth convention  ·The Conquest of Canaan (bar. 1785) ? yearning epic in eleven books, about George Washington and war of autonomy  ·Greenfield Hill (1794) †graphic sonnet about little New England town,

Career in Real Estate Essay Example | Topics and Well Written Essays - 1000 words

Vocation in Real Estate - Essay Example Realtors are escaping this industry - on the grounds that they will in general accept that the dynamic idea of this industry can generally offer money related achievement and afterward brought about a total misfortune. I prescribe you to take an alternate track, the uneven street of scarifies, battles and costs - in light of the fact that hardship manufactures character. You likely saw that life should be 'direct', not a spirit at any point promised you a 'budgetary achievement's (or a nursery brimming with red roses), however that doesn't likeness that you can't need to heat that cake, and still appreciate it, while you are preparing another. What I'm attempting to illuminate here is that the present land industry is an ideal profession, however in want, for making tremendous money related achievement straight away, there is only 'getting out' of this solid vocation opportunity. Sometimes you got the opportunity to need to look increasingly 'worried' in it. This is a deceptive thought that being an authorized realtor is likeness being given the keys to the money related achievement. Nothing could be farther than the truth. You can bring in tremendous cash, yet it requires difficult tasks, commitments, and there are the immense number of costs and costs up and down the way. How about we start with the impetus for having a land work. In the event that you might want to acquire cash, it's there to be made. In case you're attempting to figure out how to burrow yourself outside of a monetary opening rapidly, this isn't it. The colossal payday will be far away and you shouldn't anticipate any compensation whatsoever. Fruitful land agents barely ever have a successively prosperous start as 'megastars'. Indeed, even these specialists in this field have jobbed for bunches of years and have made a status and a solid relationship among their previous clients and group accomplices. They have built up a decent business where they were up to develop their possibilities and gifts, and where they set up a decent represent an effective promoting movement.Every one of you can finish an assessment to get a permit, yet not every last one can form into a successful Realtor. In the event that you are not cash persuaded and can't expect the 'enormous desires', that helps. The motivation is to think about a vocation in land as a proceeding with resource. It isn't the best approach either in the event that you can't work sound with others. Each new operator who is urgent to form into a business icon needs to set up by learning the 'ropes'. Generally do that by being a piece of a legitimate deals group and taking on a supporting role to the most phenomenal merchants in the business. For example, this resembles any 'commission deals vocation decision', turning out to be land delegate requires cautious arranging, 'benevolence' (I utilized this word since progress just stops by 'overlooking oneself', with working extended periods of time) and fitting monetary help.

How Long Should Me College Essay Be?

<h1>How Long Should Me College Essay Be?</h1><p>If you are one of the numerous understudies who need to manage that feared paper to review this semester, there is a good and bad approach to compose an exposition. This isn't an issue for just those of us who compose expositions yet additionally for the teachers who do too. Before we go any further I should state this isn't an article to pack yourself with realities so on the off chance that you are keen on that, quit perusing now.</p><p></p><p>So, what precisely are the means engaged with composing a particular school exposition? The initial step is choosing which sort of paper you might want to compose. For instance in the event that you are just going to compose a general exposition about your adoration life there are sure tips you ought to follow to compose it correctly.</p><p></p><p>If you choose to expound on your affection life you would initially compose a genera l inquiry like 'for what reason do men fall in love'what's the most ideal approach to get a person to propose to you?' These are both extremely broad inquiries, so you can anticipate that the appropriate responses should be intriguing and not simply fundamental measurements. In any case in the event that you need to compose a more inside and out and customized answer, feel free to do so.</p><p></p><p>You ought to inquire as to whether you might want to discuss things like your own data, your family ancestry, or even get some information about your preferred film. Looking at this logically these inquiries are right around a rundown of the considerable number of inquiries in one. Along these lines you would need to pick the best one from the rundown. You can ask yourself inquiries like 'What might I want to think about myself?' and 'How much time should I spend on this?' to give you the best composition for your particular needs.</p><p></p>< ;p>You likewise need to begin composing a foundation about your subject, which is the most significant part of your article on the grounds that the significant point is what is your general topic, and what is your essential or the primary focal point of your paper. On the off chance that you are composing an exposition on adoration, it is ideal to choose what parts of affection your paper is going to cover. For instance, in the event that you are composing an affection exposition about a female understudy, you might need to expound on: What her inclinations are, Where did she go to class, What is her preferred shading, and What does she need from life?</p><p></p><p>When composing your article, it is a smart thought to start by discussing to what extent you have been expounding on adoration and afterward concoct your own definition. Be that as it may in the event that you don't have a clue what the correct definitions are for the subjects you are expounding on, at that point you should discover. Look into online journals and articles about adoration and sentiment to get your thoughts down. Utilize this data to assist you with composing your exposition and you will start to feel less stressed.</p><p></p><p>There are two essential approaches to compose a school article. You should begin by making sense of what you need to state and afterward choose if you might want to incorporate explicit data that will help your writing.</p>

Tips on How to Create Good Essay Topics

<h1>Tips on How to Create Good Essay Topics</h1><p>Writing articles for school is no simple undertaking. There are numerous things that you have to know before you begin applying for school, and applying for your Texas paper themes is only one of those things.</p><p></p><p>You need to realize how to make your article points dependent on Texas writing. At the point when you are finished composing your subjects, make certain to send them to your educators so as to get the input from your instructor on what you should change and what you can enhance. In addition, you should comprehend what the instructor likes and what the educator doesn't care for so you can improve your points than the others in the class.</p><p></p><p>There are a couple of significant things that you have to would on the off chance that you like to prevail with your Texas exposition subjects. So as to compose a brilliant Texas article point, you have t o think pretty much all the books that have been expounded on Texas history and geology. These books will assist you with understanding why Texas is such an extraordinary spot to live and visit. You additionally need to get familiar with the individuals that made the state so incredible as well.</p><p></p><p>Before you begin composing your papers, you have to know some data about each province of Texas. Along these lines, you will comprehend what Texas should concentrate on and what it shouldn't. Additionally, you have to think about how better places in Texas are associated with one another's history.</p><p></p><p>Another thing that you have to learn is the guidelines for you to compose an incredible Texas exposition subject. You have to realize what you can and can't expound on, and how far you can go with your topic.</p><p></p><p>Now that you have taken shortly about Texas, you are prepared to start making th e means towards composing that article that you have for the longest time been itching to compose. The main thing that you have to do is to discover where to discover great examples of expositions that are as of now in great shape.</p><p></p><p>Don't tragically try to compose an article dependent on another person's Texas paper points. Remember this is your own gem, and you should be the one to choose where you need to go with it.</p>

Finding Top Essay Writing Organizations

<h1>Finding Top Essay Writing Organizations</h1><p>The top exposition composing organizations can make your work at home vocation a reality, in the event that you have the energy to compose and the drive to exceed expectations. They can assist you with discovering all the instruments important to deliver exceptional and convincing papers. It is likewise acceptable to realize that they have instructive assets that can assist you with arriving at your scholastic goals.</p><p></p><p>There are actually a large number of composing administrations accessible to understudy paper authors. It tends to be an overwhelming undertaking to pick the best one. There are numerous approaches to find the top exposition composing tunes. One path is to look online for organizations that work in writing.</p><p></p><p>There are national web search tools, for example, Google and Yahoo that can assist you with discovering locales that are prof icient. On the off chance that you type in paper composing, you will discover the sites by term like composing administrations, article composing association, composing administration, and other terms.</p><p></p><p>Many top exposition composing or have online projects that permit you to make and present your work. This is an extraordinary method to meet other article journalists, just as to pose inquiries and discover answers. You may need to apply for enrollment, however the organization ought to have the option to assist you with doing so.</p><p></p><p>It is essential to think of imaginative thoughts before you start to compose. It is imperative to attempt new things, with the goal that you can enhance your work. It is hard to begin, in the event that you don't have the correct apparatuses to compose a paper on.</p><p></p><p>There are numerous highlights offered by the top exposition composing melodies. One is online help and instructional exercises to assist you with making the progress you are searching for. Most top organizations offer courses and workshops. On the off chance that you locate these accommodating, you will need to take a crack at them.</p><p></p><p>The top exposition composing tunes will likewise have highlights for reference materials. These can be expected to aid the investigation and correction of your composed work. The best organizations offer total help and assist you with picking up induction into their programs.</p><p></p><p>By utilizing the Internet to locate the top exposition composing melodies, you will have the option to achieve your objective. It is anything but difficult to find a decent one that can assist you with getting a decent arrangement of acknowledgment for your composing aptitudes. The individuals you work with will be learned, useful, and devoted to your prosperity. It is a success win circumstanc e that is worth exploring.</p>

Buying Leaving Cert Irish Essay Samples

<h1> Buying Leaving Cert Irish Essay Samples </h1> <h2> The Honest to Goodness Truth on Leaving Cert Irish Essay Samples</h2> <p>Ultimately, for Project Maths you should really comprehend the thoughts unmistakably more. The All-Ireland Scholarship Scheme is anticipated to run for 10 decades or something like that. Mr Gavin expressed that every one of the inquiries on the cluaistiscint demonstrated attractive and ought to have been available to every understudy, while Ms McTernan disclosed that understudies appeared to find the aural test simpler than in earlier decades. In Protestant-oversaw auxiliary schools, understudies may be qualified for an award during the Secondary Education Committee. </p> <p>Whether you have to make a paper of extraordinary faultlessness, simply buy an article here and our scholars will give assistance. It's such a huge course it assists with being to some degree methodical about everything. At long last they probab ly won't be significant. Try not to be worried about your watch for this paper. </p> <p>While most guardians won't take a gander at sending their kids to private optional school as it's not plausible for monetary or geographic reasons, there are heaps of guardians who'd love their kid to understand that benefit and grants can make that fantasy a reality. Failing the leaving testament isn't applied. Along these lines that you don't chance your cash since you can discover the cost before concluding your purchase. This isn't an extraordinary with respect to getting cash to the detriment of universal prosperity and security. </p> <h2>Ideas, Formulas and Shortcuts for Leaving Cert Irish Essay Samples </h2> <p>This is the manner in which you build up your jargon. I attempted to comprehend the information in each subject instead of basically repetition learn and spew answers. Much like Irish, work on talking however much as could be expected. You should discover that independently for these 2 sonnets. </p> <p>You can utilize your own locations gave that they're Irish locations. You should keep a composed rundown of words, so you may audit them before you enter the test. Guarantee that you totally comprehend the titles you have chosen. Where it's conceivable, answer a few inquiries in your words. </p> <p>You will find that utilizing a predetermined number of expressions it is conceivable to answer a genuinely huge arrangement of inquiry. Truth be told, preceding making a request you're ready to discover a value quote on your article. A Triailcontains a few words that you may never have seen. Regardless of the scholarly level of the exposition models that you're searching for, we have the subject material secured easily, and would adore for you to peruse through the numerous particular themes to watch this for yourself.</p> <p>Take a look at all the past inquiries and be certain you can answer them. It's basic that you begin learning these ahead of schedule as there are a ton to endure. There are heaps of little things you should know and have clear in your mind. Try not to disregard the essential things. </p> <p>Section B 20 imprints You will have choice of inquiries dependent on a solitary sonnet. Time isn't an issue here, and in this manner don't transform it into one. </p> <p>But, at the indistinguishable time, in the occasion the inspector can't understand what you are stating then the point can't check either. Inside this circumstance you'll have the option to approach SameDayEssay. It is more straightforward to stall out on the verse question because of the aggregate sum of decision, so promise you don't spend an excessively long time pondering. This empowers the individual posing the inquiries to enter the outlook of an inspector, which is a noteworthy ability to create. </p> <h2>Leaving Cert Irish Essay Samples - the Story </h2> <p>There's no should be stressed over your absence of capability in the theme matter as we are there to support you. You should simply get in contact with the master partners at Ireland Assignment Help, and they're going to manage your learning simultaneously you continue on ahead unhindered. There are 3 particular projects that might be followed. It's fundamental that you build up your abilit ies here. </p> <p>The objective of the site is to flexibly understudies with a variety of learning assets that will make it workable for them to build their certainty and scholarly evaluations in the control. They're specialists in different scholarly teaches and learned journalists at precisely the same second. A few subjects like Art and Technology include a useful test that is directed by an outside analyst. </p>

Essay Writer Account With Academic Writing Skills

<h1>Essay Writer Account With Academic Writing Skills</h1><p>An online college degree program offers a temporary job with a school level composing task that an understudy can work with in an exposition author account. The understudy's work is credited to the record and he/she can present a task for production on their resume.</p><p></p><p>The assignments, school assignments, or research projects relegated for this reason for existing are regularly given with a free-duplicate scholastic adaptation of the task to offer the school or instructor the chance to check if the work is steady with the book. This report will incorporate the name of the creator, title, date and furthermore the copyright date. In some cases the understudy may have extra direction of different understudies who may likewise be composing as a group.</p><p></p><p>Online college degrees offer more chances to journalists than any time in recent memory. A few journalists for online college degrees don't feel great filling in as a group. Thus, online advanced educations have an alternative that empowers them to work with a co-essayist who they can examine issues that they are uncertain about, however they get confirmation that the choice is theirs and not just in the interest of their supervisor.</p><p></p><p>The composing task shouldn't be as perplexing as the task on the school paper. The main distinction is that they will be cooperating, as opposed to separately. Composing assignments for this kind of course of action can be longer and more point by point than a standard single individual theory. It can likewise be the task for a school term paper.</p><p></p><p>The research and information for the composing task will be for the specific school course, yet a significant piece of the exposition author record will be another point of view on a specific issue that was referenced in the c ontent of the understudy's book. The paper essayist record can utilize such explicit as the topic of the book. It might be an expansion to the subject or an alternate one entirely.</p><p></p><p>A enormous piece of the way toward composing an article author account is to survey the composing abilities of the essayist. So as to decide this, the article author needs to comprehend the style, tone, and topic of the book. The essayist ought to likewise have the option to decide whether the theme is applicable to his/her individual region of expertise.</p><p></p><p>There are two different ways that the author can decide to use so as to get his/her college degree. One is a conventional online school, and the other is a virtual school that require less time on the PC and in classes. This is the reason such a large number of online professional educations are self-managed and don't expect understudies to go to formal study hall classes.</p> ;<p></p><p>When settling on which school to learn at it is critical to consider which has the projects that intrigue to you. You might need to consider the huge number of colleges offering on the web courses for you to take your online advanced education. In any case, this choice procedure ought to be one that you will be engaged with to be certain that you get what you want.</p>

All About Essay Topics about Books

<h1> All About Essay Topics about Books </h1> <p>Books are drawn by all time of individuals who are intrigued and sharp in accepting data or information by understanding books. It is essential for understudies to appreciate the value of books. Yearly driving tests should be compulsory over a particular age. A territory which most portrays the book. </p> <p>Year round school is anything but a smart thought. Getting in a situation to sum up a book in not a straightforward thing particularly in case you're not perusing it mindfully. Our life is about words. Our commonsense life is likewise, just as books, subject to understanding. </p> <h2> Rumors, Deception and Essay Topics about Books</h2> <p>You're ready to utilize books in precisely the same sort or by precisely the same writer to analyze. Regular books are offered in libraries and book shops, most of the time you can even peruse there since they are very peaceful. A solitary boo k by a solitary writer may have a major effect in the whole world. </p> <h2>Ruthless Essay Topics about Books Strategies Exploited </h2> <p>You may intrigue books, motion pictures or articles which are examining the very same point you're probably going to approach in your exposition. Evaluate another subject and do precisely the same 5-minute composing test till you find a point you realize you can promptly compose on. Since you may see, the themes are part between various classifications so it would be less difficult that you select one. In the event that you might want to be certain you are in control of a particular theme for your article, you can glance through the general bearings of our subjects and chase to learn more on the web. </p> <p>Convince a peruser a self improvement guide is generally excellent for their issues. Looking through the extraordinary book is reliant upon the particular prerequisite and mental circumstance of a peruser while looking. Books and encounters are the absolute best habits of learning because of their immense importance and amazing advantages. </p> <p>There are heaps of viewpoints about a game which can be contended in an article. For example, on the off chance that you chose to go with sports, pick two differentiating themes which are in precisely the same class like soccer versus ball. The job of doling out an exposition to center school understudies is to make mindfulness and grant them to create composing aptitudes. On-line help from master journalists will help spare you an a lot of time. </p> <p>For model an individual may settle on a theme like, life in the shoes of a werewolf. With us, it doesn't make a difference what your explanation is, you probably won't have sufficient opportunity, information, aptitudes or some other explanation that may not allow you to create the paper. Expound on a difficult you have or might want to address. Try not to disregard to clarify why the issue is noteworthy to you!</p> <p>Our scholars are exceptionally screened and prepared to verify they work persistent ly to satisfy every one of your prerequisites. Understudies who exceed expectations recorded as a hard copy about such complex theme can have a chance to be enlisted into some of the perfect Art colleges to concoct their capacities and ability. However, books are the easily overlooked detail made by methods for a person yet contain valuable and priceless things looking like data or information that could be useful for all people with various age gathering, in the entire world. They can profoundly affect society and the world since they empower a person to change the world. </p> <p>You may likewise arrange a completely composed thoroughly analyze exposition and ease the amount of work you should do. Consider your exposition's proposal for a guarantee to your crowd about what sort of investigation you've made for the books and assist it with getting explicit. It's conceivable to rehash your proposal articulation and point out some of the contentions utilized over the entir e paper that backs it up. You can start with the type of subject you pick for your look into exposition. </p> <p>Look for the essential and auxiliary sources on the introduced subjects before you start your absolute first draft. There are loads of magnificent paper assortments promptly accessible on the web. So now you see how to choose the best thoroughly analyze points and the different sections you need to address when composing. </p> <h2> The Hidden Gem of Essay Topics about Books</h2> <p>Other people separate the article into explicit points that they use to help them compose. At the point when you're composing an enticing paper, you should verify that your subject is one which you're ready to convince your crowd with. Before you start, it's basic to pick points which you truly know well. An investigative exposition point that is drawing in and compelling is essential. </p> <p>You don't have to discover overly specialized with lawful factious articles, however make sure to get your work done on what the current laws about your preferred subject really state. There are a great deal of conceivable look into paper points, and various them are dubious to perform. It's essential to choose far from being obviously true pugnacious exposition themes since you need restricting focuses that you could counter to your own focuses. There are a few convincing article subjects to choose from to complete your secondary school or school task. </p> <p>Writing about sonnets requires a novel procedure. There are heaps of books imprinted on reused paper as well, yet their general rate is little. Obviously, it should be referenced that inside the homeroom, dependence towards books shouldn't be total. A minumum of one parent should work at home. </p>

Legal Research Paper Topics - A Guide

Legal Research Paper Topics - A GuideWith a little bit of creativity and motivation, you can create an exciting topic for your legal research paper. Legal research papers are very popular in the legal fraternity and you can get plenty of attention from the judges and your peers if you have the right idea. There are very many things to consider while writing a good topic for your legal research paper. Here are some useful tips for you to follow:First of all, it is essential that your topic of your legal research paper is related to your topic of the article. You need to keep it brief but not so short that it has no substance. Make sure that you come up with an interesting topic for it and one that is directly related to your article or thesis statement. It will also help in making the topic interesting.Secondly, you should not forget to think about the format of your legal research paper topics. You should be able to write it down clearly and concisely. In order to achieve this, you c an consider reading on the topic you are going to write down or discuss it with your colleagues.The third and most important thing to do is to make your topic interesting to read. This will go a long way in attracting attention from the judges and hence you will be able to produce an interesting piece of work.Fourth, once you have got the topic and the format sorted out, you should work on the flow of the topic. You can add further information as well as details. But, keep your topic as concise as possible.Fifth, once you have the topic and the format sorted out, you can start thinking about the best way to proceed with the topic. You should remember that the judges will not like the topics that are too long and therefore you can add additional details in a few sentences.Sixth, you should consider using the services of different law firms for writing your topics. You can check out their sample legal research paper topics and pick a topic that is common to them.All in all, the task o f researching legal research paper topics can be both fun and exciting. All you need to do is put your mind to it and work hard.

PANCE/PANRE HEENT Review

HEENT Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Start Congratulations - you have completed HEENT. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%% %%FORM%% Have Your Exam Results Emailed to You Enter your name and email address below to have your results as well as the test questions, your answers and the correct answers delivered to your inbox. Name First Last Email mTouch Quiz Populated FieldsmTouch Quiz will automatically populate the fields below. Feel Free to add additional fields for the Quiz Taker to complete using the "Add Fields" options to the right.Quiz NameThe name of the quizResults SummaryScoreThe number of correct answers. This has the same value as the %%SCORE%% Variable on the Final Screen.Total QuestionsThe total number of questions. This has the same value as the %%TOTAL%% Variable on the Final Screen.PercentageCorrect answer percentage. This has the same value as the %%PERCENTAGE%% Variable on the Final Screen.Wrong AnswersNumber of wrong answers. This has the same value as the %%WRONG_ANSWERS%% Variable on the Final Screen.Time Allowed (Seconds)Time allowed (Requires timer add on). This has the same value as the %%TIME_ALLOWED%% Variable on the Final Screen.Time Used (Seconds)Time used (Requires timer add on). This has the same value as the %%TIME_USED%% Variable on the Final Screen. This iframe contains the logic required to handle Ajax powered Gravity Forms. jQuery(document).ready(function($){gformInitSpinner( 7, 'https://www.thepalife.com/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery('#gform_ajax_frame_7').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_7');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_7').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_7').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_7').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_7').removeClass('gform_validation_error');}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery('#gform_wrapper_7').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_7').val();gformInitSpinner( 7, 'https://www.thepalife.com/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery(document).trigger('gform_page_loaded', [7, current_page]);window['gf_submitting_7'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_7').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_7').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [7]);window['gf_submitting_7'] = false;}, 50);}else{jQuery('#gform_7').append(contents);if(window['gformRedirect']) {gform Redirect();}}jQuery(document).trigger('gform_post_render', [7, current_page]);} );} ); jQuery(document).bind('gform_post_render', function(event, formId, currentPage){if(formId == 7) {} } );jQuery(document).bind('gform_post_conditional_logic', function(event, formId, fields, isInit){} ); jQuery(document).ready(function(){jQuery(document).trigger('gform_post_render', [7, 1]) } ); Your answers are highlighted below. Question 1A 26-year-old female presents with a whitish coating on her tongue and lips. When you attempt to rub the plaque with a tongue depressor, a small amount of bleeding is noted from the oral mucosa. Her past medical history includes asthma. What diagnostic test would you perform to confirm your diagnosis?AA culture and sensitivityHint: A culture and sensitivity is used for suspected bacterial infectionsBA wet mount potassium hydroxide preparationCA gram stainHint: A gram stain is used to identify whether a bacterial pathogen is gram positive or gram negative.DA rapid strep testQuestion 1 Explanation: The history and physical are consistent with oral thrush. A wet mount potassium hydroxide preparation will reveal fungal spores and nonseptated mycelia.Question 2A 63-year-old male presents with an asymptomatic lesion in his mouth that was discovered by his dentist at a check-up. It is ill marginated with pigment ranging from medium brown to black. Parts of the lesion are raised. W hat is the next appropriate step in management?AHave the patient return in 30 days to see if the lesion resolves on its own. Hint: Given the patient's age and suspicious nature of this lesion, waiting would be ill-advised. BKOH prep of the lesionCBiopsyDCall your supervising physicianHint: This is always a good choice if you are not sure what should be done in this instance. But on the boards, there is no such luck!Question 2 Explanation: Oropharyngeal melanoma is characterized by varying pigment occurring in an irregularly shaped lesion. Although this is a rarely occur in melanoma, a biopsy should be done and any pigmented oral lesion should be excised. Areas which are raised within the lesion usually indicate sites of invasion.Question 3A 60-year-old male presents with complaints of irritation and a white plaque on his tongue. He denies pain. During physical exam you are unable to remove the white plaque from the mucosa with a tongue depressor. What is the most likely diagnosis, r epresented as follows?AGlossitisHint: Glossitis is a generalized inflammation, and loss of papillae of the tongue is caused by vitamin deficiencies, medication reactions, auto immune reactions, or psoriasisBGeographic tongueHint: Geographic tongue is an asymptomatic serpiginous area of atrophy and erythema of the anterior tongue. The condition is self-limiting.CLichen PlanusHint: Lichen planus can mimic candidiasis, squamous cell carcinoma, or hyperkeratosis, and requires a biopsy to diagnose. DOral leukoplakiaQuestion 3 Explanation: Oral leukoplakia cannot be removed from the mucosa using a tongue depressor like oral thrush can. It is considered a premalignant lesion and the chance of transformation into oral squamous cell carcinoma is 0-20%. The vast majority will not turn malignant. The condition is more common in smokers and people should be advised to stop smoking and limit alcohol consumption to reduce their risk. Management usually involves regular review of the lesion to det ect any possible malignant change early, and thereby significantly improve the prognosis, which normally is relatively poor for OSCC. Question 4A 45-year-old male presents with purulent discharge from his right ear for three weeks. He states that despite being treated by his family doctor for an ear infection one month ago, the problem continues to get worse. Upon exam, you note purulent discharge in the ear canal, an erythemic tympanic membrane, and a possible perforation. What are the pathogens most likely to culture positive?AStrep pneumoniaeHint: Strep pneumoniae is often seen in acute otitis media. BPseudomonasCE.coliHint: E.coli is a urinary tract pathogen.DCandida albicansHint: Candida albicans is a cause of vaginitisEmycoplasmaHint: mycoplasma is a respiratory pathogen.Question 4 Explanation: The clinical vignette describes a chronic otitis media. Usually, this refers to a complication of acute otits media with perforation. Pathogens that culture from these infections are u sually pseudomonas, proteus, or staphylococcus aureus. Question 5A 38-year-old woman comes to your office with a 1-year history of episodic dizziness, ringing in both ears, a feeling of aural fullness, and hearing loss. The symptoms come on every 1 or 2 weeks and usually last for 12 hours. Nausea and vomiting are present. When asked to describe the dizziness, the patient says, â€Å"The world is spinning around me.† On physical examination, the patient has horizontal nystagmus. The slow phase of the nystagmus is to the left, and the rapid phase is to the right. Audiograms reveal bilateral sensorineural hearing loss in the low frequencies. What is the most likely diagnosis in this patient?Avestibular neuronitisBacute labyrinthitisCpositional paroxysmal vertigoDorthostatic hypotensionEMeniere diseaseQuestion 5 Explanation: This patient has Meniere disease. The classic features of Meniere disease are recurrent episodes of vertigo, fluctuating low-frequency sensorineural hearing loss, tinnitus (ringing or buzzing in the ears), and aural fullness in the affected ear. The vertigo typically lasts hours, not minutes or days. The fluctuating hearing may not be related temporally to the vertigo. For the diagnosis of Meniere disease, the characteristic pattern of vertigo lasting a matter of hours as well as sensorineural hearing loss must be present. One additional factor (aural fullness or buzzing tinnitus) should also be present.Question 6Your patient is a 64-year-old male was found to have an opacity on his lens and decreased visual acuity. Which of the following is the most likely diagnosis?AGlaucomaHint: Glaucoma is characterized by elevated intraocular pressures. BCataractCAstigmatismHint: Astigmatism is a defect in the cornea.DHyphemaHint: Hyphema is an accumulation of blood in the anterior chamber. Question 6 Explanation: A cataract is a defect in the lens. Cataracts are the leading cause of blindness in the world. The only treatment is surgical correction . Question 7Your patient is a 23-year-old female who is a contact lens wearer. She presents with an injected right conjunctiva. She has no foreign body sensation or photophobia. There is no uptake of the stain and slit lamp exam is otherwise normal. Which eye drops are the most ideal for this patient.ASulfacetamideHint: Sulfacetamide doesn't cover pseudomonas.BGentamicinCZithromaxHint: Zithromax doesn't cover pseudomonas.DCiloxanQuestion 7 Explanation: Contact lens wearers are prone to getting bacterial infections especially pseudomonas of the eye.    Ciloxan has the best pseudomonas coverage.Question 8Your patient is a 34-year-old male that has had maxillary sinus pressure and purulent drainage for 3 weeks. The patient has had a history of anaphylaxis with penicillin. Which of the following is the most appropriate antibiotic choice?AAugmentinHint: Both Augmentin and Amoxicillin are both penicillins.BCephalexinHint: Cephalexin is a cephalosporin that can have a 10 percent cross-re activity with penicillin-allergic patients. Given this patient's history of anaphylaxis it would be best to avoid this.CAmoxicillinHint: Both Augmentin and Amoxicillin are both penicillins.DBactrimQuestion 8 Explanation: The major organisms associated with bacterial acute sinusitis is streptococcus pneumonia, H. influenzae, and M. Catarrhalis. With the patients history of anaphylaxis with penicillin, the best choice is D bactrimQuestion 9Your patient is a 64-year-old female that presents with gradual onset of peripheral bilateral vision loss over the last year.    Which of the following is the most likely diagnosis is the most likely diagnose?AStrabisumusHint: Strabismus is a misalignment of the eyes. BOptic NeuritisHint: Optic Neuritis and macular degeneration both cause central vision loss. CMacular DegenerationHint: Optic Neuritis and macular degeneration both cause central vision loss. DOpen Angle GlaucomaQuestion 9 Explanation: Open angle glaucoma is an optic neuropathy that has a progressive peripheral visual field loss and is eventually followed by central visual loss.Question 10Your patient is a 54 year old male that presents with a runny nose and cough.    The patent is also complaining of vertigo, tinnitus, and right sided hearing loss.    Which of the following is the most likely diagnosis?ALabyrinthitisBAcute Vestibular NeruritisHint: There is no hearing loss associated with acute vestibular neuritis.CCerumen impactionHint: Cerumen impaction will not cause tinnitus typically and usually does not have a viral syndrome associated with it. DBenign Postural Positional VertigoHint: BPPC has recurrent episodes of vertigo associated with predictable head movements. Question 10 Explanation: Both vestibular neuritis and labyrinthitis have vertigo with usually a viral syndrome proceeding it.    The key characteristic is there is no hearing loss associated with acute vestibular neuritis.Question 11Which of the following have not been identified as a r isk factor for barotrauma to the tympanic membrane?ADivingBFlyingCAllergic RhinitisDBlast InjuriesQuestion 11 Explanation: Diving, flying, and blast injuries are identified as circumstances predisposing patients to barotrauma.    Barotrauma is caused by pressure difference between the outside world and the inside of the middle ear.    Allergic rhinitis can cause eustachian tube dysfunction but usually does not cause barotrauma.    There usually is significant pressure difference between the middle ear and the outside world when the patient is exposed to pressure differences of diving, flying or blast injuries.Question 12Which of the following areas is the most common site for epistaxis to occur?AArterioles off the external carotid arteryBArterioles off the internal carotid arteryHint: The tributaries of the internal carotid artery do supply blood to the posterior nasopharynx and can be the source of some arterial bleeds.CStensen's PlexusHint: Stensen's Plexus does not exist in the nasal cavity, it is a duct that drains the parotid glands into the oral cavity. DKiesselbach's PlexusQuestion 12 Explanation: Ninety percent of nose bleeds arising from Kiesselbach's Plexus.       Question 13All of the following are causes of otitis externa except?ATraumaHint: Trauma, infection, and allergic contact dermatitis can cause otitis externa.BInfectionHint: Trauma, infection, and allergic contact dermatitis can cause otitis externa.CAllergic contact dermatitisHint: Trauma, infection, and allergic contact dermatitis can cause otitis externa.DCerumen impactionQuestion 13 Explanation: Cerumen impaction in and of itself is not an etiologic factor of otitis externa. Aggressive cleaning abrading the external auditory canal can. Question 14Which of the following is the most common organism causing mastoiditis?AH. InfluenzaeBS. AureusCS. PneumoniaeDGroup B Hemolytic StrepQuestion 14 Explanation: Streptococcus pneumoniae is the most common organism that causes mastoiditis.   Mastoiditis is the most common suppurative complication of otitis media. Pseudomonas is another consideration especially on recurrent infections with a ruptured tympanic membrane.Question 15Your patient is a 23 year old female that presents with swelling and erythema to the upper eyelid on her right eye.    Her extra ocular movements are intact.    There is no pain with extra ocular movements.    She also has a history of Rosacea.   Which of the following is the most likely diagnosis?AHordeolumHint: Hordeolum (stye) is a painful red lump on the eyelid when the gland on the edge of the eyelid gets inflamed.BBelpharitisCChalazionHint: Chalazion is an inflammatory lesion that develops with meibomian glands becomes obstructed.    D DacrocystitisHint: Dacrocystitis is caused by the nasolacriminal gland being blocked.   Question 15 Explanation: Blepharitis is characterized by swelling of the eyelid.    Blepharitis is best treated with warm compresses and topical antibiotics such as bacitracin, erythromycin, or azithromycin.Question 16Your patient is a 19 year old female that presents with generalized headaches and blurry vision out of both eyes for several months.   Physical exam reveals swelling around both optic discs, and is otherwise normal.   All of the following are potential etiologies of this likely disorder except:ABrain TumorHint: Papilledema can be caused by brain tumors, increased CSF production, decreased CSF reabsorption and obstructive hydrocephalus.BBenign Intracranial HypertensionHint: Papilledema can be caused by brain tumors, increased CSF production, decreased CSF reabsorption and obstructive hydrocephalus.CObstructive hydrocephalusHint: Papilledema can be caused by brain tumors, incr eased CSF production, decreased CSF reabsorption and obstructive hydrocephalus.DParkinsons DiseaseQuestion 16 Explanation: Parkinson's is characterized by a decreased production of Dopamine from the Substantia Nigra of the brain.    Parkinson's does not lead to increased intracranial pressure.Question 17Your patient is a 54 year-old male that presents with headaches, decreased hearing out of the right ear, right side facial paresthesias.    The MRI of brain reveals a 2 x 3 cm right sided acoustic neuroma. Which of the following is not true regarding acoustic neuromas?AChemotherapy is the cornerstone of therapyBBilateral acoustic neuromas should increase a suspicion for neurofibromatosis CLarger tumors may cause ataxiaDYou can have decreased taste or taste disturbances with these Question 17 Explanation: Treatment management options for acoustic neuroma include surgery, radiation, and observation. Larger tumors can cause compression of adjacent structures which lead to facial and trigeminal nerve pain, and paresthesias. Because these nerves innervate the tongue they can affect taste.Question 18Your patient is a 45 year old male that presents with episodic vertigo, hearing loss, and tinnitus over the last year.    His Brain MRI was unremarkable.    He has had no preceding viral syndrome.    Which of the following is the most likely diagnosis?ABenign Postural Peripheral Vertigo Hint: Vestibular neuritis does not have any ear symptoms nor does Benign Postural Peripheral Vertigo.BVestibular NeuritisHint: Vestibular neuritis does not have any ear symptoms nor does Benign Postural Peripheral Vertigo.CLabyrinthitisHint: Labyrinthitis has similar symptoms but do not last as long and has a preceding viral infection.DMeniere's DiseaseQuestion 18 Explanation: Meniere's disease is characterized by episodic vertigo, hearing loss and tinnitus.Question 19A 54 year old male presents with fever, trismus, dysphagia, and a sore throat.    Which of the following is the most likely diagnosis?AParotitisHint: Parotitis usually does not cause feverBSialadenitisHint: GERD, and Silaadenitis do not have a feverCPeritonsillar abscessDGERDHint: GERD, and Silaadenitis do not have a feverQuestion 19 Explanation: Peritonsillar abscess present with trismus, fever, sore throat and hot potato voice. Peritonsillar abscess are typicaly caused by Group A Strep. They can compromise the upper airway. Empiric treatment is with Unasyn or Clindamycin. Ultimate treatment is incision and drainage. Question 20Which of the following is the most common cause for hearing loss? AAcoustic NeuromaBPresbycusisHint: Presbycusis is age-related hearing loss.CCerumen impactionDVestibular NeuritisHint: Vestibular Neuritis does not have hearing loss.Question 20 Explanation: Cerumen impaction by far is the most common cause of hearing lossQuestion 21Your patient is a 63 year old female that has a history of HTN and CAD.    She has had a 3 month history of recurrent episodes of vertigo.    These episodes tend to occur when she lays back in bed with her head not propped up.    Her ENT exam is unremarkable.    She has had an MRI of her brain that was negative as well as carotid dopplers.    Which of the following is the most likely diagnosis?AMeniere's Disease Hint: Meniere's disease usually has hearing loss and tinnitis with vertigoBBenign Paroxysmal Positional Vertigo CVestibular Neuritis DCerebellar InfarctHint: Cerebellar infarct is ruled out because of the negative MRI.Question 2 1 Explanation: Benign Paroxysmal Positional Vertigo tends to have brief recurrent episodes of vertigo with predictable head movements or positions. There is no auditory symptoms. BPPV usually has a positive Hallpike Maneuver. Question 22Your patient is a 72 year-old female that presents with recurrent nose bleeds of right nostril and has right sided cervical lymphadenopathy.    She is not on any anticoagulants.    Her labs including INR, CBC and PTT are normal.    Which of the following is the most likely diagnosis?ABlood dyscrasiaHint: The patients labs are normal so blood dyscrasias and thrombocytopenia is not likely.BThrombocytopeniaHint: The patients labs are normal so blood dyscrasias and thrombocytopenia is not likely.CAV malformationDMalignancyQuestion 22 Explanation: While AV malformation is a plausible explanation, the fact there is some right sided lymphadenopathy with recurrent nosebleeds should raise the suspicion for malignancy.Question 23Which of the following di sorders is characterized by a "thumb sign" on a soft tissue neck x-ray? ALaryngitisHint: Laryngitis and foreign bodies do not have any characteristic signs on soft tissue neck x-rays.BCroupHint: Croup has a steeple sign. CEpiglottitisDForeign BodyHint: Laryngitis and foreign bodies do not have any characteristic signs on soft tissue neck x-rays.Question 23 Explanation: Epiglottitis is characterized by a thumb sign.Question 24Your patient is a 23 year old female that presents with white plaques on tongue. She has no history of chemotherapy, dentures, oral inhaled glucocorticoids, or radiation therapy. She is not a diabetic. Which of the following is the most likely etiology of her symptoms? AHIVBSmokeless tobaccoHint: Smokeless tobacco is a risk factor for leukoplakia.CAphthous ulcersHint: Aphthous ulcers produce ulcers not white plaques.DHSVHint: HSV presents as vesicles.Question 24 Explanation: Whenever there is unexplained thrush is a healthy individual, HIV should be considered a s an etiology. Question 25Your patient is a 32 year-old female that presents with a nodular rubbery lesion to her upper eyelid. It is not painful. It has been there for 6 days. Which of the following is the most likely diagnosisAChalazionBHordeolumHint: Hordeolum are styes that are painful. To differentiate a hordeolum from a chalazion think "H" for "HOT", tender and painful. CDacryocystitisHint: Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac. The term derives from the Greek dà ¡kryon (tear), cysta (sac), and -itis (inflammation). It causes pain, redness, and swelling over the inner aspect of the lower eyelid and epiphora.DForeign BodyQuestion 25 Explanation: A chalazion is an inflammatory lesion that developed when the meibomian tear gland becomes obstructed. They are usually not painful. Treatment is warm compresses or surgical correction.Question 26Your patient is a 21 year-old male that prese nts with redness to right eye, photophobia, and tearing. Your patient intraocular pressure is 18 (normal 12-22 mm Hg). Slit lamp exam and staining are normal. The patient is not a contact lens wearer. When the patient was anesthetized with alacaine he still has pain. Which of the following is the most likely diagnosis? AConjunctivitisHint: Conjunctivitis and corneal abrasion are not likelyBCorneal abrasionHint: Conjunctivitis and corneal abrasion are not likelyCIritisDGlaucomaHint: The patient has normal intraocular pressures so glaucoma is not likely.Question 26 Explanation: Iritis presents as a red eye, photophobia, and tearing. Iritis is often not improved when the eyes are anesthetized with alacaine. A common treatment is eye drops that ease the inflammation. If uveitis is a result of an infection, antibiotics or antiviral medication may be prescribed.Question 27Your patient is a 34 year-old male that presents with right eye pain, photophobia, and a scratch of the cornea with st aining. There was no hyphema. Which of the following is not part of the treatment of this condition? AGentamicin eye dropsHint: Gentamicin eye drops or any eyedrops help with preventing infection and lubricate the eye.BOral analgesicsHint: Wearing sunglasses and oral analgesics help with the pain associated with corneal abrasions. CSunglassesHint: Wearing sunglasses and oral analgesics help with the pain associated with corneal abrasions. DPatchingQuestion 27 Explanation: Eye patching is no longer recommended for corneal abrasions. A meta-analysis of five randomized controlled trials (RCTs) failed to reveal an increase in healing rate or improvement on a pain scale. Two subsequent RCTs (one in children, one in adults) reported similar results. In the past, patching was thought to reduce pain by reducing blinking and decreasing eyelid-induced trauma to the damaged cornea. However, the patch itself was the main cause of pain in 48 percent of patients. Children with patches had greater difficulty walking than those without patches. Furthermore, patching can result in decreased oxygen delivery, increased moisture, and a higher chance of infection. Thus, patching may actually retard the healing processQuestion 28Your patient is a 68 year-old female that presents with several months of progressively worsening central vision loss. Physical exam reveals Drusen Spots of the eye. Which of the following is the most likely diagnosis?AMacular DegenerationBOpen Angle GlaucomaHint: Open-angle glaucoma typically causes peripheral vision loss. COptic NeuritisHint: Optic neuritis is more of an acute onset.DCataractsHint: Cataracts do not have a Drusen Spots.Question 28 Explanation: Macular degeneration causes central vision loss and can have Drusen Spots. Question 29Your patient is a 34 year-old male who presents with erythema and swelling to the upper right medial nasolacrimal duct. He has no fever. His extraocular movements are intact. He has no ectropion. Which of the follo wing is the most likely diagnosis? APeriorbital cellulitisHint: Periorbital cellulitis is an infection of the anterior portion of the eyelid. BDacryocystitis COrbital CellulitisHint: Orbital cellulitis is an infection that involves the fat and muscles around the eyeDHordeolumQuestion 29 Explanation: Dacryocystitis is caused by the nasolacrimal duct being blocked. The most common organism is alpha hemolytic strep, staph epidermis, and staph aureus. Empiric therapy with clindamycin and doxycycline or Bactrim is helpful. This can lead to periorbital cellulitis.Question 30Your patient is a 3 year-old male that presents with a bulging right tympanic membrane and a fever of 103.0. He has just finished a course of amoxicillin 14 days ago. Which of the following is the most appropriate treatment?AHigh-dose amoxicillin Hint: This patient is at risk for beta-lactam resistance, therefore Keflex and amoxicillin should not be used.BAugmentinCKeflexHint: This patient is at risk for beta-lactam re sistance, therefore Keflex and amoxicillin should not be used.DCiproHint: The patient is only 3, and Cipro should be avoided in this age group.Question 30 Explanation: Augmentin is the correct answer as this patient is at risk for beta-lactam resistance.Question 31Which of the following is the most appropriate management for an auricular hematoma?AObservationHint: Observation, antibiotics, and icing, together or alone are not effective.BIncision and drainageCIce for 20 minutes 4 times per day.Hint: Observation, antibiotics, and icing, together or alone are not effective.DStart cephalexinHint: Observation, antibiotics, and icing, together or alone are not effective.Question 31 Explanation: Auricular hematomas should be drained as soon as possible. Delay in treatment can lead to a cauliflower ear that is permanent deformity of the fibrocartilage of the ear that is an overgrowth.Question 32Which of the following is not an etiology of tinnitus?AASAHint: ASA, vascular problems, congenita l AV malformations, hearing loss, Eustachian tube dysfunction, and ototoxic medications are etiologies for tinnitus.BCongenital AV MalformationsHint: ASA, vascular problems, congenital AV malformations, hearing loss, Eustachian tube dysfunction, and ototoxic medications are etiologies for tinnitus.CCerumen ImpactionDVascular PathologyHint: ASA, vascular problems, congenital AV malformations, hearing loss, Eustachian tube dysfunction, and ototoxic medications are etiologies for tinnitus.Question 32 Explanation: Cerumen impaction is not an etiology of tinnitus. Question 33Your patient is an 18 year-old female that presents with right side purulent otorrhea.    Visualized tympanic membrane on the right side reveals a small perforation.    Which of the following is the most appropriate treatment regimen?AFloxin Otic DropsBAmoxicillin and Floxin Otic DropsCZithromaxDAmoxicillinQuestion 33 Explanation: A perforated tympanic membrane caused by infection needs to be treated with oral an tibiotics as well as topical antibiotic ear drops.    When there is a perforation the ear canal is contaminated with the purulent drainageQuestion 34Which of the following bacteria is not a possible cause of bacterial tonsillitis?AGroup A Streptococcus Hint: See answer for explanationBNeisseria Gonorrhea Hint: See answer for explanationCMycoplasmaHint: See answer for explanationDProteusQuestion 34 Explanation: All of the following are possible causes of bacterial tonsillitis: Group A Streptococcus, Neisseria Gonorrhea, Mycoplasma, Chlamydia, Tularemia, and Group C and Group G Strep. Group C and Group G Strep do not cause rheumatic fever. Viral etiologies include CMV, HSV, Mononucleosis, and Influenza.Question 35Which of the following conditions are not associated with allergic rhinitis?AAtopic DermatitisBUrticariaCSinusitisDAsthmaQuestion 35 Explanation: Atopic Dermatitis, sinusitis, and asthma are common diseases seen with allergic rhinitis.    In additional allergic conjunctiv itis is commonly seen with allergic rhinitis.    Urticaria does not have an association with allergic rhinitis.Question 36Your patient is a 45 year old male that is not immunized.    He presents with a fever of 102, dysphagia, drooling, and shortness of breath.    Lungs are clear.    O2 Sat 100%.    Pulse 102.    RR-24.   Soft tissue neck reveals a thumb sign.   All of the following are acceptable management plans except:AGive a Racemic Epinephrine aerosol treatment and discharge the patient home on steroids BBegin Vancomycin and Ceftriaxone CIntubate the patient in the operation room DConsult anesthesia or ENT Question 36 Explanation: In the treatment of epiglottitis racemic epinephrine can help momentarily, but ultimately the patient needs to be intubated and admitted to the hospital. Airway protection is the mainstay of treatment. The patient usually needs to be intubated for 2-3 days prior to weaning attempts. The role of steroids is controversial. Vancomycin hel ps with anti-staph coverage and Ceftriaxone covers the most common organism haemophilus influenza type B. Anesthesia and/ or ENT should be consulted for airway management.Question 37Which of the following is not true about peritonsillar abscess?AGroup A Streptococcus is the most common organism BMRI of the soft tissue neck is the imaging study of choice for confirmation CAppropriate empiric antibiotic therapy includes clindamycin or Unasyn DVancomycin is an appropriate add-on antibiotic if there are airway issuesQuestion 37 Explanation: CT scan of soft tissue of the neck with IV contrast is the imaging study of choice.Group A Streptococcus is the most common organism.    There are also so cases of staph.    Appropriate empiric antibiotic therapy includes Clindamycin and Unasyn. Vancomycin is an appropriate add-on antibiotic when there are airway issues.Question 38All of the following are potential etiologies for parotitis except?AStensen's Duct obstructed with a stoneBRetrograde salivary stasis and seeding in Stensen's Duct CStaphylococcus aureus DStreptococcus VirdansQuestion 38 Explanation: Potential etiologies of parotitis include: anything that obstructs Stensen's Duct (Stone or Tumor), poor oral hygiene, dehydration, retrograde salivary stasis and seeding of Stensen's Duct with oral flora, viruses, or staphylococcus aureus.Question 39Your patient is 54 year old immunocompetent male that presents with right sided parotitis, trismus, and a fever of 101.6.    Which of the following antibiotic regimens are most appropriate?A Naficillin and Metronidazole BNaficillinCMetronidazoleDAzithromycinQuestion 39 Explanation: Empiric therapy for parotitis involves nafcillin and metronidazole. Vancomycin and cefepime or imipenem is recommend for immunocompromised patients. Azithromycin does not cover staph.Question 40Your patient is a 54 year old male that presents with erythema and redness to the right submandibular area.    There is no pain to palpation over th e floor of the mouth.    Physical exam of the mouth reveals pus covering from the salivary duct.    There is no dental pain or trismus.    Which of the following is not true regarding the patient's condition?AUsually resolves in 7-10 days with antibioticsHint: The usual organism when involved is staph. This is generally sensitive to dicloxacillin or Keflex. Usually resolves itself within 7-10 days with antibiotic treatment. BTypically responds to Keflex or dicloxacillinHint: The usual organism when involved is staph. This is generally sensitive to dicloxacillin or Keflex. Usually resolves itself within 7-10 days with antibiotic treatment. CIf the diagnosis is in question an ultrasound of the neck is the best imaging modalityDCan be caused by salivary duct stoneQuestion 40 Explanation: The imaging modality of choice for sialadenitis is a CT scan of soft tissue neck with IV contrast. Question 41Your patient is a 65 year old male that presents with Fordyce spots noted in his oral cavity.   What is the likely etiology of these?AMucoceleHint: A mucocele is a fluid-filled cavity with mucous glands lining the epithelium. BMelanomaHint: Melanomas are oral pigmented lesions that have irregular borders and symmetry. CAmalgam Tattoo Hint: Amalgam tattoos are black macules seen near the gingiva of dental fillings. DBenign Sebaceous Cyst Tumor Question 41 Explanation: Fordyce spots are associated with benign sebaceous cyst tumors. Question 42Which of the following is not true regarding entropion?AIt is a turning in of the edge of an eyelidBArtificial tears help with dryness Hint: Artificial tears help with dryness and surgical t reatment is needed to correct.CTrachoma infection can cause lower lid infectionHint: Trachoma infection can be a cause but is rarely seen in the US.DUsually affects the upper eyelid Question 42 Explanation: Entropion usually affects the lower eyelid. Question 43Your patient is a 46 year-old male that presents with a piece of metal on cornea with a rust ring that is approximately twelve hours old.  Which of the following is not an acceptable method to attempt removal?A25 gauge needle Hint: A 25 gauge needle is an acceptable method for removal.BCotton Swab Hint: A cotton swab is an acceptable methods for removal.CMagnetDOphthoburrHint: An ophthoburr is an acceptable method for removal.Question 43 Explanation: Magnets are not safe for removal metal foreign bodies from the eye.Question 44Your patient is 64 year old female that presents with sudden onset of right eye pain, redness, and photophobia with tearing.    Slit lamp exam reveals some conjunctival erythema and a shallow anteri or chamber.    There is no ciliary flair.    The intraocular pressure is 44 in the right eye.    All of the following are acceptable management options except?AReferral to Ophthalmology Hint: This patient should be referred to ophthalmology.BBegin Xaltan Drops Hint: Xalatan drops help lower the pressureCInstill Cycloplegic Drops DStart Norco as needed Hint: Analgesics PRN are appropriateQuestion 44 Explanation: This patient has acute closure glaucoma. Installation of a cycloplegic can increase the pressure and make the patient worse. A cycloplegic drop causes paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation and flexibility. Question 45Your patient is a 45 year old female that presents with a sudden onset of visual loss in the left eye.    Funduscopic exam reveals hyperemia and swelling and blurring of the optic disc.    There is no history of headache.    The patient's other eye is normal.    The patient describes a scotoma in the centra l vision of his affected eye.    Based upon this data, which of the following is the most likely diagnosis?APseudotumor cerebriHint: Pseudotumor cerebri usually affects both eyes and is accompanied with a headacheBOphthalmic migraine Hint: Ophthalmic migraine usually has headaches with it and will not have any optic disc changes on exam. CRetinal detachment Hint: Retinal detachment does not have these visual field changes and will not have these optic disc changes on physical exam.DOptic NeuritisQuestion 45 Explanation: Pseudotumor cerebri usually affects both eyes and is accompanied with a headache. Ophthalmic migraine usually has headaches with it and will not have any optic disc changes on exam. Retinal detachment does not have these visual field changes and will not have these optic disc changes on physical exam.Question 46Your patient is a 69 year old female that presents with a sudden onset of floaters in the right eye, flashes of light, and floaters resemble a cobweb.    There is no pain.    Which of the following is the most likely diagnosis?AOptic Neuritis Hint: Optic neuritis does not have this presentationBRetinal Detachment CPseudotumor cerebri Hint: Pseudotumor cerebri typically affects both eyes and will have a headache.DMacular Degeneration Hint: Macular degeneration is more of a slower onset and does not have these visual field changes typically.Question 46 Explanation: This is a common presentation of retinal detachment. Question 47A 23-year-old woman comes to your office with a 6-month history of dizziness. She â€Å"feels dizzy† when she stands up (as if she is going to faint). The sensation disappears within a minute. She has a history of major depression. She started taking doxepin 6 months ago, and her depression has improved much since that time. The patient’s blood pressure is 140/ 90 mm Hg sitting and decreases to 90/ 70 mm Hg when she stands. There is no ataxia, nystagmus, or other symptoms.   What is the most li kely diagnosis in this patient?Avestibular neuronitisBacute labyrinthitisCbenign positional paroxysmal vertigoDorthostatic hypotensionQuestion 47 Explanation: d.This patient has orthostatic hypotension. This case illustrates the importance of obtaining an accurate history in the patient who complains of â€Å"feeling dizzy.† In any patient who has this complaint, it is important to ask four specific questions: (1) Can you describe your dizziness? (2) How much of the dizziness is a sensation of the â€Å"world spinning around you,† and how much would be a sensation of â€Å"things going black in front of you and a feeling that you’re about to pass out†? (3) How long does the feeling of dizziness last— seconds, minutes, or hours? and (4) Are there any other symptoms present when you feel dizzy, such as deafness, ear fullness, or ringing in the ears? The answers to these questions are the most important clues to leading you toward a diagnosis. This pa tient does not have clear symptoms of vertigo, and one should focus on non– vertigo-related dizziness. Orthostatic hypotension is typically initiated after standing up suddenly. There is a transient lack of cerebral blood flow. The feeling described is that of a subjective dizziness, and the patient feels as if he or she might faint. It is not associated with any other neurologic sensations or ear symptoms. It is also characterized by a lack of symptoms when sitting or lying. Medications are the most likely culprits in this scenario, but occasionally there is no clear etiology for the autonomic disturbance. In this clinical case problem, the orthostatic hypotension is almost certainly associated with the beginning of the tricyclic antidepressant therapy 6 months ago.Question 48A 30-year-old man comes to your office for assessment of dizziness. The dizziness occurs when he rolls over from the lying position to either the left side or the right side. It also occurs when he is l ooking up. He describes a sensation of â€Å"the world spinning around† him. The episodes usually last 10 to 15 seconds. They have been occurring for the past 6 months and occur on average one or two times per day.Avestibular neuronitisBacute labyrinthitisCpositional paroxysmal vertigoDMeniere diseaseQuestion 48 Explanation: This patient has positional paroxysmal vertigo (PPV), a disorder that consists of brief episodes (lasting 2 to 10 seconds) usually caused by turning the head. PPV is caused by the formation of crystalline debris in the semicircular canals that leads to labyrinthine irritation, causing vertigo and nystagmus.Question 49A 39-year-old woman comes to your office with a 2-day history of â€Å"unrelenting dizziness.† The room feels like it is spinning, and there is associated nausea and vomiting. There has been no hearing loss, tinnitus, or sensation of aural fullness. The patient has just recovered from an upper respiratory tract infection. The patient i s afebrile. On examination, nystagmus is present. The slow phase of the nystagmus is toward the left, and the rapid phase of the nystagmus is toward the right. There is a significant ataxia present.Avestibular neuronitisBacute labyrinthitisHint: The features of acute labyrinthitis are similar to those of vestibular neuronitis, except it includes significant sensorineural hearing loss.Cpositional vertigoDorthostatic hypotensionQuestion 49 Explanation: This patient has a left vestibular neuronitis. The etiology of this disorder is commonly associated with a viral infection (such as adenovirus) that follows a respiratory tract infection and involves some portion of the vestibular system but with total sparing of the cochlear area. It most commonly affects young or middle-aged adults. The disorder consists of severe vertigo with associated ataxia and nausea and vomiting. There is no hearing loss, aural pain, or other symptoms, which is helpful in distinguishing it from other causes of v ertigo. Recovery usually takes 1 or 2 weeks. The treatment of choice for a patient with vestibular neuronitis is rest, reassurance, and antiemetics.Question 50A 37-year-old woman comes to your office for assessment of hearing loss. She has had problems intermittently for the past 12 months. On examination, the Weber tuning fork test lateralizes to the right ear, and the Rinne tuning fork test is negative in the right ear (bone conduction is greater than air conduction [BC AC]). This suggests which of the following? Aa right-sided conductive hearing lossBa left-sided conductive hearing lossCa right-sided sensorineural hearing lossDa left-sided sensorineural hearing lossQuestion 50 Explanation: The characterization of hearing loss can be localized by a combination of the Weber test and the Rinne test. In the Weber test, placement of a 512-Hz tuning fork on the skull in the midline or on the teeth stimulates both cochleae simultaneously. If the patient has a conductive hearing loss in one ear, the sound will be perceived loudest in the affected ear (i.e., it will lateralize). When a unilateral sensorineural hearing loss is present, the tone is heard in the unaffected ear. The Rinne test compares air conduction with bone conduction. Normally, AC is greater than BC. Sound stimulation by air in front of the pinna is normally perceived twice as long as sound placed on the mastoid process (AC > BC). With conductive hearing loss, the duration of AC is less than BC (i.e., negative Rinne test result). In the presence of sensorineural hearing loss, the durations of both AC and BC are reduced; however, the 2: 1 ratio remains the same (i.e., a positive Rinne test result). Facts for this question: (1) Bone conduction is greater than air conduction. This indicates that this is a conductive hearing loss. (2) In conductive hearing loss, the Weber test lateralizes to the affected ear, and because the Weber test lateralized to the right ear in this patient, she has a unilateral right-sided conductive hearing loss. Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results There are 50 questions to complete. List Return Shaded items are complete. 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950End Return You have completed questions question Your score is Correct Wrong Partial-Credit You have not finished your quiz. If you leave this page, your progress will be lost. Correct Answer You Selected Not Attempted Final Score on Quiz Attempted Questions Correct Attempted Questions Wrong Questions Not Attempted Total Questions on Quiz Question Details Results Date Score Hint Time allowed minutes seconds Time used Answer Choice(s) Selected Question Text All doneNeed more practice!Keep trying!Not bad!Good work!Perfect! Sign up now and get an additional 10% off a 1-year membership

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