NR 545 ACTUAL EXAM PAPER 2026 QUESTIONS WITH
ANSWERS GRADED A+
● Allergic conjunctivitis:. Answer: IgE mediated disease in response to triggers. Common
triggers can be seasonal such as grass, pollens, and mold. Persistent allergic triggers include
dust mites and animal dander. Bilateral, itchy red eyes with rope like discharge and clear
nasal discharge Bilateral injected conjunctiva, clear discharge Treatment based on
identification and limiting exposure to allergen. Medications include cromolyn ophthalmic
drops, oral antihistamines, antihistamine eye drops
● Viral conjunctivitis:. Answer: Most commonly caused by the adenovirus. Unilateral or
bilateral red eyes, reports of current or recent viral infection, such as a UTI Unilateral or
bilateral injected conjunctiva, watery discharge No antibacterial therapy needed. Virus
resolves in 2-3 weeks
● Bacterial conjunctivitis:. Answer: Common bacteria include: Staphylococci, streptococci,
chlamydial organisms and gonococci. Some bacterial causes can be quite serious.
Gonococcal conjunctivitis can result in blindness and can indicate underlying systemic
infection. Usually unilateral, red and irritated Eyelids are "stuck together" upon awakening.
Injected palpebral and bulbar conjunctiva, purulent drainage Treatment is provided to
decrease spread of contagion and shorten course of illness. Eye drop treatments include
Polymixin B plus trimethoprim or azithromycin.
● Otitis Externa. Answer: inflammation of the externa ear canal, is also known commonly as
swimmer's ear. Occurring in both children and adults, otitis externa can present as a range of
physical symptoms from a minor inflammation to reports of intense pain. Otitis Externa Risk
Factors Swimming Impacted cerumen Use of hearing aids/ear plugs Trauma from cotton tip
applicators or other items used to clean ear canal Foreign bodies Anatomic causes: narrow
ear canals, sharp angles in the ear canal or excessive hair in the canal The normally acidic pH
of the ear canal tends to inhibit microorganism growth. Swimming in a pool where the pH is
usually alkaline can result in altered pH of the ear canal. It is thought that it is this alteration in
pH creates a favorable environment for bacteria or fungal growth. The most common
causative agent is P. aeruginosa, other causes include Candida or Aspergillus species.
Common complaints (subjective findings): Children: irritability, crying, disrupted sleep.
Unilateral ear tugging, unilateral otalgia Adults: unilateral otalgia Physical exam (objective
findings): Ear pain is increased upon palpation of tragus. The external ear canal epithelium
edema may extend from the pinna all the way to the tympanic membrane. Purulent or serous
, discharge is noted in the canal. Medication management depends upon the causative factors:
Pain management: OTC analgesics include ibuprofen or acetaminophen as appropriate for
age and weight Bacterial Otitis externa can be treated with antimicrobial otic drops, which
include polymyxin B plus neomycin with or without hydrocortisone, ofloxacin, and ciprofloxacin
HC otic drops In cases of severe inflammation, insertion of an ear wick may be required to
ensure medication instillation to affected areas.
● Otitis Media (AOM). Answer: Middle ear inflammation which results from and obstruction
of the Eustachian tube. The Eustachian tube dysfunction results in negative pressure within
the middle ear, enabling pharyngeal pathogens to be aspirated into the middle ear. The
causes can be viral, bacterial or allergy mediated. Viral Most common cause of otitis which
often occurs in association with an upper respiratory tract infection. Most common organisms
include respiratory syntactical virus, human rhinovirus, andenovirus and influenza virus.
Bacterial Colonization is a most often the result of fluid stasis from a respiratory virus.
Streptococcus pneumoniae and H. fluenzae are the most common bacterial pathogens found
in middle ear fluid. Allergic Responses resulting in inflammation can lead to obstruction of the
Eustachian tube Common complaints (subjective findings): Otalgia, malaise, irritability, fever
and vomiting, unilateral hearing loss, recent or current URI. Can report itching or crackling
noises in the ear. Ear tugging or rubbing in infants and toddlers. Physical exam (objective
findings): The outer ear may appear red. The tympanic membrane is erythematous and
possibly bulging or retracted. Bony landmarks and light reflex absent. Tympanic membrane
may be ruptured resulting in otorrhea. Most cases of acute otitis media resolve spontaneously
and do not require treatment. Viral cases of AOM resolve in 7-10 days with supportive care
alone. Recommend PRN OTC analgesics and antipyretics. Pain management OTC
analgesics are offered for symptomatic relief Acetaminophen or Ibuprofen as appropriate for
age and weight. Topical otic analgesics such as Auralgan Otic Solutions Antibiotic therapy
should be avoided in mild to moderate cases. Antibiotics are prescribed for those with
symptoms persisting for more than 2- 3 days, children under two years with bilateral acute
otitis media or bulging tympanic membranes and four or more symptoms or any person with
otorrhea. First line treatment for those without penicillin allergy Adults: amoxicillin OR
Amoxicillin -clavulanate OR cephalosporins for PCN allergy Children: amoxicillin OR
Amoxicillin -clavulanate
● Rhinitis. Answer: an inflammation of the nasal mucosa that is usually accompanied by
edema and a profuse nasal discharge. Whether allergic or viral in nature, the rhinorrhea will
be watery, speech will sound nasal and there will be noted mouth breathing due to nasal
edema. Bacterial rhinitis is discussed within sinusitis, which is commonly referred to as
rhinosinusitis.
ANSWERS GRADED A+
● Allergic conjunctivitis:. Answer: IgE mediated disease in response to triggers. Common
triggers can be seasonal such as grass, pollens, and mold. Persistent allergic triggers include
dust mites and animal dander. Bilateral, itchy red eyes with rope like discharge and clear
nasal discharge Bilateral injected conjunctiva, clear discharge Treatment based on
identification and limiting exposure to allergen. Medications include cromolyn ophthalmic
drops, oral antihistamines, antihistamine eye drops
● Viral conjunctivitis:. Answer: Most commonly caused by the adenovirus. Unilateral or
bilateral red eyes, reports of current or recent viral infection, such as a UTI Unilateral or
bilateral injected conjunctiva, watery discharge No antibacterial therapy needed. Virus
resolves in 2-3 weeks
● Bacterial conjunctivitis:. Answer: Common bacteria include: Staphylococci, streptococci,
chlamydial organisms and gonococci. Some bacterial causes can be quite serious.
Gonococcal conjunctivitis can result in blindness and can indicate underlying systemic
infection. Usually unilateral, red and irritated Eyelids are "stuck together" upon awakening.
Injected palpebral and bulbar conjunctiva, purulent drainage Treatment is provided to
decrease spread of contagion and shorten course of illness. Eye drop treatments include
Polymixin B plus trimethoprim or azithromycin.
● Otitis Externa. Answer: inflammation of the externa ear canal, is also known commonly as
swimmer's ear. Occurring in both children and adults, otitis externa can present as a range of
physical symptoms from a minor inflammation to reports of intense pain. Otitis Externa Risk
Factors Swimming Impacted cerumen Use of hearing aids/ear plugs Trauma from cotton tip
applicators or other items used to clean ear canal Foreign bodies Anatomic causes: narrow
ear canals, sharp angles in the ear canal or excessive hair in the canal The normally acidic pH
of the ear canal tends to inhibit microorganism growth. Swimming in a pool where the pH is
usually alkaline can result in altered pH of the ear canal. It is thought that it is this alteration in
pH creates a favorable environment for bacteria or fungal growth. The most common
causative agent is P. aeruginosa, other causes include Candida or Aspergillus species.
Common complaints (subjective findings): Children: irritability, crying, disrupted sleep.
Unilateral ear tugging, unilateral otalgia Adults: unilateral otalgia Physical exam (objective
findings): Ear pain is increased upon palpation of tragus. The external ear canal epithelium
edema may extend from the pinna all the way to the tympanic membrane. Purulent or serous
, discharge is noted in the canal. Medication management depends upon the causative factors:
Pain management: OTC analgesics include ibuprofen or acetaminophen as appropriate for
age and weight Bacterial Otitis externa can be treated with antimicrobial otic drops, which
include polymyxin B plus neomycin with or without hydrocortisone, ofloxacin, and ciprofloxacin
HC otic drops In cases of severe inflammation, insertion of an ear wick may be required to
ensure medication instillation to affected areas.
● Otitis Media (AOM). Answer: Middle ear inflammation which results from and obstruction
of the Eustachian tube. The Eustachian tube dysfunction results in negative pressure within
the middle ear, enabling pharyngeal pathogens to be aspirated into the middle ear. The
causes can be viral, bacterial or allergy mediated. Viral Most common cause of otitis which
often occurs in association with an upper respiratory tract infection. Most common organisms
include respiratory syntactical virus, human rhinovirus, andenovirus and influenza virus.
Bacterial Colonization is a most often the result of fluid stasis from a respiratory virus.
Streptococcus pneumoniae and H. fluenzae are the most common bacterial pathogens found
in middle ear fluid. Allergic Responses resulting in inflammation can lead to obstruction of the
Eustachian tube Common complaints (subjective findings): Otalgia, malaise, irritability, fever
and vomiting, unilateral hearing loss, recent or current URI. Can report itching or crackling
noises in the ear. Ear tugging or rubbing in infants and toddlers. Physical exam (objective
findings): The outer ear may appear red. The tympanic membrane is erythematous and
possibly bulging or retracted. Bony landmarks and light reflex absent. Tympanic membrane
may be ruptured resulting in otorrhea. Most cases of acute otitis media resolve spontaneously
and do not require treatment. Viral cases of AOM resolve in 7-10 days with supportive care
alone. Recommend PRN OTC analgesics and antipyretics. Pain management OTC
analgesics are offered for symptomatic relief Acetaminophen or Ibuprofen as appropriate for
age and weight. Topical otic analgesics such as Auralgan Otic Solutions Antibiotic therapy
should be avoided in mild to moderate cases. Antibiotics are prescribed for those with
symptoms persisting for more than 2- 3 days, children under two years with bilateral acute
otitis media or bulging tympanic membranes and four or more symptoms or any person with
otorrhea. First line treatment for those without penicillin allergy Adults: amoxicillin OR
Amoxicillin -clavulanate OR cephalosporins for PCN allergy Children: amoxicillin OR
Amoxicillin -clavulanate
● Rhinitis. Answer: an inflammation of the nasal mucosa that is usually accompanied by
edema and a profuse nasal discharge. Whether allergic or viral in nature, the rhinorrhea will
be watery, speech will sound nasal and there will be noted mouth breathing due to nasal
edema. Bacterial rhinitis is discussed within sinusitis, which is commonly referred to as
rhinosinusitis.
