MSN 621 FINAL EXAM 3 2026 FULL SOLVED
QUESTIONS ANSWERS CLINICAL DECISION
MAKING REVIEW SHEET
◉ A 26-year-old male comes to the emergency department
complaining of fatigue, dyspnea, chest pain, and syncope, especially
when playing soccer. This has been going on for the past 2 weeks. He
has no significant past medical history. He denies smoking, caffeine
intake, tinnitus, vomiting, or coughing. He has been taking NSAIDs
regularly for the past year due to headaches that he attributes to
"being stressed out from my new job." On examination, BP: 120/81
mmHg, HR: 55 bpm, RR: 18/min, and O2: 99% on room air. Skin
examination: no rashes, abdominal examination: mild epigastric
tenderness but no organomegaly, chest examination: equal air entry
bilaterally with no abnormal sounds. ECG shows P waves and QRS
complexes that are independent of each other. Blood tests show
antibodies to the organism in the picture. Which of the following is
the most appropriate treatment for this patient's case? (see photo)
Answer: Hospitalization for close monitoring with telemetry and IV
ceftriaxone
◉ An adolescent presents to you with sore throat, fever,
lymphadenopathy, and splenomegaly. He also complains of headache
but has been previously well. Which should be done?
Answer: Treat symptomatically
,◉ A healthy 17-year-old male presents with three days of worsening
fatigue, rhinorrhea, nasal congestion, myalgias, and subjective fever.
He is severely allergic to eggs and therefore does not receive the
annual influenza vaccine. His blood pressure is 125/75 mmHg, pulse
100 beats per minute, temperature 100 F (37.7 C), and respiratory
rate 18 breaths per minute. Examination demonstrates
conjunctivitis, oropharyngeal erythema, and clear breath sounds.
Given the likely diagnosis, what is the most appropriate treatment?
Answer: Symptomatic treatment only
◉ A 33-year-old inmate is brought to the clinic for a routine annual
checkup. The patient says that he has been in good health and does
not have any medical problems. He, however, does complain of
disturbed sleep, constipation, and weight loss. A review of systems is
negative for cough, shortness of breath, burning urination,
abdominal discomfort, or weakness. Examination shows normal
vitals, a soft, nontender abdomen with no organomegaly, normal S1
and S2 with no added sounds, and normal bronchial breathing
bilaterally. A purified protein derivative test shows an induration of
11 mm. What is the next best step in the management of this
patient?
Answer: Chest x-ray
◉ A 16-year-old patient presents to the hospital with fever, fatigue,
lymphadenopathy, and sore throat. Exudative pharyngitis is noted
on the throat examination. However, rapid strep testing is negative.
,His blood pressure is 135/85 mmHg, the pulse rate is 92/min
regular, and his respiratory rate is 16/min. Past medical history is
positive for asthma, and his father had leukemia. Social history is
notable for being involved in multiple school sporting activities.
What is the most appropriate piece of advice for this patient?
Answer: Avoid contact sports for a minimum of 6 weeks
◉ A 38-year-old man presents with numbness and tingling in his
extremities for the past week. He says his hands have been feeling
unusual, and that this interferes with his sleep. He has no muscle
weakness or memory impairment. His past medical history includes
pulmonary tuberculosis, for which he takes isoniazid, rifampin,
pyrazinamide, and ethambutol. All his vital signs are within normal
limits. Examination reveals diminished breath sounds in the left
upper lobe. A chest x-ray shows a cavitating lesion in the left lung.
What is the most appropriate next step in the management of this
patient?
Answer: Add pyridoxine
◉ A female presents with progressive confusion over weeks with
memory loss. She has a slight fever at 100.4 F. Prior to cognitive
changes, she had been complaining of arthralgias. History is
otherwise unremarkable except for the fact she is an avid camper.
What is her most likely diagnosis?
Answer: Lyme disease
, ◉ A 34-year-old forest ranger, previously healthy, presents with
dizziness, syncope, and increasing fatigue for 2 weeks. Vital signs are
the temperature of 98°F (36.7°C), blood pressure of 110/80 mm Hg,
and a heart rate of 38 beats per minute with a regular pulse. No
murmur is noted. The neurological exam reveals a Bell palsy. An
electrocardiogram (EKG) shows a complete heart block. Which joint
is most likely painful?
Answer: Knee
◉ A 35-year-old woman presents with sneezing, rhinorrhea, nasal
congestion, fatigue, and myalgias. She developed these complaints
one day back and decided to seek immediate care. A review of
symptoms reveals mild itching in the eyes and a frontal headache.
She admits to smoking two packs of cigarettes daily; however, she
denies alcohol and illicit drug use. The patient's medical history is
significant for gastroesophageal reflux disease and irritable bowel
syndrome. The patient cannot recall her last vaccination and says
that she prefers "natural immunity." Her blood pressure is 130/75
mmHg, pulse is 105/min, temperature 100 F (37.7 C), and
respiratory rate is 19/min. Examination shows red eyes, erythema
over the pharynx, and dry mucous membranes. Which of the
following is the next best step in the management of this patient?
Answer: Oseltamivir
◉ A 17-year-old female presents with a severe sore throat. She has
been sick with a fever for four days. The patient's voice is muffled,
and she prefers not to speak secondary to pain. She has not been
QUESTIONS ANSWERS CLINICAL DECISION
MAKING REVIEW SHEET
◉ A 26-year-old male comes to the emergency department
complaining of fatigue, dyspnea, chest pain, and syncope, especially
when playing soccer. This has been going on for the past 2 weeks. He
has no significant past medical history. He denies smoking, caffeine
intake, tinnitus, vomiting, or coughing. He has been taking NSAIDs
regularly for the past year due to headaches that he attributes to
"being stressed out from my new job." On examination, BP: 120/81
mmHg, HR: 55 bpm, RR: 18/min, and O2: 99% on room air. Skin
examination: no rashes, abdominal examination: mild epigastric
tenderness but no organomegaly, chest examination: equal air entry
bilaterally with no abnormal sounds. ECG shows P waves and QRS
complexes that are independent of each other. Blood tests show
antibodies to the organism in the picture. Which of the following is
the most appropriate treatment for this patient's case? (see photo)
Answer: Hospitalization for close monitoring with telemetry and IV
ceftriaxone
◉ An adolescent presents to you with sore throat, fever,
lymphadenopathy, and splenomegaly. He also complains of headache
but has been previously well. Which should be done?
Answer: Treat symptomatically
,◉ A healthy 17-year-old male presents with three days of worsening
fatigue, rhinorrhea, nasal congestion, myalgias, and subjective fever.
He is severely allergic to eggs and therefore does not receive the
annual influenza vaccine. His blood pressure is 125/75 mmHg, pulse
100 beats per minute, temperature 100 F (37.7 C), and respiratory
rate 18 breaths per minute. Examination demonstrates
conjunctivitis, oropharyngeal erythema, and clear breath sounds.
Given the likely diagnosis, what is the most appropriate treatment?
Answer: Symptomatic treatment only
◉ A 33-year-old inmate is brought to the clinic for a routine annual
checkup. The patient says that he has been in good health and does
not have any medical problems. He, however, does complain of
disturbed sleep, constipation, and weight loss. A review of systems is
negative for cough, shortness of breath, burning urination,
abdominal discomfort, or weakness. Examination shows normal
vitals, a soft, nontender abdomen with no organomegaly, normal S1
and S2 with no added sounds, and normal bronchial breathing
bilaterally. A purified protein derivative test shows an induration of
11 mm. What is the next best step in the management of this
patient?
Answer: Chest x-ray
◉ A 16-year-old patient presents to the hospital with fever, fatigue,
lymphadenopathy, and sore throat. Exudative pharyngitis is noted
on the throat examination. However, rapid strep testing is negative.
,His blood pressure is 135/85 mmHg, the pulse rate is 92/min
regular, and his respiratory rate is 16/min. Past medical history is
positive for asthma, and his father had leukemia. Social history is
notable for being involved in multiple school sporting activities.
What is the most appropriate piece of advice for this patient?
Answer: Avoid contact sports for a minimum of 6 weeks
◉ A 38-year-old man presents with numbness and tingling in his
extremities for the past week. He says his hands have been feeling
unusual, and that this interferes with his sleep. He has no muscle
weakness or memory impairment. His past medical history includes
pulmonary tuberculosis, for which he takes isoniazid, rifampin,
pyrazinamide, and ethambutol. All his vital signs are within normal
limits. Examination reveals diminished breath sounds in the left
upper lobe. A chest x-ray shows a cavitating lesion in the left lung.
What is the most appropriate next step in the management of this
patient?
Answer: Add pyridoxine
◉ A female presents with progressive confusion over weeks with
memory loss. She has a slight fever at 100.4 F. Prior to cognitive
changes, she had been complaining of arthralgias. History is
otherwise unremarkable except for the fact she is an avid camper.
What is her most likely diagnosis?
Answer: Lyme disease
, ◉ A 34-year-old forest ranger, previously healthy, presents with
dizziness, syncope, and increasing fatigue for 2 weeks. Vital signs are
the temperature of 98°F (36.7°C), blood pressure of 110/80 mm Hg,
and a heart rate of 38 beats per minute with a regular pulse. No
murmur is noted. The neurological exam reveals a Bell palsy. An
electrocardiogram (EKG) shows a complete heart block. Which joint
is most likely painful?
Answer: Knee
◉ A 35-year-old woman presents with sneezing, rhinorrhea, nasal
congestion, fatigue, and myalgias. She developed these complaints
one day back and decided to seek immediate care. A review of
symptoms reveals mild itching in the eyes and a frontal headache.
She admits to smoking two packs of cigarettes daily; however, she
denies alcohol and illicit drug use. The patient's medical history is
significant for gastroesophageal reflux disease and irritable bowel
syndrome. The patient cannot recall her last vaccination and says
that she prefers "natural immunity." Her blood pressure is 130/75
mmHg, pulse is 105/min, temperature 100 F (37.7 C), and
respiratory rate is 19/min. Examination shows red eyes, erythema
over the pharynx, and dry mucous membranes. Which of the
following is the next best step in the management of this patient?
Answer: Oseltamivir
◉ A 17-year-old female presents with a severe sore throat. She has
been sick with a fever for four days. The patient's voice is muffled,
and she prefers not to speak secondary to pain. She has not been
