MSN 620 Stat pearls quiz study guide with complete solutions

MSN 620 Stat pearls quiz study guide with complete solutions A 17-year-old boy presents with a sore throat that started yesterday afternoon. He denies any congestion or cough but reports a temperature of 102° F (38.8° C) and generalized fatigue. He has pain with swallowing but can speak normally and manage his saliva. On physical examination, the clinician sees yellow-white plaques on his tonsils and anterior cervical lymphadenopathy that is tender to palpation. What is the most appropriate next step in care? - Correct Answer️️ -Point-of-care streptococcal antigen testing A 17-year-old boy presents to the hospital with a severe sore throat and fatigue that has been ongoing for 3 days. He has a high-grade fever for which he has been taking ibuprofen at home. The pain in his throat has been making it difficult for him to swallow, though he can take cold drinks with care, which helps with the pain. He does not feel throat congestion and does not have a cough. On physical examination, the clinician notes exudates and tender cervical lymphadenopathy. The clinician treats him empirically for strep throat with amoxicillin 500 mg twice daily for 10 days. The patient returns two 2 days later, reporting a full-body, blotchy, bumpy rash and no change in his symptoms. He stopped taking the antibiotics after the rash began. What is the most TITLE: EMILLYCHARLOTTE 2024/2025 ACADEMIC PERIOD OWNER: EMILLYCHARLOTTE COPYRIGHT STATEMENT: ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED FIRST PUBLISHED: SEPTEMBER 2024 2/50 appropriate next step in care? - Correct Answer️️ -Send a throat swab for culture and order a complete blood count and heterophile antibodies An 8-year-old girl presents with a 4-day history of fever and sore throat. A review of systems is negative for cough. Her past medical and family history is insignificant. She is allergic to penicillin. Vital signs are temperature 101 °F (38.3 °C), heart rate 88 bpm, and blood pressure 110/70 mm Hg. On physical examination, some exudates are seen on the posterior pharyngeal wall, and tender anterior cervical nodes are palpated. Findings on heart and lung examination are normal. Which of the following is the recommended treatment - Correct Answer️️ -Clindamycin A 17-year-old boy presents with a sore throat. Associated symptoms include fever and chills, difficulty in swallowing, referred ear pain, headache, and muscle aches. The vital signs are temperature 39 °C (102.2 °F), heart rate 105 bpm, and respiratory rate 22 breaths/min. The physical examination reveals a dry tongue, erythematous enlarged tonsils, pharyngeal exudate, and tender cervical lymphadenopathy. Which of the following is the diagnostic test of choice? - Correct Answer️️ -Rapid antigen detection test (RADT) A 17-year-old girl presents with a thick discharge from her eyes that started 5 days ago. Associated symptoms include redness and a feeling of dirt in her eyes. Her eyes are usually matted in the morning. Her medical history is significant for multiple similar episodes. She has been using contact lenses for the past 2 years. Her vital signs are TITLE: EMILLYCHARLOTTE 2024/2025 ACADEMIC PERIOD OWNER: EMILLYCHARLOTTE COPYRIGHT STATEMENT: ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED FIRST PUBLISHED: SEPTEMBER 2024 3/50 blood pressure 120/80 mm Hg, heart rate 88 bpm, respiratory rate 14 breaths/min, and temperature 37 °C (98.6 °F). An ocular examination reveals hyperemia and elevated yellow-white lesions at the lower cul-de-sac. What is the most appropriate next step in management? - Correct Answer️️ -Topical ciprofloxacin A 6-year-old girl is brought in with a 5-day history of sore throat and fever. Other children at school have had similar symptoms. She has not had any cough during this time. Her medical and family history is insignificant. Her vitals are currently within normal limits. On physical examination, her anterior cervical nodes are palpable and tender. There are no exudates seen on the posterior pharyngeal wall. What is the next best step in the management of this patient? - Correct Answer️️ -Rapid antigen testing A 46-year-old man presents with symptoms consistent with allergic rhinitis. He has a history of depression and is treated with a selective serotonin reuptake inhibitor. He works as a school bus driver. Which of the following should be used to treat his symptoms? - Correct Answer️️ -Fexofenadine A 5-year-old boy is brought for evaluation of a sore throat for the past 5 days. His parents report no cough during this period. His medical and family history is insignificant. Vitals show blood pressure 120/80 mm Hg, temperature of 100.4 °F (38 °C), and heart rate 78 bpm. On physical examination, anterior cervical nodes are palpable and tender. Exudates are seen on the posterior pharyngeal wall. A rapid TITLE: EMILLYCHARLOTTE 2024/2025 ACADEMIC PERIOD OWNER: EMILLYCHARLOTTE COPYRIGHT STATEMENT: ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED FIRST PUBLISHED: SEPTEMBER 2024 4/50 antigen test was performed, which came back negative. Which of the following is the next best step in management? - Correct Answer️️ -Perform a throat culture A 16-year-old male presents with a 2 day history of sore throat, fever, and cough. He has been experiencing difficulty swallowing food for the last two days. He has otherwise been in good health and is up to date with his immunizations. On examinations, he has a temperature of 100.6 F, pulse rate of 100 bpm, blood pressure of 110/80 mmHg. Oral exam reveals bilateral tonsillar exudates and diffuse pharyngeal erythema. Which of the following would be the next best step in the management of this patient? - Correct Answer️️ -Order a rapid strep test A 27-year-old man presents with fever, sore throat, and a generalized maculopapular erythematous rash. He reports having sexual relations with other men. His rapid antigen test for Group A beta hemolytic streptococcus is negative. What is the next best step in the management of this patient? - Correct Answer️️ -Obtain testing for human immunodeficiency virus (HIV), syphilis, chlamydia, and gonorrhea A 2-year-old boy presents with a fever of 102 °F (38.9 °C). His physical examination reveals bilateral otitis media with effusion with noted erythema on the right side. His parents state that this is his sixth diagnosis of otitis media in the past 12 months. His parents also note that he only has 2 words that are intelligible to them. Following the treatment of this p - Correct Answer️️ -Tympanostomy tube placement TITLE: EMILLYCHARLOTTE 2024/2025 ACADEMIC PERIOD OWNER: EMILLYCHARLOTTE COPYRIGHT STATEMENT: ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED FIRST PUBLISHED: SEPTEMBER 2024 5/50 Despite trying to manage a child diagnosed with otitis media with effusion conservatively, it is decided an intervention is necessary. Following consultation with an otolaryngologist, it is decided to proceed with the placement of bilateral ventilation tubes. Informed consent is obtained from the parents. Which of the following is the most likely complication of tympanostomy tube placement? - Correct Answer️️ -The development of otorrhea A 35-year-old man with nasal congestion continues to use an over-the-counter intranasal decongestant for four weeks. He complains that he is dependant on the intranasal decongestant spray and that he needs to use it more frequently to obtain relief. Which of the following is the best approach to the management of this patient? - Correct Answer️️ -Gradually discontinue the nasal decongestant and consider the use of short-course oral corticosteroids during this withdrawal period A 28-year-old male patient with a history of asthma presents complaining of eye discharge, morning matting, and redness. He denies eye itching, burning, or recent upper respiratory symptoms. On examination, there is a bilateral diffuse conjunctival injection, purulent discharge, and conjunctival papillae. What is the most likely etiological agent for this patient's presentation? - Correct Answer️️ -Staphylococcal aureus A 6-day-old girl presents with significant redness and copious discharge from her eyes. She was born via spontaneous vaginal delivery to a gravida three, para two mother. TITLE: EMILLYCHARLOTTE 2024/2025 ACADEMIC PERIOD OWNER: EMILLYCHARLOTTE COPYRIGHT STATEMENT: ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED FIRST PUBLISHED: SEPTEMBER 2024 6/50 Thick, purulent discharge is noted from both eyes on examination. Which of the following is the most appropriate treatment? - Correct Answer️️ -Hospital admission, intravenous administration of ceftriaxone, and saline solution irrigation A 17-year-old female presents to the office with a severe sore throat. The symptoms, which began four days ago, have become unilateral and much worse over the last day. She has had fevers of 101-103 F at home and was taking over-the-counter medications but now cannot tolerate swallowing even liquid ibuprofen. She has no trouble breathing, but reports that it is very difficult to open her mouth because of pain in her jaw and the clinician struggles to visualize her throat but notes unilateral tonsillar swelling. The clinician also notes tender cervical lymphadenopathy and some right-sided facial swelling but only minimal tenderness to palpation over the right jaw. What is the most appropriate next step in care? - Correct Answer️️ -Referral to the emergency department for imaging and aspiration A 10-year-old boy presents to the provider with complaints of left eye tearing. He states that when he woke up this morning, his left eye was crusted with his eyelids glued together. He adds that he has noticed some redness and mild discomfort over the previous 2 days. The patient also reports left ear pain and fullness. On further examination, his visual acuity is 20/25 on the right and 20/90 in the left eye. There is left-sided conjunctival erythema and clear discharge, but there does not appear to be any corneal involvement. On otoscopic examination, the left tympanic membrane is TITLE: EMILLYCHARLOTTE 2024/2025 ACADEMIC PERIOD OWNER: EMILLYCHARLOTTE COPYRIGHT STATEMENT: ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED FIRST PUBLISHED: SEPTEMBER 2024 7/50 bulging and red. Which of the following factors best indicates the need for an ophthalmologic referral? - Correct Answer️️ -Decreased visual acuity An 11-year-old girl presents with a 1-day history of sore throat, fatigue, and nausea but no congestion and no cough. Her temperature is 103 °F (39.4 °C), and the clinician palpates tender anterior cervical lymph nodes and observes exudates on her swollen tonsils, but a rapid strep test is negative. What is the most appropriate next step? - Correct Answer️️ -Obtain a throat sample for bacterial culture A 27-year-old man presents to the healthcare provider for regular follow-up but mentions that he has had a severe sore throat with fever, pain with swallowing, and painful lymph nodes on the front of his neck but no cough or congestion. He also asks for a refill of the emtricitabine-tenofovir pill he takes for preexposure prophylaxis to prevent HIV. He is reluctant to answer questions about sexual activity. What is the most likely pathogen causing his symptoms? - Correct Answer️️ -Group A Streptococcus A 38-year-old man complains of chronic nasal allergies. He has used over-the-counter antihistamines without much success. He believes he is allergic to ragweed but has had no testing. His past medical history is remarkable for hypertension, which is controlled by hydrochlorothiazide. He does not drink, smoke, or use illicit drugs. He works in a relatively new office but lives in a 60-year-old house with his family. They have carpets, drapes, and a cat. The exam shows pale and boggy nasal mucosa and cobblestoning of the posterior pharynx. Lungs are clear on auscultation. Skin prick testing shows cat TITLE: EMILLYCHARLOTTE 2024/2025 ACADEMIC PERIOD OWNER: EMILLYCHARLOTTE COPYRIGHT STATEMENT: ©2024 EMILLYCHARLOTTE. ALL RIGHTS RESERVED FIRST PUBLISHED: SEPTEMBER 2024 8/50 dander, dust mites, ragweed, and tree pollen allergies. Which of the following would be an appropriate step to take? - Correct Answer️️ -Intranasal corticosteroids A 65-year-old man presents with postauricular pain, facial weakness, and excessive tearing that started 24 hours ago. He denies a history of these symptoms before this episode. His history is significant for cold sores and asthma. He is not currently taking any medication and has no allergies. Physical examination demonstrates severe but incomplete paralysis of the left side of his face, with normal sensation on both sides of his face. There are no other symptoms or findings. What is the most appropriate next step in management? - Correct Answer️️ -Prescribe prednisone and acyclovir. An 88-year-old man presents with progressive dementia and increasing difficulty in remembering things. He can ambulate with a walker and can swallow without any difficulty. He is unable to express his needs from time to time resulting in decreased oral intake which is associated with progressive weakness. He currently lives by himself. Which of the following is the best option? - Correct Answer️️ -Assisted living facility with meal and medication administration services A 56-year-old woman presents with intermittent, severe, brief episodes of lancinating pain in the right cheek and lips for the past 4 mont