MSN 620 final Exam Questions Fully Solved Latest Update 2025 (Already Passed)
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? - Answers 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 appropriate next step in care? - Answers 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? - Answers 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? - Answers Rapid antigen detection test
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 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? -
Answers 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? - Answers 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? - Answers 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 antigen test was performed, which came back negative. Which of the following is the next best
step in management? - Answers Perform a throat culture
A 16-year-old boy presents with a 2-day history of sore throat, fever, and cough. He has been
experiencing difficulty swallowing food for the last 2 days. He has no significant medical history and is up
to date with his immunizations. His vital signs are temperature 100.6 °F (38.1 °C), heart rate 100 bpm,
and blood pressure 110/80 mm Hg. His physical examination reveals bilateral tonsillar exudates and
diffuse pharyngeal erythema. What is the next best step in management? - Answers 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? -
Answers 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 patient for his acute otitis media, which of the
following is an appropriate management strategy? - Answers Tympanostomy tube placement
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? - Answers 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? - Answers 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? - Answers
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. Thick, purulent discharge is noted
from both eyes on examination. Which of the following is the most appropriate treatment? - Answers
Hospital admission, intravenous administration of ceftriaxone, and saline solution irrigation
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 bulging and red. Which
of the following factors best indicates the need for an ophthalmologic referral? - Answers Decreased
visual acuity
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? -
Answers Referral to the emergency department for imaging and aspiration
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 nex - Answers 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
pre-exposure prophylaxis to prevent HIV. He is reluctant to answer questions about sexual activity.
What is the most likely pathogen causing his symptoms? - Answers 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
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? - Answers 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 appropriate next step in care? - Answers 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? - Answers 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? - Answers Rapid antigen detection test
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 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? -
Answers 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? - Answers 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? - Answers 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 antigen test was performed, which came back negative. Which of the following is the next best
step in management? - Answers Perform a throat culture
A 16-year-old boy presents with a 2-day history of sore throat, fever, and cough. He has been
experiencing difficulty swallowing food for the last 2 days. He has no significant medical history and is up
to date with his immunizations. His vital signs are temperature 100.6 °F (38.1 °C), heart rate 100 bpm,
and blood pressure 110/80 mm Hg. His physical examination reveals bilateral tonsillar exudates and
diffuse pharyngeal erythema. What is the next best step in management? - Answers 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? -
Answers 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 patient for his acute otitis media, which of the
following is an appropriate management strategy? - Answers Tympanostomy tube placement
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? - Answers 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? - Answers 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? - Answers
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. Thick, purulent discharge is noted
from both eyes on examination. Which of the following is the most appropriate treatment? - Answers
Hospital admission, intravenous administration of ceftriaxone, and saline solution irrigation
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 bulging and red. Which
of the following factors best indicates the need for an ophthalmologic referral? - Answers Decreased
visual acuity
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? -
Answers Referral to the emergency department for imaging and aspiration
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 nex - Answers 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
pre-exposure prophylaxis to prevent HIV. He is reluctant to answer questions about sexual activity.
What is the most likely pathogen causing his symptoms? - Answers 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
