MSN 620 FINAL EXAM || 140
QUESTIONS AND ANSWERS 2024/2025
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? - ANSWER- 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? - ANSWER- 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? - ANSWER- 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? - ANSWER-
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? -
ANSWER- 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? - ANSWER- 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? - ANSWER-
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? - ANSWER- 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? - ANSWER-
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? - ANSWER- 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? - ANSWER- Tympanostomy tube
placement
QUESTIONS AND ANSWERS 2024/2025
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? - ANSWER- 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? - ANSWER- 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? - ANSWER- 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? - ANSWER-
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? -
ANSWER- 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? - ANSWER- 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? - ANSWER-
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? - ANSWER- 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? - ANSWER-
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? - ANSWER- 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? - ANSWER- Tympanostomy tube
placement
