MSN 620 Final Exam with complete
solutions latest version
A .32-year-old .female .who .is .nine .weeks .pregnant .presents .with .nasal
.congestion .bilaterally. .She .has .been .using .an .over-the-counter .intranasal
.decongestant .for .a .prolonged .period, .but .her .symptoms .have .not .improved.
.Physical .examination .shows .a .midline .septum .and .4+ .turbinates. .The .nasal
.mucosa .is .hyperemic .and .erythematous .without .cobblestoning. .On .further
.inquiry, .she .denies .illicit .drug .use. .Which .of .the .following .medications .is .most
.appropriate .to .help .ease .her .symptoms .as .she .weans .off .the .topical
.decongestant?
1. .Intranasal .azelastine .
2. .Intranasal .fluticasone .
3. .Intranasal .ipratropium .
4. .Oral .prednisone .- .CORRECT .ANSWER-2. .Intranasal .fluticasone
A .17-year-old .boy .presents .to .the .office .with .a .sore .throat .that .started
.yesterday .afternoon. .He .denies .any .congestion .or .cough .but .reports .a
.temperature .of .102 .degrees .F .and .generalized .fatigue. .He .has .pain .with
.swallowing .but .can .speak .normally .and .manage .his .saliva. .On .exam, .the
.clinician .notes .yellow-white .plaques .on .his .tonsils .and .anterior .cervical
.lymphadenopathy .that .is .tender .to .palpation. .Besides .his .fever, .his .vital .signs
.are .all .within .normal .limits. .What .is .the .most .appropriate .next .step .in .care?
1. .Weight-based .dosing .of .ibuprofen .
2. .Weight-based .dosing .of .azithromycin .for .a .five-day .treatment .
3. .Point-of-care .streptococcal .antigen .testing .
4. .Bacterial .culture .of .the .throat .- .CORRECT .ANSWER-3. .Point-of-care
.streptococcal .antigen .testing
A .17-year-old .male .presents .with .purulent .discharge .from .his .right .ear .for .three
.days. .He .is .recovering .from .a .recent .upper .respiratory .illness, .with .no .fever
.over .the .past .three .days. .His .ear .was .painful .initially .but .is .not .currently. .The
.tympanic .membrane .appears .to .have .a .small .perforation .with .copious .purulent
.discharge. .The .external .auditory .canal .shows .very .faint .erythema. .There .is .no
.tragus .tenderness .and .no .nasopharyngeal .mass. .What .is .the .most .appropriate
.management .for .this .patient?
1. .Ear .wick .
2. .Culture .of .the .discharge .
,3. .Oral .antibiotics .
4. .Ototopical .corticosteroids .- .CORRECT .ANSWER-3. .Oral .antibiotics
A .17-year-old .male .patient .presents .with .a .complaint .of .watery .discharge .from
.his .eyes .for .the .past .three .days. .He .also .complains .of .itching .and .redness
.associated .with .it. .Upon .further .questioning, .he .reveals .a .history .of .upper
.respiratory .tract .infections. .His .vital .signs .show .blood .pressure .of .120/80
.mmHg, .heart .rate .of .80 .beats .per .minute, .respiratory .rate .of .14 .breaths .per
.minute, .and .temperature .of .98.6 .F .(37 .C). .Ocular .examination .findings .are
.shown .in .the .image. .A .polymerase .chain .reaction .(PCR) .performed .confirms
.the .diagnosis. .What .is .the .most .common .causative .organism?
1. .Adenovirus .
2. .Herpes .simplex .
3. .Herpes .zoster .
4. .Enterovirus .- .CORRECT .ANSWER-1. .Adenovirus
A .17-year-old .female .with .asthma .presents .with .a .three-hour .history .of .burning
.and .itching .in .both .eyes .and .mild .eyelid .swelling .that .started .after .she .went .on
.a .hike .with .her .friends. .She .is .afebrile, .and .ocular .examination .shows .bilateral
.watery .discharge .and .erythema .of .both .the .bulbar .and .tarsal .conjunctiva. .What
.is .the .most .appropriate .next .step .in .treatment?
1. .Warm .compresses .
2. .Antihistamine .eye .drops .
3. .Corticosteroid .eye .drops .
4. .Oral .antihistamines .- .CORRECT .ANSWER-2. .Antihistamine .eye .drops
A .17-year-old .male .presents .to .the .hospital .with .a .severe .sore .throat .and
.fatigue .that .has .been .ongoing .for .three .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 .ten .days. .The .patient .returns .two
.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?
1. .Send .a .throat .swab .for .culture .and .record .the .patient's .allergy .to .ampicillin.
.2. .Send .a .throat .swab .for .culture .and .orde .- .CORRECT .ANSWER-2. .Send .a
.throat .swab .for .culture .and .order .a .complete .blood .count .and .heterophile
.antibodies.
A .65-year-old .woman .presents .to .the .hospital .with .a .sore .throat .and .cough .that
.started .three .days .ago .and .has .not .resolved .despite .regular .use .of .a
.combination .of .cold .and .cough .medicines. .She .reports .feeling .mildly
.uncomfortable .but .not .having .a .fever .at .home. .She .takes .medication .for .high
.blood .pressure .and .high .cholesterol .but .reports .that .they .are .well .controlled.
.Her .vital .signs, .including .oxygen .saturation, .are .all .within .normal .limits. .On
, .examination, .her .primary .provider .notes .injected .conjunctiva, .nasal .congestion,
.a .red .pharynx .with .no .exudates, .and .shotty .cervical .lymphadenopathy .that .is
.not .tender. .She .is .fully .vaccinated .against .COVID-19, .and .her .PCR .is .negative
.for .COVID-19. .What .is .the .most .appropriate .next .step .in .care?
1. .Reassurance .and .prescription .for .symptom-directed .medications .
2. .Empiric .therapy .with .amoxicillin .twice .daily .for .10 .days .
3. .Multiplex .PCR .for .viral .pathogens .
4. .Bacterial .cultur .- .CORRECT .ANSWER-1. .Reassurance .and .prescription .for
.symptom-directed .medications
A .17-year-old .male .patient .presents .to .the .hospital .with .a .sore .throat. .His
.condition .is .associated .with .fever .and .chills, .difficulty .in .swallowing, .referred
.ear .pain, .headache, .and .muscle .aches. .The .vital .sign .shows .a .temperature .of
.39 .C .(102.2 .F), .pulse .rate .105/min, .and .respiratory .rate .of .22 .breaths/min. .The
.physical .exam .reveals .a .dry .tongue, .erythematous .enlarged .tonsils, .pharyngeal
.exudate, .and .tender .cervical .lymphadenopathy. .What .would .be .most .beneficial
.investigation .in .establishing .a .diagnosis .in .this .case?
1. .ASO .titer .
2. .CRP .
3. .Rapid .antigen .detection .test .(RADT) .
4. .Throat .culture .- .CORRECT .ANSWER-3. .Rapid .antigen .detection .test .(RADT)
A .17-year-old .female .patient .presents .with .a .complaint .of .thick .discharge .from
.her .eyes .that .started .five .days .ago. .She .also .complains .of .redness .and .a
.feeling .of .dirt .in .her .eyes. .On .further .questioning, .she .reveals .that .her .eyes .are
.usually .matted .in .the .morning. .A .detailed .medical .history .reveals .that .she .has
.had .multiple .similar .episodes .previously. .She .has .been .using .contact .lenses
.for .the .past .two .years. .Her .vital .signs .show .blood .pressure .120/80 .mmHg,
.heart .rate .88/min, .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 .the
.management .of .her .condition?
1. .Topical .neomycin .
2. .Topical .bacitracin .
3. .Topical .ciprofloxacin .
4. .Oral .azithromycin .- .CORRECT .ANSWER-3. .Topical .ciprofloxacin
A .9-year-old .male .is .brought .by .his .mother, .who .states .that .he .has .had .a .stuffy
.and .runny .nose .for .around .eight .months. .The .patient .admits .to .occasional
.sneezing .and .congestion .to .the .point .that .he .has .to .breathe .through .his
.mouth. .He .denies .fever, .wheezing, .or .ear .discomfort. .On .physical .examination,
.he .is .noted .to .have .mild .darkening .under .both .eyes, .a .small .crease .above .the
.tip .of .his .nose, .clear .rhinorrhea .bilaterally, .mild .turbinate .swelling .with .pale
.blue .mucosa, .and .some .cobblestoning .in .the .posterior .pharynx. .His .lungs .are
.clear .on .auscultation. .Which .of .the .following .physical .signs .of .his .condition .is
.commonly .found .in .children .but .not .adults?
1. .Darkening .around .the .eyes .
2. .Cobblestoning .of .the .posterior .pharynx .
solutions latest version
A .32-year-old .female .who .is .nine .weeks .pregnant .presents .with .nasal
.congestion .bilaterally. .She .has .been .using .an .over-the-counter .intranasal
.decongestant .for .a .prolonged .period, .but .her .symptoms .have .not .improved.
.Physical .examination .shows .a .midline .septum .and .4+ .turbinates. .The .nasal
.mucosa .is .hyperemic .and .erythematous .without .cobblestoning. .On .further
.inquiry, .she .denies .illicit .drug .use. .Which .of .the .following .medications .is .most
.appropriate .to .help .ease .her .symptoms .as .she .weans .off .the .topical
.decongestant?
1. .Intranasal .azelastine .
2. .Intranasal .fluticasone .
3. .Intranasal .ipratropium .
4. .Oral .prednisone .- .CORRECT .ANSWER-2. .Intranasal .fluticasone
A .17-year-old .boy .presents .to .the .office .with .a .sore .throat .that .started
.yesterday .afternoon. .He .denies .any .congestion .or .cough .but .reports .a
.temperature .of .102 .degrees .F .and .generalized .fatigue. .He .has .pain .with
.swallowing .but .can .speak .normally .and .manage .his .saliva. .On .exam, .the
.clinician .notes .yellow-white .plaques .on .his .tonsils .and .anterior .cervical
.lymphadenopathy .that .is .tender .to .palpation. .Besides .his .fever, .his .vital .signs
.are .all .within .normal .limits. .What .is .the .most .appropriate .next .step .in .care?
1. .Weight-based .dosing .of .ibuprofen .
2. .Weight-based .dosing .of .azithromycin .for .a .five-day .treatment .
3. .Point-of-care .streptococcal .antigen .testing .
4. .Bacterial .culture .of .the .throat .- .CORRECT .ANSWER-3. .Point-of-care
.streptococcal .antigen .testing
A .17-year-old .male .presents .with .purulent .discharge .from .his .right .ear .for .three
.days. .He .is .recovering .from .a .recent .upper .respiratory .illness, .with .no .fever
.over .the .past .three .days. .His .ear .was .painful .initially .but .is .not .currently. .The
.tympanic .membrane .appears .to .have .a .small .perforation .with .copious .purulent
.discharge. .The .external .auditory .canal .shows .very .faint .erythema. .There .is .no
.tragus .tenderness .and .no .nasopharyngeal .mass. .What .is .the .most .appropriate
.management .for .this .patient?
1. .Ear .wick .
2. .Culture .of .the .discharge .
,3. .Oral .antibiotics .
4. .Ototopical .corticosteroids .- .CORRECT .ANSWER-3. .Oral .antibiotics
A .17-year-old .male .patient .presents .with .a .complaint .of .watery .discharge .from
.his .eyes .for .the .past .three .days. .He .also .complains .of .itching .and .redness
.associated .with .it. .Upon .further .questioning, .he .reveals .a .history .of .upper
.respiratory .tract .infections. .His .vital .signs .show .blood .pressure .of .120/80
.mmHg, .heart .rate .of .80 .beats .per .minute, .respiratory .rate .of .14 .breaths .per
.minute, .and .temperature .of .98.6 .F .(37 .C). .Ocular .examination .findings .are
.shown .in .the .image. .A .polymerase .chain .reaction .(PCR) .performed .confirms
.the .diagnosis. .What .is .the .most .common .causative .organism?
1. .Adenovirus .
2. .Herpes .simplex .
3. .Herpes .zoster .
4. .Enterovirus .- .CORRECT .ANSWER-1. .Adenovirus
A .17-year-old .female .with .asthma .presents .with .a .three-hour .history .of .burning
.and .itching .in .both .eyes .and .mild .eyelid .swelling .that .started .after .she .went .on
.a .hike .with .her .friends. .She .is .afebrile, .and .ocular .examination .shows .bilateral
.watery .discharge .and .erythema .of .both .the .bulbar .and .tarsal .conjunctiva. .What
.is .the .most .appropriate .next .step .in .treatment?
1. .Warm .compresses .
2. .Antihistamine .eye .drops .
3. .Corticosteroid .eye .drops .
4. .Oral .antihistamines .- .CORRECT .ANSWER-2. .Antihistamine .eye .drops
A .17-year-old .male .presents .to .the .hospital .with .a .severe .sore .throat .and
.fatigue .that .has .been .ongoing .for .three .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 .ten .days. .The .patient .returns .two
.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?
1. .Send .a .throat .swab .for .culture .and .record .the .patient's .allergy .to .ampicillin.
.2. .Send .a .throat .swab .for .culture .and .orde .- .CORRECT .ANSWER-2. .Send .a
.throat .swab .for .culture .and .order .a .complete .blood .count .and .heterophile
.antibodies.
A .65-year-old .woman .presents .to .the .hospital .with .a .sore .throat .and .cough .that
.started .three .days .ago .and .has .not .resolved .despite .regular .use .of .a
.combination .of .cold .and .cough .medicines. .She .reports .feeling .mildly
.uncomfortable .but .not .having .a .fever .at .home. .She .takes .medication .for .high
.blood .pressure .and .high .cholesterol .but .reports .that .they .are .well .controlled.
.Her .vital .signs, .including .oxygen .saturation, .are .all .within .normal .limits. .On
, .examination, .her .primary .provider .notes .injected .conjunctiva, .nasal .congestion,
.a .red .pharynx .with .no .exudates, .and .shotty .cervical .lymphadenopathy .that .is
.not .tender. .She .is .fully .vaccinated .against .COVID-19, .and .her .PCR .is .negative
.for .COVID-19. .What .is .the .most .appropriate .next .step .in .care?
1. .Reassurance .and .prescription .for .symptom-directed .medications .
2. .Empiric .therapy .with .amoxicillin .twice .daily .for .10 .days .
3. .Multiplex .PCR .for .viral .pathogens .
4. .Bacterial .cultur .- .CORRECT .ANSWER-1. .Reassurance .and .prescription .for
.symptom-directed .medications
A .17-year-old .male .patient .presents .to .the .hospital .with .a .sore .throat. .His
.condition .is .associated .with .fever .and .chills, .difficulty .in .swallowing, .referred
.ear .pain, .headache, .and .muscle .aches. .The .vital .sign .shows .a .temperature .of
.39 .C .(102.2 .F), .pulse .rate .105/min, .and .respiratory .rate .of .22 .breaths/min. .The
.physical .exam .reveals .a .dry .tongue, .erythematous .enlarged .tonsils, .pharyngeal
.exudate, .and .tender .cervical .lymphadenopathy. .What .would .be .most .beneficial
.investigation .in .establishing .a .diagnosis .in .this .case?
1. .ASO .titer .
2. .CRP .
3. .Rapid .antigen .detection .test .(RADT) .
4. .Throat .culture .- .CORRECT .ANSWER-3. .Rapid .antigen .detection .test .(RADT)
A .17-year-old .female .patient .presents .with .a .complaint .of .thick .discharge .from
.her .eyes .that .started .five .days .ago. .She .also .complains .of .redness .and .a
.feeling .of .dirt .in .her .eyes. .On .further .questioning, .she .reveals .that .her .eyes .are
.usually .matted .in .the .morning. .A .detailed .medical .history .reveals .that .she .has
.had .multiple .similar .episodes .previously. .She .has .been .using .contact .lenses
.for .the .past .two .years. .Her .vital .signs .show .blood .pressure .120/80 .mmHg,
.heart .rate .88/min, .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 .the
.management .of .her .condition?
1. .Topical .neomycin .
2. .Topical .bacitracin .
3. .Topical .ciprofloxacin .
4. .Oral .azithromycin .- .CORRECT .ANSWER-3. .Topical .ciprofloxacin
A .9-year-old .male .is .brought .by .his .mother, .who .states .that .he .has .had .a .stuffy
.and .runny .nose .for .around .eight .months. .The .patient .admits .to .occasional
.sneezing .and .congestion .to .the .point .that .he .has .to .breathe .through .his
.mouth. .He .denies .fever, .wheezing, .or .ear .discomfort. .On .physical .examination,
.he .is .noted .to .have .mild .darkening .under .both .eyes, .a .small .crease .above .the
.tip .of .his .nose, .clear .rhinorrhea .bilaterally, .mild .turbinate .swelling .with .pale
.blue .mucosa, .and .some .cobblestoning .in .the .posterior .pharynx. .His .lungs .are
.clear .on .auscultation. .Which .of .the .following .physical .signs .of .his .condition .is
.commonly .found .in .children .but .not .adults?
1. .Darkening .around .the .eyes .
2. .Cobblestoning .of .the .posterior .pharynx .
