MSN 620 UPDATED SCRIPT 2026 PRACTICE
SOLUTIONS GRADED A+
● 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. 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. 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. 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. 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. 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. 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. 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
SOLUTIONS GRADED A+
● 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. 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. 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. 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. 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. 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. 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. 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
