NR511 Midterm Differential Diagnosis
and Primary Care Practicum Study
Guide
QUESTION
. Martin, age 13, just started taking amoxicillin for otitis media. His mother said that he woke up
this morning with a rash on his trunk. What is your first action?
Answer:
Stop the amoxicillin.
QUESTION
A 10-year-old male in 5th grade presents to the pediatric office with his mother complaining of
itchy and red eyes for 1 day. The patient complains of watery drainage in both eyes, associated
with repetitive itching. On physical exam, he has no fever or constitutional symptoms. His vision
is normal, with no decrease in extraocular movements. The patient has a sibling that just
started day care recently. He also has bilateral preauricular lymph nodes that are inflamed.
What is the patient's diagnosis?
Answer:
Viral conjunctivitis.
,QUESTION
A 16-year-old male presents to your office. He was sent by an orthopedist. He has recently had
surgical fixation of a humerus fracture. The patient has been going to physical therapy and has
been developing a rash on his arm after therapy that disappears shortly after returning home.
He does not have the rash prior to therapy. The patient denies fevers and chills, and his incision
is well healed, with no signs of infection. Of note, the patient has been experiencing more hand
edema than the average patient and has had edema wraps used at the end of therapy to help
with his swelling. The wraps are made of a synthetic plastic material. The rash the patient gets
is erythematous and blotchy, not raised; it is on the operative upper extremity. What is the
most likely diagnosis?
Answer:
Contact dermatitis.
QUESTION
A 20-year-old male presents to your primary care clinic. This patient is a college student. He
complains of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a
temperature of 100.7°F. His ear exam is normal. His nose and throat exam shows mild
erythema of the nasal mucosa and edematous, enlarged tonsils bilaterally, with erythema of
the pharyngeal wall and tonsillar exudates. He has inflamed posterior cervical lymph nodes. He
has a mild nonproductive cough and clear lung exam. What is his most likely diagnosis? –
Answer:
Mononucleosis.
QUESTION
A 22-year-old African American female presents to your family practice office complaining of
progressive skin discoloration. She is adopted and has no known family history of skin
problems. The patient notes nonpalpable patches of skin loss and blanching of her forehead
and both hands and feet. It has developed over a period of 6 months and appears to have
,stopped. It is not pruritic, and there is no erythema or sign of infectious etiology. What is the
most likely diagnosis?
Answer:
Vitiligo.
QUESTION
A 22-year-old college student presents to your urgent care clinic complaining of a rash. She was
recently on spring break and spent every night in the hot tub at her hotel. On physical exam,
she has multiple small areas of 1- to 2-mm erythematous pustules that are present mostly
where her bathing suit covered her buttocks. What is the most likely pathogen causing these
lesions
Answer:
Pseudomonas aeruginosa.
QUESTION
A 25-year-old client who plays in a band complains that he finds it difficult to understand his
fellow musicians at the end of a night of performing, a problem that is compounded by the
noisy environment of the club. These symptoms are most characteristic of which of the
following?
Answer:
Sensorineural loss.
QUESTION
, A 25-year-old male presents with "bleeding in my eye" for 1 day. He awoke this morning with a
dark area of redness in his eye. He has no visual loss or changes. He denies constitutional
symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as a
dark red area in the patient's sclera of the right eye only and takes up less than 50% of the eye.
The patient's remaining sclera is clear and white. He also notes he was drinking alcohol last
night and vomited afterward. What is the best treatment?
Answer:
Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks.
QUESTION
A 27-year-old female comes in to your primary care office complaining of a perioral rash. The
patient noticed burning around her lips a couple days ago that quickly went away. She awoke
from sleep yesterday and noticed a group of vesicles with erythematous bases where the
burning had been before. There is no burning today. She is afebrile and has no difficulty eating
or swallowing. What test would confirm her diagnosis?
Answer:
Tzanck smear.
QUESTION
A 3-year-old patient presents to your pediatric office with her mother. She has recently been
started in day care. Her mother noted slight perioral erythema on the right side of the patient's
mouth prior to bed last night. The patient awoke today with 3 small, superficial, honey-colored
vesicles where the erythema was last night. The patient has no surrounding erythema. She had
no difficulty eating this morning and is active and energetic and doesn't appear lethargic or
fatigued. She is also afebrile. How would you treat this child?
and Primary Care Practicum Study
Guide
QUESTION
. Martin, age 13, just started taking amoxicillin for otitis media. His mother said that he woke up
this morning with a rash on his trunk. What is your first action?
Answer:
Stop the amoxicillin.
QUESTION
A 10-year-old male in 5th grade presents to the pediatric office with his mother complaining of
itchy and red eyes for 1 day. The patient complains of watery drainage in both eyes, associated
with repetitive itching. On physical exam, he has no fever or constitutional symptoms. His vision
is normal, with no decrease in extraocular movements. The patient has a sibling that just
started day care recently. He also has bilateral preauricular lymph nodes that are inflamed.
What is the patient's diagnosis?
Answer:
Viral conjunctivitis.
,QUESTION
A 16-year-old male presents to your office. He was sent by an orthopedist. He has recently had
surgical fixation of a humerus fracture. The patient has been going to physical therapy and has
been developing a rash on his arm after therapy that disappears shortly after returning home.
He does not have the rash prior to therapy. The patient denies fevers and chills, and his incision
is well healed, with no signs of infection. Of note, the patient has been experiencing more hand
edema than the average patient and has had edema wraps used at the end of therapy to help
with his swelling. The wraps are made of a synthetic plastic material. The rash the patient gets
is erythematous and blotchy, not raised; it is on the operative upper extremity. What is the
most likely diagnosis?
Answer:
Contact dermatitis.
QUESTION
A 20-year-old male presents to your primary care clinic. This patient is a college student. He
complains of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a
temperature of 100.7°F. His ear exam is normal. His nose and throat exam shows mild
erythema of the nasal mucosa and edematous, enlarged tonsils bilaterally, with erythema of
the pharyngeal wall and tonsillar exudates. He has inflamed posterior cervical lymph nodes. He
has a mild nonproductive cough and clear lung exam. What is his most likely diagnosis? –
Answer:
Mononucleosis.
QUESTION
A 22-year-old African American female presents to your family practice office complaining of
progressive skin discoloration. She is adopted and has no known family history of skin
problems. The patient notes nonpalpable patches of skin loss and blanching of her forehead
and both hands and feet. It has developed over a period of 6 months and appears to have
,stopped. It is not pruritic, and there is no erythema or sign of infectious etiology. What is the
most likely diagnosis?
Answer:
Vitiligo.
QUESTION
A 22-year-old college student presents to your urgent care clinic complaining of a rash. She was
recently on spring break and spent every night in the hot tub at her hotel. On physical exam,
she has multiple small areas of 1- to 2-mm erythematous pustules that are present mostly
where her bathing suit covered her buttocks. What is the most likely pathogen causing these
lesions
Answer:
Pseudomonas aeruginosa.
QUESTION
A 25-year-old client who plays in a band complains that he finds it difficult to understand his
fellow musicians at the end of a night of performing, a problem that is compounded by the
noisy environment of the club. These symptoms are most characteristic of which of the
following?
Answer:
Sensorineural loss.
QUESTION
, A 25-year-old male presents with "bleeding in my eye" for 1 day. He awoke this morning with a
dark area of redness in his eye. He has no visual loss or changes. He denies constitutional
symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as a
dark red area in the patient's sclera of the right eye only and takes up less than 50% of the eye.
The patient's remaining sclera is clear and white. He also notes he was drinking alcohol last
night and vomited afterward. What is the best treatment?
Answer:
Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks.
QUESTION
A 27-year-old female comes in to your primary care office complaining of a perioral rash. The
patient noticed burning around her lips a couple days ago that quickly went away. She awoke
from sleep yesterday and noticed a group of vesicles with erythematous bases where the
burning had been before. There is no burning today. She is afebrile and has no difficulty eating
or swallowing. What test would confirm her diagnosis?
Answer:
Tzanck smear.
QUESTION
A 3-year-old patient presents to your pediatric office with her mother. She has recently been
started in day care. Her mother noted slight perioral erythema on the right side of the patient's
mouth prior to bed last night. The patient awoke today with 3 small, superficial, honey-colored
vesicles where the erythema was last night. The patient has no surrounding erythema. She had
no difficulty eating this morning and is active and energetic and doesn't appear lethargic or
fatigued. She is also afebrile. How would you treat this child?
