MSN 620 Final (100% correct answers)

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 answers2. 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 answers3. 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 answers3. 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