MSN 620 Final UPDATED Exam Questions
and 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 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
and 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 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
