MSN 620 Final UPDATED ACTUAL Exam
Questions and CORRECT Answers
A 32-year-old female who is 9 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? - CORRECT ANSWER - Intranasal
fluticasone
A 17-year-old boy presents with a sore throat that started yesterday afternoon. He denies any
congestion or cough but reports a temperature of 102° F (38.8° C) and generalized fatigue. He
has pain with swallowing but can speak normally and manage his saliva. On physical
examination, the clinician sees yellow-white plaques on his tonsils and anterior cervical
lymphadenopathy that is tender to palpation. What is the most appropriate next step in care? -
CORRECT ANSWER - Point-of-care streptococcal antigen testing
A 17-year-old boy presents with purulent discharge from his right ear for 3 days. He is
recovering from a recent upper respiratory illness, with no fever over the past 3 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? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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? - CORRECT
ANSWER - Antihistamine eye drops
A 17-year-old boy presents to the hospital with a severe sore throat and fatigue that has been
ongoing for 3 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 10 days. The patient returns two 2 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? - CORRECT ANSWER - Send a throat
swab for culture and order a complete blood count and heterophile antibodies.
A 67-year-old female presents 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 is 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, she has 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
polymerase chain reaction (PCR) is negative for COVID-19. What is the most appropriate next
step in care? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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? -
CORRECT ANSWER - Nasal supratip crease
A 46-year-old man presents with symptoms consistent with allergic rhinitis. He has a history of
depression and is treated with a selective serotonin reuptake inhibitor. He works as a school bus
driver. Which of the following should be used to treat his symptoms? - CORRECT
ANSWER - Fexofenadine
A 16-year-old male presents with a 2 day history of sore throat, fever, and cough. He has been
experiencing difficulty swallowing food for the last two days. He has otherwise been in good
health and is up to date with his immunizations. On examinations, he has a temperature of 100.6
F, pulse rate of 100 bpm, blood pressure of 110/80 mmHg. Oral exam reveals bilateral tonsillar
exudates and diffuse pharyngeal erythema. Which of the following would be the next best step in
the management of this patient? - CORRECT ANSWER - Order a rapid strep test
A 27-year-old male patient presents with fever, sore throat, and a generalized maculopapular
erythematous rash. He reports having sexual relations with other men. His rapid antigen test for
group A beta-hemolytic streptococcus is negative. What is the next best step in the management
of this patient? - CORRECT ANSWER - Obtain testing for human immunodeficiency virus
(HIV), syphilis, chlamydia, and gonorrhea
A 2-year-old male presents with a fever of 102 F (38.9 C). His physical examination reveals
bilateral otitis media with effusion with noted erythema on the right side. His parents state that
this is his sixth diagnosis of otitis media in the past twelve months. His parents also note that he
only has two words that are intelligible to them. Following the treatment of this patient for his
Questions and CORRECT Answers
A 32-year-old female who is 9 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? - CORRECT ANSWER - Intranasal
fluticasone
A 17-year-old boy presents with a sore throat that started yesterday afternoon. He denies any
congestion or cough but reports a temperature of 102° F (38.8° C) and generalized fatigue. He
has pain with swallowing but can speak normally and manage his saliva. On physical
examination, the clinician sees yellow-white plaques on his tonsils and anterior cervical
lymphadenopathy that is tender to palpation. What is the most appropriate next step in care? -
CORRECT ANSWER - Point-of-care streptococcal antigen testing
A 17-year-old boy presents with purulent discharge from his right ear for 3 days. He is
recovering from a recent upper respiratory illness, with no fever over the past 3 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? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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? - CORRECT
ANSWER - Antihistamine eye drops
A 17-year-old boy presents to the hospital with a severe sore throat and fatigue that has been
ongoing for 3 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 10 days. The patient returns two 2 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? - CORRECT ANSWER - Send a throat
swab for culture and order a complete blood count and heterophile antibodies.
A 67-year-old female presents 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 is 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, she has 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
polymerase chain reaction (PCR) is negative for COVID-19. What is the most appropriate next
step in care? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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? - CORRECT ANSWER - 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? -
CORRECT ANSWER - Nasal supratip crease
A 46-year-old man presents with symptoms consistent with allergic rhinitis. He has a history of
depression and is treated with a selective serotonin reuptake inhibitor. He works as a school bus
driver. Which of the following should be used to treat his symptoms? - CORRECT
ANSWER - Fexofenadine
A 16-year-old male presents with a 2 day history of sore throat, fever, and cough. He has been
experiencing difficulty swallowing food for the last two days. He has otherwise been in good
health and is up to date with his immunizations. On examinations, he has a temperature of 100.6
F, pulse rate of 100 bpm, blood pressure of 110/80 mmHg. Oral exam reveals bilateral tonsillar
exudates and diffuse pharyngeal erythema. Which of the following would be the next best step in
the management of this patient? - CORRECT ANSWER - Order a rapid strep test
A 27-year-old male patient presents with fever, sore throat, and a generalized maculopapular
erythematous rash. He reports having sexual relations with other men. His rapid antigen test for
group A beta-hemolytic streptococcus is negative. What is the next best step in the management
of this patient? - CORRECT ANSWER - Obtain testing for human immunodeficiency virus
(HIV), syphilis, chlamydia, and gonorrhea
A 2-year-old male presents with a fever of 102 F (38.9 C). His physical examination reveals
bilateral otitis media with effusion with noted erythema on the right side. His parents state that
this is his sixth diagnosis of otitis media in the past twelve months. His parents also note that he
only has two words that are intelligible to them. Following the treatment of this patient for his
