M4 Dunphy Questions with Complete
Solutions
Jonathan, age 19, has just been given a diagnosis of mononucleosis. Which of the following
statements is true? Jonathan should avoid contact sports and heavy lifting
Samantha, age 12, presents with ear pain. When you begin to assess her ear, you tug on her
normal-appearing auricle, eliciting severe pain. This leads you to suspect: Otitis externa
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?
Mononucleosis
What is the most common bacterial pathogen associated with acute otitis media?
Streptococcus pneumoniae
,Marlene, a 57-year-old cashier, comes to the clinic because she is unable to differentiate between
sharp and dull stimulation on both sides of her face. You suspect: A lesion affecting the
trigeminal nerve
Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge.
You cannot transilluminate the sinuses. You suspect which sinus to be affected? Maxillary
sinus
Mr. Johnson, age 69, has had Meniere disease for several years. He has some hearing loss but
now has persistent vertigo. What treatment might be instituted to relieve the vertigo? A
vestibular neurectomy
Cataracts are a common occurrence in patients over 60 years of age. You counsel your patient
that the best cure for cataracts is: Corrective lens surgery
Which of the following is not a complication of untreated group A streptococcal pharyngitis?
Hemolytic anemia
, Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for a red eye. You
are trying to decide between a diagnosis of conjunctivitis and iritis. One distinguishing
characteristic between the two is: A ciliary flush
Kathleen, age 54, has persistent pruritus of the external auditory canal. External otitis and
dermatological conditions, such as seborrheic dermatitis and psoriasis, have been ruled out. What
can you advise her to do? Apply mineral oil to counteract dryness
An 80-year-old woman comes in to the office with complaints of a rash on the left side of her
face that is blistered and painful and accompanied by left-sided eye pain. The rash broke out 2
days ago, and she remembers being very tired and feeling feverish for a week before the rash
appeared. On examination, the rash follows the trigeminal nerve on the left, and she has some
scleral injection and tearing. You suspect herpes zoster ophthalmicus. Based on what you know
to be complications of this disease, you explain to her that she needs: Ophthalmological
consultation
Ellen, a 56-year-old social worker, is seen by the nurse practitioner for complaints of fever; left-
sided facial pain; moderate amounts of purulent, malodorous nasal discharge; and pain and
headache when bending forward. The symptoms have been occurring for approximately 6 days.
On physical assessment, there is marked redness and swelling of the nasal passages and
Solutions
Jonathan, age 19, has just been given a diagnosis of mononucleosis. Which of the following
statements is true? Jonathan should avoid contact sports and heavy lifting
Samantha, age 12, presents with ear pain. When you begin to assess her ear, you tug on her
normal-appearing auricle, eliciting severe pain. This leads you to suspect: Otitis externa
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?
Mononucleosis
What is the most common bacterial pathogen associated with acute otitis media?
Streptococcus pneumoniae
,Marlene, a 57-year-old cashier, comes to the clinic because she is unable to differentiate between
sharp and dull stimulation on both sides of her face. You suspect: A lesion affecting the
trigeminal nerve
Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge.
You cannot transilluminate the sinuses. You suspect which sinus to be affected? Maxillary
sinus
Mr. Johnson, age 69, has had Meniere disease for several years. He has some hearing loss but
now has persistent vertigo. What treatment might be instituted to relieve the vertigo? A
vestibular neurectomy
Cataracts are a common occurrence in patients over 60 years of age. You counsel your patient
that the best cure for cataracts is: Corrective lens surgery
Which of the following is not a complication of untreated group A streptococcal pharyngitis?
Hemolytic anemia
, Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for a red eye. You
are trying to decide between a diagnosis of conjunctivitis and iritis. One distinguishing
characteristic between the two is: A ciliary flush
Kathleen, age 54, has persistent pruritus of the external auditory canal. External otitis and
dermatological conditions, such as seborrheic dermatitis and psoriasis, have been ruled out. What
can you advise her to do? Apply mineral oil to counteract dryness
An 80-year-old woman comes in to the office with complaints of a rash on the left side of her
face that is blistered and painful and accompanied by left-sided eye pain. The rash broke out 2
days ago, and she remembers being very tired and feeling feverish for a week before the rash
appeared. On examination, the rash follows the trigeminal nerve on the left, and she has some
scleral injection and tearing. You suspect herpes zoster ophthalmicus. Based on what you know
to be complications of this disease, you explain to her that she needs: Ophthalmological
consultation
Ellen, a 56-year-old social worker, is seen by the nurse practitioner for complaints of fever; left-
sided facial pain; moderate amounts of purulent, malodorous nasal discharge; and pain and
headache when bending forward. The symptoms have been occurring for approximately 6 days.
On physical assessment, there is marked redness and swelling of the nasal passages and
