,1. A 45-year-old male presents with sudden onset of severe eye pain, blurred vision, and seeing
"halos" around lights. On exam, the pupil is mid-dilated and non-reactive. What is the most likely
diagnosis?
A) Bacterial Conjunctivitis
B) Acute Angle-Closure Glaucoma
C) Viral Keratitis
D) Cataracts
Answer: B.
Rationale: Acute angle-closure glaucoma is a medical emergency. The classic triad is eye pain,
"halos," and a fixed, mid-dilated pupil. Bacterial conjunctivitis typically presents with discharge but
no vision loss or severe pain.
2. A 6-year-old child presents with a sore throat, fever of 102°F, and a "sandpaper" rash on the torso.
The tongue appears bright red with prominent papillae. What is the priority diagnosis?
A) Mononucleosis
B) Scarlet Fever
C) Hand, Foot, and Mouth Disease
D) Viral Pharyngitis
Answer: B.
Rationale: Scarlet fever (Scarlatina) is caused by Group A Strep. Key identifiers are the "sandpaper"
rash and "strawberry tongue." Mononucleosis usually presents with significant lymphadenopathy
and splenomegaly.
3. During a physical exam, the NP notes a cluster of small, shallow ulcers with a red halo on the buccal
mucosa. The patient reports they are painful but not itchy. These are likely:
A) Aphthous ulcers (Canker sores)
B) Herpes Simplex (Cold sores)
C) Leukoplakia
D) Oral Candidiasis
Answer: A.
Rationale: Aphthous ulcers occur inside the mouth on non-keratinized tissue and are painful. Herpes
simplex usually occurs on the lips (keratinized tissue) and starts with a tingling prodrome.
4. A 30-year-old female complains of "the room spinning" whenever she turns her head quickly in bed.
The episodes last less than a minute. No hearing loss is noted. What is the most likely condition?
A) Meniere’s Disease
B) Labyrinthitis
, C) Benign Paroxysmal Positional Vertigo (BPPV)
D) Acoustic Neuroma
Answer: C.
Rationale: BPPV is triggered by head movement and is brief (seconds to minutes). Meniere’s disease
includes hearing loss and tinnitus, and episodes last much longer (hours).
5. On otoscopic exam, the NP sees a retracted tympanic membrane (TM) with yellowish fluid and air
bubbles behind it. The patient denies pain but feels "stuffed up." This is consistent with:
A) Acute Otitis Media (AOM)
B) Otitis Media with Effusion (OME)
C) Otitis Externa
D) Mastoiditis
Answer: B.
Rationale: OME is characterized by fluid behind the TM without signs of acute infection (fever/pain).
AOM would show a bulging, red TM with intense pain.
6. A patient presents with a 10-day history of nasal congestion and facial pain that is worse when
bending forward. They initially felt better, but symptoms recently returned. What is the likely
management?
A) Viral support (fluids/rest)
B) Start Amoxicillin-Clavulanate (Augmentin)
C) Immediate Referral to ENT
D) Antiviral medication
Answer: B.
Rationale: "Double worsening" (getting better then worse) and symptoms lasting >10 days suggest
Acute Bacterial Rhinosinusitis, requiring antibiotics.
7. An elderly patient presents with a slow-growing, painless, pearly nodule with telangiectasia (tiny
blood vessels) on the bridge of the nose. This is most suspicious for:
A) Squamous Cell Carcinoma
B) Basal Cell Carcinoma
C) Malignant Melanoma
D) Actinic Keratosis
Answer: B.
Rationale: Basal cell carcinoma is the most common skin cancer; its classic description is a "pearly"
lesion with telangiectasia.
"halos" around lights. On exam, the pupil is mid-dilated and non-reactive. What is the most likely
diagnosis?
A) Bacterial Conjunctivitis
B) Acute Angle-Closure Glaucoma
C) Viral Keratitis
D) Cataracts
Answer: B.
Rationale: Acute angle-closure glaucoma is a medical emergency. The classic triad is eye pain,
"halos," and a fixed, mid-dilated pupil. Bacterial conjunctivitis typically presents with discharge but
no vision loss or severe pain.
2. A 6-year-old child presents with a sore throat, fever of 102°F, and a "sandpaper" rash on the torso.
The tongue appears bright red with prominent papillae. What is the priority diagnosis?
A) Mononucleosis
B) Scarlet Fever
C) Hand, Foot, and Mouth Disease
D) Viral Pharyngitis
Answer: B.
Rationale: Scarlet fever (Scarlatina) is caused by Group A Strep. Key identifiers are the "sandpaper"
rash and "strawberry tongue." Mononucleosis usually presents with significant lymphadenopathy
and splenomegaly.
3. During a physical exam, the NP notes a cluster of small, shallow ulcers with a red halo on the buccal
mucosa. The patient reports they are painful but not itchy. These are likely:
A) Aphthous ulcers (Canker sores)
B) Herpes Simplex (Cold sores)
C) Leukoplakia
D) Oral Candidiasis
Answer: A.
Rationale: Aphthous ulcers occur inside the mouth on non-keratinized tissue and are painful. Herpes
simplex usually occurs on the lips (keratinized tissue) and starts with a tingling prodrome.
4. A 30-year-old female complains of "the room spinning" whenever she turns her head quickly in bed.
The episodes last less than a minute. No hearing loss is noted. What is the most likely condition?
A) Meniere’s Disease
B) Labyrinthitis
, C) Benign Paroxysmal Positional Vertigo (BPPV)
D) Acoustic Neuroma
Answer: C.
Rationale: BPPV is triggered by head movement and is brief (seconds to minutes). Meniere’s disease
includes hearing loss and tinnitus, and episodes last much longer (hours).
5. On otoscopic exam, the NP sees a retracted tympanic membrane (TM) with yellowish fluid and air
bubbles behind it. The patient denies pain but feels "stuffed up." This is consistent with:
A) Acute Otitis Media (AOM)
B) Otitis Media with Effusion (OME)
C) Otitis Externa
D) Mastoiditis
Answer: B.
Rationale: OME is characterized by fluid behind the TM without signs of acute infection (fever/pain).
AOM would show a bulging, red TM with intense pain.
6. A patient presents with a 10-day history of nasal congestion and facial pain that is worse when
bending forward. They initially felt better, but symptoms recently returned. What is the likely
management?
A) Viral support (fluids/rest)
B) Start Amoxicillin-Clavulanate (Augmentin)
C) Immediate Referral to ENT
D) Antiviral medication
Answer: B.
Rationale: "Double worsening" (getting better then worse) and symptoms lasting >10 days suggest
Acute Bacterial Rhinosinusitis, requiring antibiotics.
7. An elderly patient presents with a slow-growing, painless, pearly nodule with telangiectasia (tiny
blood vessels) on the bridge of the nose. This is most suspicious for:
A) Squamous Cell Carcinoma
B) Basal Cell Carcinoma
C) Malignant Melanoma
D) Actinic Keratosis
Answer: B.
Rationale: Basal cell carcinoma is the most common skin cancer; its classic description is a "pearly"
lesion with telangiectasia.
