N675 FINAL EXAM | Acute Care Exam 1

N675 FINAL EXAM Acute Care Exam 1 Week 1 – EENT A primary care provider notes painless, hard lesions on a patient’s external ears that expel a white crystalline substance when pressed. What diagnostic test is indicated? Rheumatoid factor Endocrine studies Biopsy of the lesions Uric acid chemical profile A patient has painful oral lesions and the provider notes several white, verrucous lesions in clusters throughout the mouth. What is the recommended treatment for this patient? Oral hygiene measures Nystatin oral suspension Surgical excision Oral acyclovir A patient has sore throat, a temperature of 38.5° C, tonsillar exudates, and cervical lymphadenopathy. What will the provider do next to manage this patient’s symptoms? Prescribe empiric penicillin Perform a rapid antigen detection test Refer to an otolaryngologist Order an antistreptolysin O titer A 61 year old male presents with a 12 hour history of extremely painful left red eye. The patient complains of blurred vision, haloes around lights, and vomiting. It began yesterday evening. On exam, the eye is red, tender and inflamed. The cornea is hazy and pupil reacts poorly to light. The most likely diagnosis in this patient is: Macular degeneration Acute angle glaucoma Increased intracranial pressure Detached cornea A patient has recurrent epistaxis without localized signs of irritation. Which laboratory tests may be performed to evaluate this condition? (Select all that apply.) CBC with platelets BUN and creatinine PT and PTT Liver function tests PT/INR A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain when manipulating the external ear structures. What is the likely diagnosis? Chronic otitis externa Acute otitis externa Otitis media with effusion Acute otitis media Patient has been diagnosed with acute rhinosinusitis. Symptoms began 3 days ago. Based on the most likely etiology, how should this patient be managed? Azithromycin and decongestant Decongestant and analgesic Levofloxacin Amoxicillin with clavulanate The vast majority of rhinosinusitis is of viral etiology, antibiotics would not be helpful and would only lead to continued antibacterial resistance. If symptoms persist for longer than 10 days, reevaluation is necessary with possible antibiotics at that time A 20-year-old male of Hispanic descent who reports a history of a cold that resolved 2 weeks ago except for a dry cough and pain over his right cheek that worsens when he bends down. The patient denies fever. The patient tells you that he is very allergic to Keflex and erythromycin. Vital signs are stable except temperature is 99.2°F. Which showed the following conditions is most likely? Fever secondary to previous viral URI Acute sinusitis Acute bronchitis Hay fever Patient's symptoms match most closely to acute sinusitis which includes cough, facial pain, low- grade fever An adult patient has epiglottitis secondary to a chemical burn. Which medication will be given initially to prevent complications? Chloramphenicol biopsyrecu Dexamethasone Metronidaz ole Clindamyci n What are factors associated with acute suppurative parotitis? (Select all that apply.) Anticholinergic medications Diabetes mellitus Radiothera py Hypervole mia Allergies A 39 year old has a sudden onset of painful right red eye. He reports sensitivity to light and the sensation of a foreign body, though his history for a foreign body is negative. He does not wear contact lenses. How should the NP manage this? Observe for 24 hours if visual acuity is normal Treat for bacterial conjunctivitis Treat for viral conjunctivitis Refer to ophthalmology No clear diagnosis can be made from signs/symptoms, but there are several red flags. collectively the red flags necessitate a referral. There is no mention of eye discharge necessary for conjunctivitis. Red flags present point more towards active corneal process although glaucoma should also be a differential. A 17-year-old has a complaint of ear pain. If he has otitis externa, which complaint is most likely/most common? Concurrent URI Fever Difficulty hearing TV Tragal pain A patient has an initial episode otitis external associated with swimming. The patient’s ear canal is mildly inflamed and the tympanic membrane is not involved. Which medication will be ordered? Cipro HC Neomyci n Fluconaz ole Vinegar and alcohol A patient has gingival inflammation with several areas of separate ulceration and a small amount of purulent discharge. What is required to diagnose this condition? Culture and sensitivity Tzank smear Physical examination Microscopic exam of oral scrapings A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues without discharge. Which is the initial course of action by the provider? Recommend oral antiseptic rinses and follow up in one week Perform an incision and drainage of the edematous tissue Prescribe amoxicillin and refer to a dentist in 2 to 3 days Refer to an oral surgeon for emergency surgery A patient presents to your clinic with a painless red eye. Her vision is normal, but her sclera has a blood red area. What is this termed? Conjunctiv itis Glaucoma Acute iritis Subconjunctival hemorrhage Which physical examination finding suggests viral rather than bacterial parotitis? Unilateral edema of parotid glands Enlargement and pain of affected glands Gradual reduction in saliva production Clear discharge from Stensen’s duct A child is hit with a baseball bat during a game and sustains an injury to the nose, along with a transient loss of consciousness. A health care provider at the game notes bleeding from the child’s nose and displacement of the septum. What is the most important intervention at this time? Immobilize the child’s head and neck and call 911 Turn the child’s head to the side to prevent aspiration of blood Place nasal packing in both nares to stop the bleeding Apply ice to the injured site to prevent airway occlusion A pediatric patient has otalgia, fever of 38.8° C, and a recent history of upper respiratory examination. The examiner is unable to visualize the tympanic membranes in the right ear because of the presence of cerumen in the ear canal. The left tympanic membrane is dull gray with fluid levels present. What is the correct action? Remove the cerumen and visualize the tympanic membrane Perform a tympanogram on the right ear Recommend symptomatic treatment for fever and pain Treat empirically with amoxicillin 80 to 90 mg/kg/day A patient presents with findings of pain, warmth, redness, and swelling below the inner canthus toward nose. Tearing is present and when pressure is applied to the lacrimal sac, purulent discharge from the puncta is noted. This is suggestive of: Belpharit is A chalazion A hordeolum Dacryocystitis Group A strep pharyngitis: Is commonly accompanied by inflamed uvula Can be accompanied by abdominal pain Is characterized by single symptom Usually does not have exudative symptoms Group A strep is usually accompanied by multiple symptoms with abrupt onset. GI symptoms are common such as nausea, vomiting, no abdominal pain. Inflamed uvula is not common Which symptoms may occur with vestibular neuritis? (Select all that apply.) Nausea and vomiting Disequilibri um Fever Tinnitus Hearing loss A patient who has acute suppurative parotitis has been taking amoxicillin-clavulanate for 4 days without improvement in symptoms. The provider will order an antibiotic for Methicillin-resistant S. aureus. Which other measure may be helpful? Discouraging chewing gum Topical corticosteroids Cool compresses Surgical drainage A NP preforms a fundoscopic exam. He identifies small areas of dull, yellowish-white coloration in the retina. What might these be? Cotton wool spots Hemorrhages Exudates Microaneurys m The provider sees a child with a history of high fever and sore throat. When entering the exam room, the provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety. What is the initial action for this patient? Administer empiric intravenous antibiotics and steroids Obtain an immediate consultation with an otolaryngologist Perform a thorough examination of the oropharynx Have the child lie down and administer high-flow, humidified oxygen A patient reports ear pain after being hit in the head with a baseball. The provider notes a large perforated tympanic membrane. What is the recommended treatment? Prescribe analgesics and follow up in 1 to 2 days Order antibiotic ear drops if signs of infection occur Refer the patient to an otolaryngologist for evaluation Reassure the patient that this will heal without problems Papilledema is noted n a patient with a headache. What is the importance of papilledema in this patient? it is not related to the headache this is a common finding in patients with headache it