MSN 620 FINAL EXAM QUESTIONS WITH 100%
CORRECT ANSWERS VERIFIED AND UPDATED
1.A 32-year-old female who is 9 weeks pregnant presents with nasal con- gestion
bilaterally. She has been using an over-the-counter intranasal de- congestant 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?: Intranasal fluticasone
2. A 17-year-old boy presents with a sore throat that started yesterday after- noon
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 th
, most appropriate next step in care?: - Point-of-care streptococcal antigen
testing
3.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?: Oral antibiotics
4. 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 bea
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?: Adenovirus
,5.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?: Antihista- mine eye drops
6. 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?: Send a throat swab for
culture and order a complete blood count and heterophile antibodies.
, 7.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?: Reassurance and prescription for symptom-directed medications
8.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,
pha- ryngeal exudate, and tender cervical lymphadenopathy. What would be
CORRECT ANSWERS VERIFIED AND UPDATED
1.A 32-year-old female who is 9 weeks pregnant presents with nasal con- gestion
bilaterally. She has been using an over-the-counter intranasal de- congestant 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?: Intranasal fluticasone
2. A 17-year-old boy presents with a sore throat that started yesterday after- noon
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 th
, most appropriate next step in care?: - Point-of-care streptococcal antigen
testing
3.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?: Oral antibiotics
4. 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 bea
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?: Adenovirus
,5.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?: Antihista- mine eye drops
6. 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?: Send a throat swab for
culture and order a complete blood count and heterophile antibodies.
, 7.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?: Reassurance and prescription for symptom-directed medications
8.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,
pha- ryngeal exudate, and tender cervical lymphadenopathy. What would be
