MSN 620 Final
A 16-year-antique male gives with a 2 day history of sore throat, fever, and cough. He has
been experiencing issue swallowing meals for the last two days. He has in any other case
been in appropriate fitness and is updated with his immunizations. On examinations, he has
a temperature of 100.6 F, pulse charge of one hundred bpm, blood pressure of a hundred
and ten/80 mmHg. Oral examination exhibits bilateral tonsillar exudates and diffuse
pharyngeal erythema. Which of the subsequent will be the next first-rate step in the control
of this patient?
1. Start the patient on amoxicillin empirically
2. Order a culture and sensitivity of a throat swab
3. Order a fast strep take a look at
four. Order a heterophile antibody test - ANS-3. Order a speedy strep test
A sixteen-yr-old affords with a protracted records of stomach pain, intermittent diarrhea,
constipation, rectal bleeding, and loss of weight. She has been to many providers with out a
analysis. She undergoes a colonoscopy which exhibits that the rectum is inflamed with
mucus inside the lumen. Biopsy of the specimen reveals an inflammatory response that is
confined to the mucosa and submucosa. Numerous neutrophils and cryptic abscesses are
visible. Her carcinoembryonic antigen ranges (CEA) is improved. What is the maximum in all
likelihood analysis?
1. Hepatitis A
2. Ulcerative colitis
3. Acute cholecystitis
4. Diverticulitis - ANS-2. Ulcerative colitis
A 17-yr-antique boy offers to the office with a sore throat that commenced yesterday
afternoon. He denies any congestion or cough however reports a temperature of 102 ranges
F and generalized fatigue. He has pain with swallowing but can talk commonly and control
his saliva. On exam, the clinician notes yellow-white plaques on his tonsils and anterior
cervical lymphadenopathy that is smooth to palpation. Besides his fever, his important signs
are all within everyday limits. What is the maximum appropriate subsequent step in care?
1. Weight-primarily based dosing of ibuprofen
2. Weight-based totally dosing of azithromycin for a 5-day treatment
3. Point-of-care streptococcal antigen checking out
4. Bacterial culture of the throat - ANS-3. Point-of-care streptococcal antigen testing
A 17-yr-antique girl is seen in the hospital with lawsuits of negative sleep, loss of hobby in
each day living activities, low libido, and feeling depressed. She became diagnosed with
depression two years ago however has been reluctant to take her antidepressants. She has
been feeling 'down' for some of months and has tried several types of natural treatments but
without tons fulfillment. She would love to realize what factors are making her melancholy
worse. Based on latest facts, what aspect may additionally genuinely assist lower the risk of
a first-rate depressive sickness?
1. Religious ideals
2. Low socioeconomic popularity
three. Being single
,4. Living within the city - ANS-1. Religious ideals
A 17-yr-vintage lady patient offers with a grievance of thick discharge from her eyes that
began 5 days ago. She also complains of redness and a feeling of dirt in her eyes. On in
addition questioning, she famous that her eyes are generally matted inside the morning. A
exact scientific records famous that she has had a couple of similar episodes previously. She
has been the usage of touch lenses for the beyond years. Her critical symptoms show blood
pressure a hundred and twenty/eighty mmHg, heart charge 88/min, breathing price 14
breaths/min, and temperature 37 C (ninety eight.6 F). An ocular exam famous hyperemia
and multiplied yellow-white lesions on the decrease cul-de-sac. What is the most suitable
subsequent step inside the control of her condition?
1. Topical neomycin
2. Topical bacitracin
three. Topical ciprofloxacin
4. Oral azithromycin - ANS-three. Topical ciprofloxacin
A 17-year-old lady offers to the workplace with a intense sore throat. The signs, which
commenced four days ago, have turn out to be unilateral and lots worse during the last day.
She has had fevers of a hundred and one-103 F at domestic and became taking
up-the-counter medicines however now can not tolerate swallowing even liquid ibuprofen.
She has no problem respiration, but reports that it is very difficult to open her mouth because
of ache in her jaw and the clinician struggles to visualise her throat however notes unilateral
tonsillar swelling. The clinician also notes soft cervical lymphadenopathy and a few
proper-sided facial swelling but most effective minimum tenderness to palpation over the
right jaw. What is the maximum appropriate next step in care?
1. Referral to the emergency branch for imaging and aspiration
2. In-workplace aspiration of possibly peritonsillar abscess
3. Topical benzocaine spray and amoxicillin-clavulanic acid twice every day for seven day -
ANS-1. Referral to the emergency department for imaging and aspiration
A 17-year-vintage woman with bronchial asthma gives with a 3-hour records of burning and
itching in each eyes and slight eyelid swelling that began after she went on a hike along with
her buddies. She is afebrile, and ocular exam indicates bilateral watery discharge and
erythema of both the bulbar and tarsal conjunctiva. What is the most appropriate next step in
treatment?
1. Warm compresses
2. Antihistamine eye drops
three. Corticosteroid eye drops
four. Oral antihistamines - ANS-2. Antihistamine eye drops
A 17-12 months-old immunocompetent male offers with a pruritic rash on his left leg (see
picture). He reports that it lately advanced after starting a weightlifting program at a local
gymnasium. What is the most suitable preliminary treatment for this patient's circumstance?
1. Topical nystatin
2. Oral griseofulvin
3. Oral terbinafine
4. Topical clotrimazole - ANS-4. Topical clotrimazole
A 17-yr-vintage male patient presents to the sanatorium with a sore throat. His situation is
related to fever and chills, problem in swallowing, referred ear ache, headache, and muscle
aches. The important sign shows a temperature of 39 C (102.2 F), pulse price one hundred
and five/min, and breathing charge of twenty-two breaths/min. The physical exam famous a
, dry tongue, erythematous enlarged tonsils, pharyngeal exudate, and soft cervical
lymphadenopathy. What might be most useful research in setting up a prognosis in this
situation?
1. ASO titer
2. CRP
three. Rapid antigen detection test (RADT)
four. Throat lifestyle - ANS-three. Rapid antigen detection check (RADT)
A 17-yr-vintage male affected person offers with a grievance of watery discharge from his
eyes for the past three days. He also complains of itching and redness associated with it.
Upon in addition questioning, he well-knownshows a history of upper respiration tract
infections. His important signs show blood strain of 120/80 mmHg, coronary heart charge of
80 beats consistent with minute, respiratory price of 14 breaths according to minute, and
temperature of 98.6 F (37 C). Ocular examination findings are proven within the picture. A
polymerase chain response (PCR) finished confirms the diagnosis. What is the most not
unusual causative organism?
1. Adenovirus
2. Herpes simplex
three. Herpes zoster
4. Enterovirus - ANS-1. Adenovirus
A 17-12 months-vintage male gives to the sanatorium with a excessive sore throat and
fatigue that has been ongoing for three days. He has a excessive-grade fever for which he
has been taking ibuprofen at domestic. The pain in his throat has been making it hard for
him to swallow, though he can take bloodless beverages with care, which allows with the
ache. He does not feel throat congestion and does no longer 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 every day for ten
days. The affected person returns days later, reporting a complete-body, blotchy, bumpy
rash and no trade in his signs. He stopped taking the antibiotics after the rash started out.
What is the maximum suitable next step in care?
1. Send a throat swab for culture and report the affected person's hypersensitive reaction to
ampicillin. 2. Send a throat swab for lifestyle and orde - ANS-2. Send a throat swab for
culture and order a whole blood rely and heterophile antibodies.
A 17-year-old male gives with purulent discharge from his proper ear for three days. He is
convalescing from a current higher respiration infection, and not using a fever during the last
three days. His ear changed into painful to begin with however isn't always currently. The
tympanic membrane appears to have a small perforation with copious purulent discharge.
The external auditory canal shows very faint erythema. There isn't any tragus tenderness
and no nasopharyngeal mass. What is the maximum appropriate control for this patient?
1. Ear wick
2. Culture of the release
three. Oral antibiotics
four. Ototopical corticosteroids - ANS-three. Oral antibiotics
A 22-yr-antique male college pupil gives to the office because of headaches and neck pain.
He has had those signs and symptoms for many years. The patient attends university and
says that although he's doing ok, he feels crushed and fatigued. He sleeps very fitfully and
regularly issues approximately his grades, fitness, and social existence. He obsesses about
minor feedback from his friends and receives depressed, questioning that he isn't always
A 16-year-antique male gives with a 2 day history of sore throat, fever, and cough. He has
been experiencing issue swallowing meals for the last two days. He has in any other case
been in appropriate fitness and is updated with his immunizations. On examinations, he has
a temperature of 100.6 F, pulse charge of one hundred bpm, blood pressure of a hundred
and ten/80 mmHg. Oral examination exhibits bilateral tonsillar exudates and diffuse
pharyngeal erythema. Which of the subsequent will be the next first-rate step in the control
of this patient?
1. Start the patient on amoxicillin empirically
2. Order a culture and sensitivity of a throat swab
3. Order a fast strep take a look at
four. Order a heterophile antibody test - ANS-3. Order a speedy strep test
A sixteen-yr-old affords with a protracted records of stomach pain, intermittent diarrhea,
constipation, rectal bleeding, and loss of weight. She has been to many providers with out a
analysis. She undergoes a colonoscopy which exhibits that the rectum is inflamed with
mucus inside the lumen. Biopsy of the specimen reveals an inflammatory response that is
confined to the mucosa and submucosa. Numerous neutrophils and cryptic abscesses are
visible. Her carcinoembryonic antigen ranges (CEA) is improved. What is the maximum in all
likelihood analysis?
1. Hepatitis A
2. Ulcerative colitis
3. Acute cholecystitis
4. Diverticulitis - ANS-2. Ulcerative colitis
A 17-yr-antique boy offers to the office with a sore throat that commenced yesterday
afternoon. He denies any congestion or cough however reports a temperature of 102 ranges
F and generalized fatigue. He has pain with swallowing but can talk commonly and control
his saliva. On exam, the clinician notes yellow-white plaques on his tonsils and anterior
cervical lymphadenopathy that is smooth to palpation. Besides his fever, his important signs
are all within everyday limits. What is the maximum appropriate subsequent step in care?
1. Weight-primarily based dosing of ibuprofen
2. Weight-based totally dosing of azithromycin for a 5-day treatment
3. Point-of-care streptococcal antigen checking out
4. Bacterial culture of the throat - ANS-3. Point-of-care streptococcal antigen testing
A 17-yr-antique girl is seen in the hospital with lawsuits of negative sleep, loss of hobby in
each day living activities, low libido, and feeling depressed. She became diagnosed with
depression two years ago however has been reluctant to take her antidepressants. She has
been feeling 'down' for some of months and has tried several types of natural treatments but
without tons fulfillment. She would love to realize what factors are making her melancholy
worse. Based on latest facts, what aspect may additionally genuinely assist lower the risk of
a first-rate depressive sickness?
1. Religious ideals
2. Low socioeconomic popularity
three. Being single
,4. Living within the city - ANS-1. Religious ideals
A 17-yr-vintage lady patient offers with a grievance of thick discharge from her eyes that
began 5 days ago. She also complains of redness and a feeling of dirt in her eyes. On in
addition questioning, she famous that her eyes are generally matted inside the morning. A
exact scientific records famous that she has had a couple of similar episodes previously. She
has been the usage of touch lenses for the beyond years. Her critical symptoms show blood
pressure a hundred and twenty/eighty mmHg, heart charge 88/min, breathing price 14
breaths/min, and temperature 37 C (ninety eight.6 F). An ocular exam famous hyperemia
and multiplied yellow-white lesions on the decrease cul-de-sac. What is the most suitable
subsequent step inside the control of her condition?
1. Topical neomycin
2. Topical bacitracin
three. Topical ciprofloxacin
4. Oral azithromycin - ANS-three. Topical ciprofloxacin
A 17-year-old lady offers to the workplace with a intense sore throat. The signs, which
commenced four days ago, have turn out to be unilateral and lots worse during the last day.
She has had fevers of a hundred and one-103 F at domestic and became taking
up-the-counter medicines however now can not tolerate swallowing even liquid ibuprofen.
She has no problem respiration, but reports that it is very difficult to open her mouth because
of ache in her jaw and the clinician struggles to visualise her throat however notes unilateral
tonsillar swelling. The clinician also notes soft cervical lymphadenopathy and a few
proper-sided facial swelling but most effective minimum tenderness to palpation over the
right jaw. What is the maximum appropriate next step in care?
1. Referral to the emergency branch for imaging and aspiration
2. In-workplace aspiration of possibly peritonsillar abscess
3. Topical benzocaine spray and amoxicillin-clavulanic acid twice every day for seven day -
ANS-1. Referral to the emergency department for imaging and aspiration
A 17-year-vintage woman with bronchial asthma gives with a 3-hour records of burning and
itching in each eyes and slight eyelid swelling that began after she went on a hike along with
her buddies. She is afebrile, and ocular exam indicates bilateral watery discharge and
erythema of both the bulbar and tarsal conjunctiva. What is the most appropriate next step in
treatment?
1. Warm compresses
2. Antihistamine eye drops
three. Corticosteroid eye drops
four. Oral antihistamines - ANS-2. Antihistamine eye drops
A 17-12 months-old immunocompetent male offers with a pruritic rash on his left leg (see
picture). He reports that it lately advanced after starting a weightlifting program at a local
gymnasium. What is the most suitable preliminary treatment for this patient's circumstance?
1. Topical nystatin
2. Oral griseofulvin
3. Oral terbinafine
4. Topical clotrimazole - ANS-4. Topical clotrimazole
A 17-yr-vintage male patient presents to the sanatorium with a sore throat. His situation is
related to fever and chills, problem in swallowing, referred ear ache, headache, and muscle
aches. The important sign shows a temperature of 39 C (102.2 F), pulse price one hundred
and five/min, and breathing charge of twenty-two breaths/min. The physical exam famous a
, dry tongue, erythematous enlarged tonsils, pharyngeal exudate, and soft cervical
lymphadenopathy. What might be most useful research in setting up a prognosis in this
situation?
1. ASO titer
2. CRP
three. Rapid antigen detection test (RADT)
four. Throat lifestyle - ANS-three. Rapid antigen detection check (RADT)
A 17-yr-vintage male affected person offers with a grievance of watery discharge from his
eyes for the past three days. He also complains of itching and redness associated with it.
Upon in addition questioning, he well-knownshows a history of upper respiration tract
infections. His important signs show blood strain of 120/80 mmHg, coronary heart charge of
80 beats consistent with minute, respiratory price of 14 breaths according to minute, and
temperature of 98.6 F (37 C). Ocular examination findings are proven within the picture. A
polymerase chain response (PCR) finished confirms the diagnosis. What is the most not
unusual causative organism?
1. Adenovirus
2. Herpes simplex
three. Herpes zoster
4. Enterovirus - ANS-1. Adenovirus
A 17-12 months-vintage male gives to the sanatorium with a excessive sore throat and
fatigue that has been ongoing for three days. He has a excessive-grade fever for which he
has been taking ibuprofen at domestic. The pain in his throat has been making it hard for
him to swallow, though he can take bloodless beverages with care, which allows with the
ache. He does not feel throat congestion and does no longer 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 every day for ten
days. The affected person returns days later, reporting a complete-body, blotchy, bumpy
rash and no trade in his signs. He stopped taking the antibiotics after the rash started out.
What is the maximum suitable next step in care?
1. Send a throat swab for culture and report the affected person's hypersensitive reaction to
ampicillin. 2. Send a throat swab for lifestyle and orde - ANS-2. Send a throat swab for
culture and order a whole blood rely and heterophile antibodies.
A 17-year-old male gives with purulent discharge from his proper ear for three days. He is
convalescing from a current higher respiration infection, and not using a fever during the last
three days. His ear changed into painful to begin with however isn't always currently. The
tympanic membrane appears to have a small perforation with copious purulent discharge.
The external auditory canal shows very faint erythema. There isn't any tragus tenderness
and no nasopharyngeal mass. What is the maximum appropriate control for this patient?
1. Ear wick
2. Culture of the release
three. Oral antibiotics
four. Ototopical corticosteroids - ANS-three. Oral antibiotics
A 22-yr-antique male college pupil gives to the office because of headaches and neck pain.
He has had those signs and symptoms for many years. The patient attends university and
says that although he's doing ok, he feels crushed and fatigued. He sleeps very fitfully and
regularly issues approximately his grades, fitness, and social existence. He obsesses about
minor feedback from his friends and receives depressed, questioning that he isn't always
