N675 Final Exam Acute Care Exam 1
Acute Care Exam 1
Week 1 – EENT
A primary care provider notes painless, hard lesions on a patient’s external
... [Show More] 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, lowgrade fever
An adult patient has epiglottitis secondary to a chemical burn. Which medication will be given initially to
prevent complications?
Chloramphenicol biopsyrecu
Dexamethasone
Metronidazole
Clindamycin
What are factors associated with acute suppurative parotitis? (Select all that apply.)
Anticholinergic medications
Diabetes mellitus
Radiotherapy
Hypervolemia
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
Neomycin
Fluconazole
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?
Conjunctivitis
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:
Belpharitis
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
Disequilibrium
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
Microaneurysm
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 is an incidental finding in patient with migraines
It could be an important finding in this patient
A patient has seasonal rhinitis symptoms and allergy testing reveals sensitivity to various trees and
grasses. What is the first-line treatment for this patient?
Intranasal steroids
Antihistamine sprays
Intranasal comolyn
Oral antihistamine
A patient with gingival inflammation with several areas of separated ulceration and a small amount of
purulent discharge. What is required to diagnose this condition?
Microscopic exam of oral scrapings
Physical examination
Tzank smear
Culture and sensitivity
A 70 year old male has a yellowish, triangular nodule near the iris. This is probably:
A chalazion
A pinguecula
A stye
Subconjunctival hemorrhage.
A 32-year-old patient is a newly diagnosed diabetic. She has developed a sinus infection. Her symptoms
have persisted for 10 days. 6 weeks ago, she was treated with amoxicillin for a URI. It cleared without
incident. Which be recommended today?
Prescribe amoxicillin again
Do not prescribe an antibiotic, only a decongestant as indicated
Prescribe amoxicillin-clavulanate today
Prescribe a decongestant and an antihistamine
A patient has recurrent sneezing, alterations in taste and smell, watery, itchy eyes, and thin, clear nasal
secretions. The provider notes puffiness around the eyes. The patient’s vital signs are normal. What is
the most likely diagnosis for this patient?
Allergic rhinitis
Acute sinusitis
Viral rhinitis
Chronic sinusitis
The patient presents with complaints of morning eyelash crusting and itchy red eyes. It began on the left
and now has become bilateral. Based on the most likely diagnosis, what should the NP tell the caregivers
about this condition?
Anterior cervical lymphadenopathy is common
This usually begins as a viral infections
Pain is normal in the affected eye
It produces blurred vision in the affected eye
An adolescent has fever, chills, and a severe sore throat. On exam, the provider notes foul-smelling
breath and a muffled voice with marked edema and erythema of the peritonsillar tissue. What will the
primary care provider do?
Perform a rapid strep and throat culture
Refer the patient to an otolaryngologist
Prescribe empiric oral antibiotics
Evaluate for possible epiglottitis
Which patient may be given symptomatic treatment with 24 hours follow-up assessment without initial
antibiotic therapy?
A 4 year old, afebrile child with bilateral otorrhea
A 6 month old with fever of 39.2° C, poor sleep and appetite and bulging TM
A 36 month old with fever of 38.5° C, mild otalgia, and red, non-bulging TM
A 5 year old with fever of 38.0° C, severe otalgia, and red, bulging TM
A patient has nasal congestion, fever, purulent nasal discharge, headache, and facial pain and begins
treatment with amoxicillin-clavulanate. At a follow-up visit 10 days after initiation of treatment, the
patient continues to have purulent discharge, congestion, and facial pain without fever. What is the next
course of action for this patient?
A referral to an otolaryngologist
A trial of azithromycin
A CT scan of the paranasal sinuses
A second course of amoxicillin-clavulanate
A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea
and vomiting. What is part of the initial diagnostic workup for this patient?
Auditory brainstem testing
Electrocochleography
Vestibular testing
Audiogram and MRI
A patient has two palpable, tender, left preauricular nodes that are about 0.5cm in diameter. What
condition might this be associated with?
Ear infection
Conjunctivitis
Ulceration on the tongue
Sore throat
A kindergarten teacher was diagnosed with acute streptococcal pharyngitis. On exam, her throat is
bright red color with no tonsillar exudate, and clear mucus is seen on the lower nasal turbinates. The
urinalysis shows a large amount of white blood cells and is positive for nitrates. The patient has a
significant sulfa allergy and thinks she is also allergic to penicillin. Which with the following is the best
treatment choice?
Levofloxacin
Amoxicillin–clavulanic acid
Trimethoprim–sulfamethoxazole
Clarithromycin
During routine physical exam of an elderly woman, a triangular thickening of the bulbar conjunctiva on
the temporal side is noted to be encroaching on the cornea. She denies any eye pain or visual changes.
Which of the following is most likely?
Corneal arcus
Pterygium
Chalazion
Pinguecula
Group A strep pharyngiitis:
Can be accompanied by abdominal pain
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
A 70 year old male patient complains of a bright red colored spot that has been present in his left
eye for 2 days. He denies eye pain, visual changes, or headaches. He ha a new onset cough from a
recent URI. The only medicine he is taking is aspirin 1 tablet daily. Which of the following actions is
appropriate follow up for this patient?
Refer the patient to an opthalmologist
Refer the patient to an optometrist
Prescribe an ophthalmic antibiotic solution
Advise the patient that the condition is benign and will resolve spontaneously
A patient reports painful oral lesions 3 days after feeling pain and tingling in the mouth. The provider
notes vesicles and ulcerative lesions on the buccal mucosa. What is the most likely cause of these
symptoms?
1. Herpes simplex virus
2. Bacterial infection
3. Candida albicans
4. Human papillomavirus
A patient diagnosed with strep throat received a prescription for azithromycin. She has not improved in
48 hours. What course of action is acceptable?
1. Different macrolide antibiotic should be prescribed
2. Penicillin or cephalosporin with beta-lactamase coverage should be considered
3. The patient should wait another 24 hours for improvement
4. That antibiotics should be changed to a first generation cephalosporin
A patient is concerned about frequent nasal stuffiness and congestion that begins shortly after getting
out of bed in the morning. The patient denies itching and sneezing. A physical examination reveals
erythematous nasal mucosa with scant watery discharge. What treatment will the provider recommend
for this patient?
1. Consultation for immunotherapy
2. Oral antihistamines each morning
3. Oral decongestants as needed
4. Daily intranasal steroids
A patient has bilateral bleeding from the nose with bleeding into the pharynx. What is the initial
intervention for this patient
1. Assess airway safety and vital signs
2. Clear the blood with suction to identify site of bleeding
3. Apply firm, continuous pressure to the nostrils
4. Have the patient sit up straight and tilt the head forward
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?
1. Acute iritis
2. Conjunctivitis [Show Less]