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
... [Show More] 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 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
pinguecul
a 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
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