NURS 624 Med Challenger HEENT QUESTIONS AND ANSWERS REVISED VERSION 2018, BEST EXAM REVIEW
Question 1
Edited: Aug 21, 2018
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This
... [Show More] patient with AIDS has developed multiple painful ulcers in his mouth (see Figure).
Figure.
Rapid plasma reagin (RPR), viral culture, and biopsy have not revealed a specific diagnosis.
Which of the following is the most likely diagnosis?
aphthous stomatitis
deep fungal infection
herpes simplex virus (HSV) infection
drug reaction
Educational Objective:
Recognize the various disorders that may affect the mouth in immunocompromised individuals
(e.g., those with HIV/AIDS).
Key Point:
Patients with HIV/AIDS are at increased risk for major aphthous ulcers, which may involve the
mouth but can also extend to the esophagus.
Explanation:
This patient has multiple, clean, well-demarcated ulcers with a rim of erythema typical of
aphthous stomatitis. It is important to rule out other infectious processes. Ulcers associated
with HSV infection are often shallow, grouped, or present as multiple lesions coalescing
together. The syphilitic chancre may occur in the mouth but is usually painless and does not
present as multiple lesions.
Deep fungal infections (Cryptococcus, Aspergillus, and Histoplasmosis) with a tendency to occur
on mucous membranes present as deep, indurated ulcers with irregular borders. Drug reactions
(eg, those seen with foscarnet) may include diffuse oral and genital erosions, but not well
demarcated deep ulcers.
Reference:
O’Handley JG, et al. Otorhinolaryngology (chapter 18). In: Rakel RE, Rakel DP. Textbook of Family
Medicine. 9th ed., 2016:305-350.
Question 2
Edited: Aug 21, 2018
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A fair-skinned, 24-year-old woman complaining of sensitive gums that bleed easily presents to
you. She first noticed the symptoms about 3 weeks ago and she says they have become
increasingly more pronounced.
On examination, you note that the patient’s gingiva are tender, bluish-red in color, edematous,
and nearly cover some of her teeth. The rest of the physical examination is normal, except for
slight pallor. There are no petechiae or ecchymoses.
What laboratory test would you order for this patient to uncover the most likely, associated
systemic disease or condition?
lupus serology
complete blood count (CBC) with differential
levels of fasting glucose, electrolytes, creatinine, and blood urea nitrogen
pregnancy test
Educational Objective:
Discuss the differential diagnosis for disorders of the gums.
Key Point:
The first manifestation of acute leukemia may be sore gums.
Explanation:
You should order a CBC with differential because the patient’s presentation is suggestive of
acute leukemia. In this disease, leukemic cells may infiltrate the gingiva and lead to bluish-red
edematous gingiva. These symptoms resolve during remission.
Phenytoin presents with gingival hyperplasia in 40% of patients taking the drug, but it is not
typically accompanied by discoloration of the gingiva. In cases of phenyt [Show Less]