EENT - Fitzgerald
1. A 19 year old man presents with a chief complaint of a red, irritated right eye for the past 48 hours with eyelids that were "stuck together" this morning when he awoke. Examination reveals injected palpebral and bulbar conjunctiva and reactive pupils; vision screen with the Snellen chart evaluation reveals 20/30 in the right eye (OD), left eye (OS), and both eyes (OU); and purulent eye discharge on the right. this presentation is most consistent with: A. suppurative (pus-forming) conjunctivitis. B. vital conjunctivitis. C. allergic conjunctivitis. D. mechanical injury.
1. A. suppurative (pus-forming) conjunctivitis.
10. The most common clinical finding in patients with severe or refractory epistaxis: A. type diabetes mellitus. B. hypertension. C. acute bacterial sinusitis. D. anemia.
10. B. hypertension.
100. A 23 year old man is diagnosed with pharyngitis caused by S. pyogenes serotype 4. Which of the following statements is false regarding this patient? A. antimicrobial therapy will reduce the risk of developing rheumatic fever. B. onset of glomerulonephritis symptoms can occur 1 to 3 weeks after pharyngeal infection. C. Antimicrobial therapy minimizes the risk of glomerulonephritis. D. Post streptococcal glomerulonephritis is usually a self-limiting condition.
100. C. Antimicrobial therapy minimizes the risk of glomerulonephritis.
101. The rash associated with scarlet fever typically occurs how long after the start of the symptomatic infection? A. 2 days B. 4 days C. 7 to 10 days D. 2 to 3 weeks
101. A. 2 days
102. Treatment of scarlet fever in a 19 year old woman with no allergy to penicillin can include all of the following except: A. penicillin. B. cefdinir. C. TMP-SMX D. cefpodoxime.
102. C. TMP-SMX
103. A 25 year old woman who has seasonal allergic rhinitis likes to spend time outdoors. She asks you when the pollen count is likely to be the lowest. You respond: A. "Early in the morning." B. "During breezy times of the day." C. "After a rain shower." D. "When the sky is overcast."
103. C. "After a rain shower."
104. The physiological response causing allergic rhinitis is primarily mediated through: A. IL-10 B. IgE antibodies. C. anti-IgM antibodies D. anti-TNF antibodies
104. B. IgE antibodies.
109. You prescribe nasal corticosteroid spray for a patient with perennial allergic rhinitis. What is the anticipated onset of symptom relief with its use? A. immediately with the first spray. B. 1 to 2 days. C. a few days to a week. D. 2 or more weeks.
109. C. a few days to a week.
11. a 22 year old man with recurrent epistaxis episodes fails to respond to simple pressure. Alternative approaches include all of the following except: A. initial systemic prothrombotic therapy. B. nasal packing. C. chemical cautery. D. topical antifibrinolytic agents.
11. A. initial systemic prothrombotic therapy.
110. Which of the following medications is most appropriate for allergic rhinitis therapy in an acutely symptomatic 24 year old machine operator? A. nasal cromolyn B. diphenhydramine C. flunisolide nasal spray. D. loratadine.
110. D. loratadine.
111. Antihistamines work primarily through: A. vasoconstriction B. diphenhydramine C. flunisolide nasal spray D. loratadine.
111. B. diphenhydramine
112. Decongestants work primarily through: A. vasoconstriction. B. action on the H1 receptor sites. C. inflammatory mediation D. peripheral vasodilation.
112. A. vasoconstriction.
113. Which of the following medications affords the best relief of acute nasal itch? A. anticholinergic nasal spray B. oral decongestant C. corticosteroid nasal spray D. oral antihistamine
113. D. oral antihistamine
114. According to the Allergic Rhinitis and Its Effects on Asthma (ARIA) treatment guidelines, which of the following medications affords the best relief of acute nasal congestion? A. anticholinergic nasal spray B. decongestant nasal spray C. corticosteroid nasal spray D. oral antihistamine
114. B. decongestant nasal spray
115. According to the ARIA treatment guidelines which of the following medications affords the least control of rhinorrhea associated with allergic rhinitis? A. anticholinergic nasal spray B. anticholinergic nasal spray C. corticosteroid nasal spray D. oral antihistamine
115. D. oral antihistamine
116. Ipratropium bromide (Atrovent) helps control nasal secretions through: A. antihistaminic action B. anticholinergic effect. C. vasodilation. D. Vasoconstriction
116. B. anticholinergic effect.
117. Oral decongestant use should be discouraged in patients with: A. allergic rhinitis. B. migraine headache. C. cardiovascular disease. D. chronic bronchitis.
117. C. cardiovascular disease.
118. Cromolyn's mechanism of action is a/an: A. anti-immunoglobulin E antibody. B. vasoconstrictor. C. Mast cell stabilizer. D. Leukotriene modifier
118. C. Mast cell stabilizer.
119. In the treatment of allergic rhinitis, leukotriene modifiers should be used as: A. an agent to relieve nasal itch. B. an inflammatory inhibitor. C. a rescue drub. D. an intervention in acute inflammation.
119. B. an inflammatory inhibitor.
12. All of the following are components of the classic opthalmological emergency except: A. eye pain. B. purulent eye discharge C. red eye. D. new onset change in visual acuity.
12. B. purulent eye discharge
120. According to the Global Resources in Allergy (GLORIA) guidelines, which of the following is recommended for intervention in persistent allergic conjunctivitis? A. topical mast cell stabilizer with a topical antihistamine B. ocular decongestant C. topical nonsteroidal anti-inflammatory drug D. topical corticosteroid
120. A. topical mast cell stabilizer with a topical antihistamine
121. Allergen subcutaneous immunotherapy should be considered in all of the following except: A. when allergy symptoms are controlled with environmental management. B. when allergy symptoms persist despite optimal use of appropriate medications. C. when there is a desire to reduce the use of allergy medications. D. to prevent progression or development of asthma.
121. A. when allergy symptoms are controlled with environmental management.
122. Which of the following is most appropriate for the treatment of moderate-to-severe allergic rhinitis and conjunctivitis when symptoms are not controlled with current therapy? A. short course of an oral corticosteroids. B. single dose of a long-acting parenteral or IM corticosteroids C. daily dose of oral first-generation antihistamine D. immediate initiation of allergy immunotherapy.
122. A. short course of an oral corticosteroids.
123. Which of the following findings is most consistent with the diagnosis of acute bacterial rhinosinusitis (ABRS)? A. upper respiratory tract infection symptoms persisting beyond 7 to 10 days. B. mild mid facial fullness and tenderness C. preauricular lymphadenopathy D. marked eyelid edema
123. A. upper respiratory tract infection symptoms persisting beyond 7 to 10 days.
124. The most common causative bacterial pathogen in ABRS in a 40 year old adult is: A. M pneumoniae B. S. pneumoniae. C. M. catarrhalis. D. E. coli
124. B. S. pneumoniae.
125. Risk factors for ABRS include all of the following except: a. VIRAL INFECTION. b. ALLERGIES. c. TOBACCO USE. d. RECENT HISTORY OF EPISTAXIS
125. d. RECENT HISTORY OF EPISTAXIS
126. Which of the following is a first-line therapy for the treatment of ABRS in an adult with no recent antimicrobial use? A. amoxicillin-clavulanate B. trimethoprim-sulfamethoxazole C. clarithromycin D. moxifloxacin
126. A. amoxicillin-clavulanate
127. Which of the following represents a therapeutic option for ABRS in an adult patient with no recent antimicrobial care with treatment failure after 72 hours of appropriate doxycycline therapy. A. clindamycin B. clarithromycin C. trimethoprim-sulfamethoxazole D. high-dose amoxicillin with clavulanate
127. D. high-dose amoxicillin with clavulanate
128. A 34 year old man with penicillin allergy presents with ABRS. Three weeks ago, he was treated with doxycycline for "bronchitis." You now prescribe: A. clarithromycin. B. moxifloxacin. C. cephalexin. D. amoxicillin.
128. B. moxifloxacin.
129. A 45 year old person with severe ABRS has shown no clinical improvement after a total of 10 days of an antimicrobial therapy. Initially treated with doxycycline for days, he was then switched to levofloxacin for the past days. This is the third episode of ABRS in the past 12 months. You consider: A. initiating a course of oral corticosteroid. B. switching treatment to moxifloxacin. C. prompt referral for sinus imaging with a CT scan. D. discontinuing antimicrobial therapy, performing a nasal swab for culture and sensitivity, and treatment dependent on these results.
129. C. prompt referral for sinus imaging with a CT scan.
13. Mrs. Murphy is a 58 year old woman presenting with a sudden left sided headache that is most painful in her left eye. Her vision is blurred, and the left pupil is slightly dilated and poorly reactive. The left conjunctiva is markedly injected, and the eyeball is firm. Vision screen with the Snellen chart is 20/30 OD and 20/90 OS. The most likely diagnosis is: A. unilateral herpetic conjunctivitis. B. open-angle glaucoma C. angle-closure glaucoma. D. anterior uveitis.
13. C. angle-closure glaucoma.
130. According to the latest evidence, all of the following have demonstrated efficacy in relieving symptoms of ABRS: A. saline nasal spray. B. nasal corticosteroid. C. oral decongestant. D. acetaminophen
130. C. oral decongestant.
131. An 18 year old woman presents with a chief complaint of a 3-day history of a "sore throat and swollen glands." Her physical examination includes exudative pharyngitis, minimally tender anterior and posterior cervical lymphadenopathy, and maculopapular rash. She is diagnosed with infectious mononucleosis and was likely infected with the causative organism how many days ago? A. 5 to 10 B. at least 1 month C. at least 3 months D. at least 6 months
131. C. at least 3 months
132. The Epstein-Barr virus is primarily transmitted via: A. skin-to-skin contact B. contact with blood. C. oropharyngeal secretions D. genital contact
132. C. oropharyngeal secretions
133. Which of the following is most likely to be found in the laboratory data of a person with infectious mononucleosis? A. neutrophilia with reactive forms. B. lymphocytosis with atypical lymphocytes C. thrombocytosis D. macrocytosis
133. B. lymphocytosis with atypical lymphocytes
134. you examine a 5 year old man who has infectious mononucleosis with tonsillar hypertrophy, exudative pharyngitis, poor fluid intake due to difficulty swallowing, and a patent airway. You prescribe: A. amoxicillin B. prednisone C. ibuprofen D. acyclovir.
134. B. prednisone
135. In patients with infectious mononucleosis, which medication should be avoided due to a risk of rash development? A. acetaminophen B. sulfamethoxazole C. erythromycin D. amoxicillin
135. D. amoxicillin
136. What percentage of the patients with infectious mononucleosis has splenomegaly during the acute phase of the illness? A. at least 10% B. about 25% C. at least 50% D. nearly 100%
136. C. at least 50%
137. The size of a normal spleen is approximately: A. 1" x " x 3" B. 1" x 3" x 5" C. 2" x 4" x 6" D. 3" x 5" x 7"
137. B. 1" x 3" x 5"
138. Because of a risk for splenic rupture, persons who have recovered from infectious mononucleosis should wait for how long before participating in collision or contact sports? A. at least 2 weeks B. at least 1 month C. at least 3 months D. at least 6 months.
138. B. at least 1 month
14. In caring for Mrs. Murphy, the most appropriate next action is: A. prompt referral to an ophthalmologist. B. to provide analgesia and repeat the evaluation with the patient is more comfortable. C. to instill a corticosteroid ophthalmic solution. D. to patch the eye and arrange for follow-up in 24 hours.
14. A. prompt referral to an ophthalmologist.
15. A 48 year old man presents with new-onset right eye vision change accompanied by dull pain, tearing, and photophobia. The right pupil is small, irregular, and poorly reactive. Vision testing obtained by using the Snellen chart is 20/30 OS and 20/80 OD. The most likely diagnosis is: A. unilateral herpetic conjunctivitis. B. open-angle glaucoma. C. angle-closure glaucoma. D. anterior uveitis.
15. D. anterior uveitis.
16. Mrs. Allen is a 67 year old woman with type diabetes who complains of seeing flashing lights and floaters, decreased visual acuity, and metamorphopsia in her left eye. The most likely diagnosis is: A. open-angle glaucoma. B. central retinal artery occlusion. C. anterior uveitis. D. retinal detachment.
16. D. retinal detachment.
17. For Mrs. Allen, the most appropriate next course of action is: A. placement of an eye shield and follow-up in 48 hours. B. initiate treatment with an ophthalmic antimicrobial solution. C. initiate treatment with corticosteroid ophthalmic solution. D. immediate referral to an ophthalmologist.
17. D. immediate referral to an ophthalmologist.
18. A 45 year old man presents with eye pain. He reports that he was cutting a tree with a chain saw when some wood fragments hit his eye. You consider all of the following except: A. educating the patient on the use of appropriate eye protection for primary prevention of eye trauma. B. immediately removing any protruding foreign body from the eye. C. using fluorescein staining to detect small objects in the eye. D. prompt referral to an eye care specialist.
18. B. immediately removing any protruding foreign body from the eye.
19. Which of the following is a common vision problem in the person with untreated primary open-angle glaucoma (POAG)? A. peripheral vision loss B. blurring of near vision C. difficulty with distant vision D. need for increased illumination
19. A. peripheral vision loss
2. A 19 year old woman presents with a complaint of bilaterally itchy, red eyes with tearing that occurs intermittently throughout the year and is often accompanied by a rope-like eye discharge and clear nasal discharge. This is most consistent with conjunctival inflammation caused by a(n): A. bacterium. B. virus. C. allergen. D. injury
2. C. allergen.
20. POAG is primarily caused by: A. hardening of the lens. B. elevated intraocular pressure. C. degeneration of the optic nerve. D. hypotension in the anterior maxillary artery.
20. B. elevated intraocular pressure.
21. Which of the following is most likely to be found on the funduscopic examination in a patient with untreated POAG? A. excessive cupping of the optic disc B. arteriovenous nicking C. papilledema D. flame-shaped hemorrhages.
21. A. excessive cupping of the optic disc
22. Risk factors for POAG include all of the following except: A. African ancestry. B. type 2 diabetes mellitus. C. advanced age. D. blue eye color
22. D. blue eye color
23. Key diagnostic findings in POAG include which of the following? A. intraocular pressure greater than 25 mm Hg. B. papilledema. C. cup-to-disk ratio greater than 0.4 D. sluggish pupillary response.
23. A. intraocular pressure greater than 25 mm Hg.
24. Adults at night risk for POAG should undergo a complete eye exam every: A. 1-2 years. B. 3-4 years. C. 5-6 years. D. 3-6 months.
24. A. 1-2 years.
25. Treatment options for POAG include all of the following topical ocular agents except: A. beta-adrenergic antagonists. B. alpha2-agonists. C. prostaglandin analogues. D. mast cell stabilizers.
25. D. mast cell stabilizers.
26. A 22 year old woman presents with a "pimple" on her right eyelid. Examination reveals a 2d mm pustule on the lateral border of the right eyelid margin. This is the most consistent with: A. a chalazion. B. hordeolum. C. blepharitis. D. cellulitis
26. B. hordeolum.
27. 22 year old woman presents with a bump on her right eyelid. Examination reveals a 2 mm, hard non tender swelling on the lateral border of the right eyelid margin. This is most consistent with: A. a chalazion. B. a hordeolum C. blepharitis. D. cellulitis.
27. A. a chalazion.
28. First-line treatment for uncomplicated hordeolum is: A. topical corticosteroid. B. warm compresses to the affected area. C. incision and drainage. D. oral antimicrobial therapy.
28. B. warm compresses to the affected area.
29. A potential complication of hordeolum is: A. conjunctivitis. B. cellulitis of the eyelid. C. corneal ulceration. D. sinusitis.
29. B. cellulitis of the eyelid.
3. Common causative organisms of acute suppurative conjunctivitis include all of the following except: A. Staphylococcus aureus. B. Haemophylus influenzae. C. Streptococcus pneumonia. D. Pseudomonas aeruginosa.
3. D. Pseudomonas aeruginosa.
30. Initial treatment for chalazion is: A. topical fluoroquinolone. B. topical corticosteroid. C. warm compresses of the affected area. D. surgical excision.
30. C. warm compresses of the affected area.
31. to 33. Indicate whether each case represents Meniere's disease (D) or Meniere's syndrome (S). _________31. A 24 year old man who experienced trauma to the head during a car accident
31. Meniere's Syndrome
__________32. A 45 year old woman with no apparent underlying cause for the condition.
32. Meniere's Disease
___________33. A 17 year old received aminoglycoside therapy for an intra abdominal infection.
33. Meniere's Syndrome
34. Which of the following is true concerning Meniere's disease? A. Neuroimaging helps located the offending cochlear lesion. B. Associated high-frequency hearing loss is common. C. This is largely a diagnosis of exclusion. D. Tinnitus is rarely reported.
34. C. This is largely a diagnosis of exclusion.
35. Alterations in the ear involved in Meniere's disease include all of the following except: A. change in endolymphatic pressure. B. breakage in the membrane separating the endolymph and perilymph fluids. C. distension of the tympanic membrane causing low-tone roaring tinnitus. D. sudden change in the vestibular nerve firing rate.
35. C. distension of the tympanic membrane causing low-tone roaring tinnitus.
36. to 40. Indicate whether each of the following clinical findings would be present in a patient with Meniere's disease. (answer yes or no). ____________36. the Weber tuning test lateralizes to the affected ear.
36. No
_____________37. The Rinne's test reveals that air exceeds bone conduction.
37. Yes
_____________38. Pneumatic otoscopy in the affected ear can elicit symptoms or cause nystagmus.
38. Yes
_____________39. The Romberg test is negative.
39. No
4. Treatment options in suppurative conjunctivitis include all of the following ophthalmic preparations except: A. polyyxin B plus trimethoprim. B. levofloxacin C. polymyxin. D. azithromycin.
4. C. polymyxin.
_____________40. A positive Fukuda marching step test.
40. Yes
41. When evaluating a patient with Meniere's disease, the procedure of observing for nystagmus while moving the patient from sitting to supine with the head angled 4 degrees to one side and then the other is called: A. the Romberg test. B. Dix-Hallpike test. C. the Rinne's test. D. The Fukuda test.
41. B. Dix-Hallpike test.
42. Prevention and prophylaxis in Meniere's disease include all of the following except: A. avoiding ototoxic drugs. B. protecting the ears from loud noise. C. limiting sodium intake. D. restricting fluid intake.
42. D. restricting fluid intake.
47. You inspect the oral cavity of a 69 year old man who has a 100-pack per year cigarette smoking history. You find a lesion suspicious for malignancy and describe it as: A. raised, red, and painful. B. a denuded patch with a removable white coating. C. an ulcerated lesion with indurated margins. D. a vesicular-form lesion with macerated margins.
47. C. an ulcerated lesion with indurated margins.
48. A firm, painless, relatively fixed submandibular node would most likely be seen in the diagnosis of: A. herpes simplex. B. acute otitis media (AOM) C. bacterial pharyngitis D. oral cancer.
48. D. oral cancer.
49. Which of the following is the most common form of oral cancer. A. adenocarcinoma B. sarcoma-form C. squamous cell carcinoma D. basal cell carcinoma
49. C. squamous cell carcinoma
5. Treatment options in acute and recurrent allergic conjunctivitis include all of the following except: A. cromolyn ophthalmic drops. B. oral antihistamines. C. opthalmological antihistamines. D. corticosteroid ophthalmic drops.
5. D. corticosteroid ophthalmic drops.
50. An independent risk factor for oral cancer is infection with: A. human herpes virus type 1 B. human papillomavirus type 16 C. every two years. D. Epstein-Barr virus.
50. B. human papillomavirus type 16
51. Screening for oral cancer is recommended: A. for high-risk patients only. B. at regularly scheduled dental visits. C. every two years. D. to be conducted by qualified healthcare providers only.
51. B. at regularly scheduled dental visits.
52. Which of the following medications is not a penicillin form? A. amoxicillin. B. ampicillin. C. dicloxacillin. D. imipenem
52. D. imipenem
53. A cutaneous reaction nearly always occurs with the use of amoxicillin in the presence of infection with: A. human herpes virus type 1 B. human papillomavirus type II C. adenovirus type 20 D. Epstein-Barr virus.
53. D. Epstein-Barr virus
54. In a person with a well-documented history of systemic cutaneous reaction without airway impingement following penicillin use, the use of which of the following cephalosporin's is most likely to result in an allergic response. A. cephalexin B. cefprozil C. ceftriaxone D. cefpodoxime
54. A. cephalexin
55. Which of the following antimicrobial classes is associated with the highest rate of allergic reaction? A. the macrolides. B. the beta-lactams C. the aminoglycosides. D. the sulfonamides.
55. B. the beta-lactams
56. A 36 year old man presents for his initial visit to become a patient in a primary care practice. He is generally in good health with a history of hyperlipidemia and is currently taking an HMG-CoA reductase inhibitor. He reports that he is allergic to just about every antibiotic," and reports a variety of reactions including diffuse urticaria gastrointestinal upset, and fatigue but without respiratory involvement. He is unclear as to which antibiotics have caused these reactions and states that much of what he knows is from his mother who "told me I always got sicker instead of better when I took an antibiotic." His last use of an antimicrobial was more than 0 years ago and was without reaction. He does not recall the name of this medication, but he remembers that he was being treated for a "sinus infection." The next most appropriate step in his care is to: A. advise the patient to obtain a more detailed history of what antibiotics he was given during his childhood. B. refer to allergy and immunology for evaluation. C. inform the patient to start an antihistamine whenever he is given an antibiotic. D. provide a prescription for a systemic corticosteroid to take if he develops a reaction to his next antimicrobial course.
56. B. refer to allergy and immunology for evaluation.
57. Serious allergic reactions caused by the use of trimethoprim-sulfamethoxazole include all of the following except: A. anaphylaxis. B. Stevens-Johnson syndrome. C. toxic epidermal necrolysis. D. fixed drug eruptions.
57. D. fixed drug eruptions.
58. A 27 year old woman presents with acute bacterial rhinosinusitis that has failed to respond to 5 days of treatment with amoxicillin. She reports that she experiences an allergic reaction to levofloxacin a few years ago that caused a rash as well as swelling of the lips and tongue. In deciding on a new antimicrobial, you consider avoiding the use of: A. amoxicillin-clavulanate. B. azithromycin. C. moxifloxacin. D. cefpodoxime.
58. C. moxifloxacin.
59. You prescribe a regimen of doxycycline to treat an acute exacerbation of chronic bronchitis for a 56 year old man. This is his first exposure to this antimicrobial. You advise that: A. he should no experience an allergic reaction since he has no reported penicillin allergy. B. if he experiences an allergic reaction, he should stop taking the antibiotic and contact a healthcare provider immediately. C. if he experiences an allergic reaction, he should continue taking the medication until he meets with a healthcare provider to avoid resistance development. D. any allergic reaction will eventually resolve once the regimen is complete.
59. B. if he experiences an allergic reaction, he should stop taking the antibiotic and contact a healthcare provider immediately.
6. The most common virological cause of conjunctivitis is: A. coronavirus B. adenovirus. C. rhinovirus. D. human papillomavirus.
6. B. adenovirus.
60. A 4 year old man presents with otitis externa. Likely causative pathogens include all of the following except: A. Enterobacteriaceae. B. P. aeruginosa. C. Proteus spp. D. M. catarrhalis.
60. D. M. catarrhalis.
61. Risk factors for otitis externa include all of the following except: A. frequent air travel. B. vigorous use of a cotton swab. C. frequent swimming D. cerumen impaction.
61. A. frequent air travel.
62. Appropriate oral antimicrobial therapy for otitis externa with an accompanying facial cellulitis suitable for outpatient therapy includes a course of an oral: A. macrolide B. cephalosporin C. fluoroquinolone. D. penicillin.
62. C. fluoroquinolone.
63. Physical examination findings in otitis externa include: A. tympanic membrane immobility. B. increased ear pain with tragus palpitation. C. tympanic membrane erythema. D. tympanic membrane bullae.
63. B. increased ear pain with tragus palpitation.
64. A risk factor for malignant otitis externa includes: A. the presence of an immunocompromised condition. B. age younger than 21 years. C. a history of a recent upper respiratory tract infection (URI) D. a complicated course of otitis media with effusion.
64. A. the presence of an immunocompromised condition.
65. Diagnostic approaches commonly used to identify malignant otitis externa include all of the following except: A. CT scan. B. x-ray imaging. C. radionucleotide bone scanning. D. gallium scanning.
65. B. x-ray imaging.
66. to 69. Indicate which of the following viruses are implicated in causing acute otitis media (AOM). (Answer yes or no.) _____________66. respiratory syncytial virus
66. Yes
______________67. herpes simplex virus 2
67. No
______________68. influenza virus
68. Yes
______________69. rhinovirus
69. Yes
7. Treatment of viral conjunctivitis can include: A. moxifloxacin ophthalmic drops. B. polymyxin B ophthalmic drops. C. oral acyclovir. D. no antibiotic therapy needed.
7. D. no antibiotic therapy needed.
70. to 74 Indicate which of the following bacteria are commonly implicated in causing OAM. (Answer yes or no) 70. S pneumoniae
70. Yes
71. H. influenzae
71. Yes
72. E. coli
72. No
73. M. catarrhalis
73. Yes
74. Risk factors for AOM include all of the following except? A. upper respiratory tract infection. B. untreated allergic rhinitis. C. tobacco use. D. aggressive ear canal hygiene.
74. D. aggressive ear canal hygiene.
75. Expected findings in AOM include: A. prominent bony landmarks. B. tympanic membrane immobility. C. itchiness and crackling in the affected ear. D. submental lymphadenopathy
75. B. tympanic membrane immobility.
76. A 25 year old woman has a 3 day history of left ear pain that began after 1 week of URI symptoms. On physical examination, you find that she has AOM. She is allergic to penicillin (use results in a rapidly developing hive form reaction accompanied by difficulty breathing). She took an oral antimicrobial for the treatment of a urinary tract infection 2 weeks ago. the most appropriate oral antimicrobial option for this patient is: A. Clarithromycin. B. levofloxacin. C. amoxicillin. D. cefadroxil.
76. B. levofloxacin.
77. A reasonable treatment option for AOM in an adult who develops GI upset while taking amoxicillin is: A. cefpodoxime. B. erythromycin. C. cephalexin. D. trimethoprim-sulfamethazole
77. A. cefpodoxime.
78. Characteristics of M. catarrhalis include: A. high rate of beta-lactamase production. B. antimicrobial resistance resulting from altered protein-binding sites. C. often being found in middle ear exudate in recurrent otitis media. D. gram-positive organisms
78. A. high rate of beta-lactamase production.
79. Drug-resistant S. pneumonia is least likely to exhibit resistance to which of the following antimicrobial classes? A. advanced macrolides B. tetracycline forms C. first generation cephalosporins D. respiratory fluoroquinolones
79. D. respiratory fluoroquinolones
8. Anterior epistaxis is usually caused by: A. hypertension. B. bleeding disorders. C. localized nasal mucosa trauma. D. a foreign body.
8. C. localized nasal mucosa trauma.
80. Which of the following is a characteristic of H. influenzae? A. Newer macrolides are ineffective against the organism. B. its antimicrobial resistance results from altered protein binding sites within the wall of the bacteria. C. some isolates exhibit antimicrobial resistance via production of beta-lactamase. D. This is a gram-positive organism.
80. C. some isolates exhibit antimicrobial resistance via production of beta-lactamase.
81. Which of the following is a characteristic of S. pneumonia? A. mechanism of antimicrobial resistance primarily because of the production of beta-lactamase. B. mechanism of antimicrobial resistance usually via altered protein-binding sites held within the microbe's cell C. organisms most commonly isolated from mucoid middle ear effusion D. gram-negative organisms
81. B. mechanism of antimicrobial resistance usually via altered protein-binding sites held within the microbe's cell
82. Which of the following is absent in otitis media with effusion? A. fluid in the middle ear B. otalgia C. fever D. itch
82. C. fever
83. Treatment of otitis media with effusions usually includes symptomatic treatment. A. Symptomatic treatment B. antimicrobial therapy. C. antihistamine. D. a mucolytic
83. A. Symptomatic treatment
84. An 18 year old woman has a chief complaint of a "sore throat and swollen glands" for the past 3 days. Her physical examination includes a temperature of 101 F, exudative pharyngitis, and tender anterior cervical lymphadenopathy. Right and left upper quadrant abdominal tenderness is absent. The most likely diagnosis is: A. Streptococcus pyogenes pharyngitis. B. infectious mononucleosis. CC. vital pharyngitis. D. Vincent angina.
84. A. Streptococcus pyogenes pharyngitis.
85. Treatment options for streptococcal pharyngitis for a patient with penicillin allergy include all of the following except: A. azithromycin. B. trimethoprim-sulfamethoxazole C. clarithromycin. D. clindamycin
85. B. trimethoprim-sulfamethoxazole
86. S. pyogenes is transmitted primarily through: A. sexual intercourse. B. skin-to-skin contact C. saliva and droplet contact D. contaminated surfaces.
86. C. saliva and droplet contact
87. You are seeing a 25 year old man with s pyogenes pharyngitis. He asks if he can get a "shot of penicillin" for therapy. He has no history of drug allergy. You consider the following when counseling about use of intramuscular penicillin: A. There is nearly a 100% cure rate in streptococcal pharyngitis when it is used. B. Treatment failure rates approach 20% C. This is the preferred agent in treating group G streptococcal infection. D. Injectable penicillin has a superior spectrum of antimicrobial coverage compared with the oral version of the drug.
87. B. Treatment failure rates approach 20%
88. With regard to pharyngitis caused by group C streptococci, the NP considers that: A. potential complications include glomerulonephritis. B. appropriate antimicrobial therapy helps to facilitate more rapid resolution of symptoms C. infection with these organisms caries a significant risk of subsequent rheumatic fever. D. acute infectious hepatitis can occur if not treated with an appropriate antimicrobial.
88. B. appropriate antimicrobial therapy helps to facilitate more rapid resolution of symptoms
89. A 26 year old man presents with a progressively worsening sore throat with dysphagia, trismus, and unilateral otalgia. His voice is muffled, and examination reveals an erythematous swollen tonsil with contralateral uvular deviation. The most likely diagnosis is: A. infectious mononucleosis B. viral pharyngitis. C. peritonsillar abscess. D. early-stage scarlet fever.
89. C. peritonsillar abscess.
9. First-line intervention for anterior epistaxis includes: A. nasal packing B. application of topical thrombin C. firm pressure to the area superior to the nasal alar cartilage. D. chemical cauterization
9. C. firm pressure to the area superior to the nasal alar cartilage.
90. Patients with strep throat can be cleared to return to work or school after_____________hours of antimicrobial therapy. A. 12 B. 24 C. 36 D. 48
90. B. 24
91. Common causative organisms of peritonsillar abscess include all of the following except: A. Fusobacterium necrophorum. B. Candida albicans. C. group C or G streptococcus. D. group A beta-hemolytic streptococcus (GABHS)
91. B. Candida albicans.
92. When advising a patient with scarlet fever, the NP considers that: A. there is increased risk for post streptococcal glomerulonephritis. B. the rash often peels during recovery. C. an injectable cephalosporin is the preferred treatment option. D. throat culture is usually negative for group A streptococci.
92. B. the rash often peels during recovery.
93. The incubation period for S. pyogenes is usually: A. 1 to 3 days. B. 3 to 5 days. C. 6 to 9 days D. 10 to 13 days
93. B. 3 to 5 days.
94. The incubation period for M. pneumoniae is usually: A. less than 1 week B. 1 week. C. 2 weeks. D. 3 weeks.
94. D. 3 weeks.
98. All of the following are common causes of penicillin treatment failure in streptococcal pharyngitis except: A. infection with a strain of Streptococcus producing beta-lactamase. B. failure to initiate or complete the antimicrobial course. C. concomitant infection or carriage with an organism producing beta-lactamase. D. inadequate penicillin dosage.
98. A. infection with a strain of Streptococcus producing beta-lactamase.
99. The symptoms of thematic fever include: A. sever, intermittent headaches. B. carditis and arthritis. C. hepatic dysfunction. D. generalized rash
99. B. carditis and arthritis.
95. to 97. Match the patient with the likely causative pathogen for pharyngitis. __________________95. S. pyogenes __________________96. M. pneumoniae __________________97. respiratory virus A. a 17 year old man with a bothersome dry cough, lymphadenopathy, and tonsillar enlargement B. a 34 year old with cough, nasal discharge, hoarseness, conjunctival inflammation and diarrhea C. A 26 year old woman with sore throat and fever, swollen tonsils covered with exudate, palatal petechiae, and anterior cervical lymphadenopathy
_______C___________95. S. pyogenes _______A___________96. M. pneumoniae _______B___________97. respiratory virus
105. to 108. Match each allergen with the appropriate characteristic. (An answer can be used more than once). ________________105. Pollens ________________106. Pet dander ________________107. Dust Mites ________________108. Mold spores A. most common perennial allergen B. Most common seasonal allergen. C. most common indoor allergen.
________B________105. Pollens ________C________106. Pet dander ________A________107. Dust Mites _________C_______108. Mold spores