CAM Final Questions (complete)
A 45 yo male presents to your family practice complaining of flaking of his eyelashes bilaterally. He has an allergy to PCN. He denies any pain. Upon PE you notice that the patient's eyes are red and there are scales on his eyelashes. This condition is usually treated by proper lid hygiene along with baby shampoo and removal of scales with a hot washcloth. Based on this above treatment, what is the most likely diagnosis? A. Blepharitis B. Bacterial conjunctivitis C. Allergic conjunctivitis D. Foreign body E. Cataract
A. Blepharitis (Current, pg. 175)
An 8yo female patient presents to the ER with complaint of SOB. Her vitals reveal she is tachycardic, tachypneic with an open mouth, tripoding, drooling, and can only answer you with a muffled voice. An enlarged "thumb print" sign is noticed upon X-Ray. Which of the following would be an INAPPROPRIATE treatment? A. Supplemental Oxygen B. Albuterol C. IV Ceftriaxone D. IV Dexamethasone E. Airway management
B. Albuterol
A 28-year-old female presents to your clinic with a diminished sense of smell. She complains of feeling congested in one nostril. She has a history of asthma and allergic rhinitis. You prescribe her an intranasal corticosteroid. Which of the following further counseling points would you recommend for this patient? (Current pages 232-233) A. Do not use the intranasal corticosteroid for more than 3 days as it will cause rebound congestion B. Avoid taking aspirin as it could cause a severe episode of bronchospasm C. Biopsy and immediate surgical removal should be scheduled D. Rinse her mouth out after using the newly prescribed corticosteroid E. Reassurance that such symptoms will never happen again
B. Avoid taking aspirin as it could cause a severe episode of bronchospasm
A 28 year old pregnant female presents to the emergency department with sudden onset of dyspnea. Patient has a blood pressure of 128/90, pulse of 116, respiration rate of 27, oxygen saturation of 91% on room air, temperature of 98.3F, and BMI of 32. Patient reports syncope and chest pain that is worse when taking a deep breath. Patient denies cough, hemoptysis, fever, and chills. Chest X-ray and physical exam are normal. What other lab finding do you expect to see with this patient? (CURRENT, pg. 307) A. Ground-glass opacities on chest CT B. Positive D-dimer C. Honeycombing on chest CT D. Elevated WBC count E. Reduced FEV1/FVC ratio
B. Positive D-dimer
Tony, a 13 yo male patient, presents to your clinic with complaint of right ear pain and slight loss of hearing. Tony's temperature is 102.2 F but all other vitals are within normal limits. PE shows conductive hearing loss in the right ear and normal hearing in the left ear. The patient's mother tells you this is the 4th time he has had something similar to this problem in the past year. The ear is tender to palpation. Otoscopic examination of ear reveals a bulging and inflamed tympanic membrane. There are no other remarkable signs on PE. What is the best next step in the management of this patient? (ENT 1 slides 37-47) A. Tx with Augmentin B. Recommend Tympanostomy tubes with Ciprodex ear drops C. Obtain a CT scan D. Admit the patient and start IV Ciprofloxacin E. Obtain a CBC
B. Recommend tympanostomy tubes with Ciprodex ear drops
A 16 Y/o male presents to the clinic with a sore throat and a chief complaint of "hoarseness" when speaking. He appears to be in no acute distress and all vital signs are normal. The patient states that he has been feeling fine, no fever or malaise. On physical exam, there is no sign of pharyngeal injection and breath sounds are vesicular bilaterally. Two nights ago, he was at a concert where he says he was singing at the top of his lungs. What is the most appropriate management of this patient? (Pearls Pg. 257) A. Oral Prednisone B. Penicillin VK C. Nystatin Liquid D. Warm saline gargles, lozenges, and vocal rest E. obtain a lateral neck X-Ray
D. Warm saline gargles, lozenges, and vocal rest
A 45 yo male presents to the clinic with sudden loss of visual field in the left eye. The patient's blood pressure is 150/90 and has a known history of A-fib. On fundoscopic exam, you notice retinal swelling and some cotton wool spots. You immediately recognize this as an emergency and proceed to have the patient lay flat on the table. To confirm your diagnosis, you order duplex ultrasonography of the carotid arteries. You follow this with an ocular massage, high concentrations of inhaled oxygen, and IV acetazolamide. What emergent condition are you treating this patient for?(Current, page 195) A. Central Retinal Artery Occlusion B. Diabetic retinopathy C. Branch Retinal Artery Occlusion D. Macular Degeneration E. Ischemic Optic Neuropathy
C. Branch Retinal Artery Occlusion
A 25 y/o female patient presents to your clinic complaining of throat inflammation and difficulty swallowing. She states that it is difficult to speak. Trismus is noted and anterior cervical lymphadenopathy is seen upon physical exam. There is lateral deviation of the uvula. What is the most appropriate initial diagnostic test to perform?(Current Ch. 8 p. 230 Online), (PANCE Prep Pearls, pg. 257) A. Throat culture B . Rapid antigen detection test C. CT scan D. Biopsy E. Laryngoscopy
C. CT scan
A 73 year old female patient presents to the office with complaints of progressive blurring of vision and a "glare" that is worse when exposed to bright light or driving at night. Patient denies any associated pain or redness of the eyes. Past medical history includes diabetes mellitus as well as pack per day smoker for the last 40 years. On physical exam utilizing an ophthalmoscope or slit lamp, you notice bilateral clouding of the lens. What are you most concerned about? A. Retinoblastoma B. Detached Retina C. Cataract D. Uveitis E. Glaucoma
C. Cataract
A 16 yo male patient presents to the clinic with right sided ear pain. In the patient history, you discover that he was competing in a swimming competition just a couple days ago. He claims that the external ear is "mildly itchy" and sometimes has discharge. On exam, you note erythema and edema of the ear canal, but are not able to visualize the tympanic membrane. The patient claims that the exam you performed was moderately painful, but tolerable. You easily diagnose Otitis Externa of the right ear. From your exam findings, what medication should you prescribe this patient?(Current, page 212) A. Oral Amoxicillin B. Neomycin/Polymyxin B otic drops C. Ciprofloxacin otic drops D. Topical Corticosteroid E. IV ciprofloxacin
C. Ciprofloxacin otic drops
A 14yo girl was brought into your clinic with complaint of sore throat, pain with swallowing, fever, and malaise. Examination reveals an erythematous throat without exudates. What might you include in this patient's treatment plan? A. Starting amoxicillin B. Starting Augmentin C. Counseling on avoiding contact sports D. Refer the patient to the ER E. Administer an IM shot of Rocephin in the office
C. Counseling on avoiding contact sports
A 35 y/o male presents to the ER with complaints of eye pain and swelling for the last 3 days. Upon examination you notice notice erythema around the lower, medial eyelid. Patient denies any trauma and is afebrile. You perform some ocular tests and find that he has normal EOMS and vision. Upon palpation, he complains of slight pain and you notice purulent discharge come out from near the inner canthus of the eye. What is your diagnosis? A. Endophthalmitis B. Preseptal cellulitis C. Dacryocystitis D. Blepharitis E. All of the above
C. Dacryocystitis
MK is a 35 y/o male comes into your clinic with "severe allergies." He has a past medical history of Cystic Fibrosis and asthma. The patient reports that, although his CF is currently well controlled, he has been having rhinorrhea, chronic post nasal drip, and sinus tenderness. Upon examination, you observe an erythematous mass in his right nare that is pale and appears like a "peeled grape." A nasal endoscopy and CT confirms your suspected diagnosis of (Current 232): A. Nasal foreign body B. Nonallergic rhinitis C. Nasal Polyp D. Rhinosinusitis E. Septal Deviation
C. Nasal Polyp
A 30 year-old male presents to the ED approximately 24 hours after an assault in which he reports that he was punched in the face by an unknown party. He states that he initially had diplopia and was having trouble "looking up". The patient is now having difficulty opening his left eye altogether. You note marked swelling around the affected eye on physical exam and crepitus upon palpation, but the area does not feel warm to the touch. What other physical finding would most likely be present? (Pearls p. 236) A. Urinary incontinence B. Multiple foreign bodies in the left eye C. Positive tear drop sign on CT scan D. Purulent discharge from left eye E. Cotton wool spots
C. Positive tear drop sign on CT scan
A 28 year old female present with severe eye pain and photophobia. You notice perilimbal injection and keratic precipitates on slit lamp exam. What is the most appropriate next step in management of this patient? (CURRENT, page 190) A. Reassure the patient B. Genetic testing C. Prednisolone eye drops and urgent ophthalmology referral D. Prescribe Ciprofloxacin ophthalmic solution and follow up in one week E. MRI
C. Prednisolone eye drops and urgen ophthalmology referral
Your patient is a 40 year old male presenting to a primary clinic concerned about a yellowish, elevated conjunctival nodule. It is on the nasal side, in the area of the palpebral fissure and has been present for 6 months. The patient denies pain, and the nodule does not interfere with vision. What is the most appropriate course of action? A. Refer the patient to ophthalmology for surgical excision B. Reassure the patient; this is a pterygium and is benign C. Reassure the patient; this is a pinguecula and is benign D. Prescribe ciprofloxacin drops E. Prescribe corticosteroid drops
C. Reassure the patient; this is a pinguecula and is benign
A 35 y/o male patient presents to your clinic with neck pain and swelling. Pus is present on the floor of the mouth, and displacement of the tongue is present. The patient states this is the first incidence of these symptoms. Which of the following from the patient's medical history would not be indicative of this disease?(Online Current Ch. 8 p. 231), (PANCE Prep Pearls pg. 260) A. Penetrating Trauma B. Cervical osteomyelitis C. Drug abuse D. Branchial cleft cyst E. Odontogenic Infection
D. Branchial cleft cyst
60 y/o female patient presents to your primary care clinic with complaints of decreased visual acuity in both eyes. She notes that her vision has been declining for many years but has not seen a provider for this before. Patient has a PMHx of diabetes and hypertension. On physical exam, you noticed a cloudy opacity on both lens. What is the most likely diagnosis for this patient? A. Astigmatism B. Hyphema C. Glaucoma D. Cataract E. Macular Degeneration
D. Cataract
A 56 yo Caucasian male presents to the Emergency Department with sudden, acute left eye vision loss. He states he was watching his grandson's soccer game when he initially noticed losing his vision. He denies pain in the left eye. Past medical history indicates hypertension, DM, and glaucoma. Fundoscopic examination reveals retinal cotton-wool spots, macular and optic disk edema with retinal hemorrhages in all four quadrants. Relative afferent pupillary defect is noted. What is the most likely diagnosis?(Current, p.194) A. Central Retinal Artery Occlusion B. Acute Narrow Angle Closure Glaucoma C. Amaurosis Faux D. Central Retinal Vein Occlusion E. Optic Neuritis
D. Central Retinal Vein Occlusion
Tony, a 16 year old male, presents to your clinic with complaint of painful swallowing. Temp is 39 degrees celsius. On PE you note pharyngeal erythema, tonsillar exudate, edematous uvula, palatine petechiae, and anterior cervical lymphadenopathy. Both lung and heart examinations are normal and the patient has no other signs and symptoms. You, being a great PA, perform a rapid strep test which comes back positive. On his chart you note an allergy to penicillin medication. When you ask Tony about the penicillin allergy he reports he gets a slight rash on his chest and arms and no other symptoms. Which of the following is the best treatment for the patient? (throat p1 slides 32-36) A. Bactrim B. OTC NSAIDs C. PCN VK D. Cephalexin E. Dexamethasone
D. Cephalexin
A 26 y/o female brings in her 5 year old child to your clinic with pain in his left ear. The mother states this has happened five other times in the past year. You note purulent discharge coming from the ear and upon examination you observe a perforated tympanic membrane. No pain or tenderness noted on the auricle or mastoid bone. There is conductive hearing loss in the left ear. What is the most likely diagnosis? (Nose part 1 lecture slides) A. Malignant otitis externa B. Mastoiditis C. Otitis externa D. Chronic otitis media E. Serous otitis media
D. Chronic Otitis Media
4yo F presents to Family practice complaining of R earache for 3 days with fever of 101.2*F. Mother reports that 5 days ago, her daughter had a runny nose and cough which resolved after 2 days. That is when she started tugging at her ear, not sleeping well, and increased "fussiness". Upon examination you see a bulging, erythematous "angry" TM. While examining, the patient starts to squirm, then screams! You end your otoscopic examination and find bloody/purulent discharge coming from her R ear. After a few minutes the girl stops crying. Mother reports a minor rash when the pt was treated with penicillin 2 years ago. What do you prescribe. A. PO cephalexin B. PO augmentin C. Augmentin otic drops D. Ciprodex otic drops E. Cephalexin otic drops
D. Ciprodex otic drops
7 y/o female with a history of recurrent bronchitis presents to your clinic with a chief complaint of nasal congestion that has been worsening for the last month. Pt's mother states that pt was seen by her pediatrician 2 weeks ago and was diagnosed with a sinus infection and was prescribed amoxicillin which cleared up her purulent nasal discharge, however the pt's congestion remains. Upon examination, you notice swellings inside pt's R nare, and you diagnose the patient with nasal polyps. What disease should be ruled out in this patient considering their age and chief complaint? A. Chronic rhinosinusitis B. Infectious mononucleosis C. Rhinitis Medicamentosa D. Cystic Fibrosis E. Allergic rhinitis
D. Cystic Fibrosis
TR is a 34 y/o patient that presents with "flashing lights" and sudden monocular vision loss. It appears as if a "shadow coming down" but has no pain or redness noted. Upon examination of your patient, what is something you can expect to see during your fundoscopic exam? (Current, pg. 192, PANCE Prep Pearls, pg. 239) A. papilledema B. macular edema C. notching of the optic disc D. "flapping" in the vitreous humor E. Cotton wool spots
D. Flapping in the vitreous humor
A 21 year old male presents to the E.R. Upon arrival he is distressed and having trouble talking. His girlfriend is there and explains that he had strep two weeks ago, but the practitioner failed to give him antibiotics because it was "viral." She is now worried his strep has made his throat swell up. Upon examination, you diagnose him with a peritonsillar abscess. What finding would you NOT expect to find? A. A deviated uvula B. Dry nasal mucosa C. A muffled voice when he tries to speak D. Good skin turgor E. All of the above are present in the patient
D. Good skin turgor
A 34 y/o male complains of a rash and painful, swollen joints. After a thorough history, you find that the patient had a sore throat and a fever 2 weeks ago. What additional findings might this patient present with? (slide 33 of "Mouth and Pharynx lecture) A. sleep apnea B. hematuria C. trismus D. heart murmur E. "hot potato" voice
D. Heart murmur
A mother brings her 13 yo son into your family practice stating he has been complaining of shortness of breath and coughing, especially at night. He experiences the symptoms daily but is only woken-up by his coughing 3-4 x/month. On exam you hear prolonged expiration with wheezing and hyperresonance to percussion. The patient has NKDA and is not on any medications. What is the best form of treatment for the patient? Pance Pearls pg. 81-83 A. SABA inhaler B. ICS inhaler (high dose) and LABA inhaler C. LAMA inhaler D. ICS inhaler (low dose) and LABA inhaler E. Montelukast
D. ICS inhaler (low dose) and LABA inhaler
A 21-year-old female presents to your family practice with a sore throat, hoarseness, and speaking at a whisper level. She states she went to a concert two days ago and woke up yesterday with these symptoms. The patient works as a professional vocalist and has a performance scheduled for next week. Her past medical history is unremarkable, and she takes oral birth control. She is afebrile and normotensive. Pulse is 63 bpm, respirations are 14 rpm, SPO2 is 99% on room air. On exam, she has an erythematous pharynx with no exudates or lymphadenopathy. Rapid strep test was negative. You diagnose the patient with laryngitis. What are you concerned about if you give this patient corticosteroids? (Current p. 244) A. Nothing, they are safe to use in all cases B. If she has an underlying bacterial pharyngitis, taking corticosteroids may put her at risk for sepsis C. Corticosteroids may worsen the patient's condition and should not be given D. If her vocal folds are inflamed, she is at risk for hemorrhage E. Corticosteroids may increase the time it takes for her to recover and should not be given
D. If her vocal folds are inflamed, she is at risk for hemorrhage
6yo patient presents to your clinic with cough, malaise, chills, muscle aches, fever, and headache for the last 3 days. On physical exam patient does not present with tonsillar exudates, shows no hepatomegaly or splenomegaly, and nasal discharge is not purulent. What is your most likely diagnosis? Source: UptoDate A. Acute bronchitis B. Infectious mononucleosis C. Sinusitis D. Influenza E. Allergic rhinitis
D. Influenza
A 40yo patient presents to your clinic with severe right ear pain. States she felt like she had an ear infection for the past 3 weeks but was hoping it would go away on its own. She has a history of 3 previous episodes of otitis externa, hypertension, hyperlipidemia, and uncontrolled diabetes mellitus type II. On physical exam you note a swollen, tender ear, cervical lymphadenopathy, purulence from the ear, and trismus. What is your most likely diagnosis? (Ears pt 1) A. Otitis externa B. Otitis media C. Chronic otitis media D.Malignant otitis externa E. Mastoiditis
D. Malignant Otitis Externa
48 y/o F presents to your clinic complaining of congestion and sneezing. She reports clear rhinorrhea and drainage from her nose, with some mild eye irritation and itching. She states she just moved to the area three months ago and has no current pets in the home. What would you expect to find upon physical exam? (CURRENT, p. 229). A. Purulent discharge around the turbinates B. Erythematous turbinates C. Goopy, yellow discharge from the eyes D. Pale turbinates E. More than one of the above is correct
D. Pale turbinates
Jackie's husband is complaining of her nightly snoring, and so Jackie presents to your clinic today to get it checked out. She states she feels tired often and very unrested. On physical examination her neck circumference is greater than normal. She denies any recent illness and states she has no drug allergies. What is the first line diagnostic tool to confirm your suspicion of sleep apnea? Pance Pearls pg. 122 A. Polycythemia lab B. Epworth sleep scale C. Checking how many pillows she sleeps with. D. Polysomnography E. Sleep satisfaction score
D. Polysomnography
A 68-year-old female presents to the urgent care with left sided facial drooping and a severely painful rash that recently emerged on her left ear. She has been very dizzy. PE reveals a vesicular rash on her external left ear, decreased hearing in her left ear, and obvious paralysis of CN 7 on her left side. She lives with her husband of 40 years, has 2 grown children, no troublesome exposures or risky behaviors. She has a childhood history of chickenpox. She has NKDA, currently uses albuterol to control her intermittent asthma, takes loratadine and intranasal fluticasone to manage her seasonal allergic rhinitis, gets regular exercise and eats a heart-healthy diet. She admits to excess stress recently trying to find the right long-term care facility for her mother. Based on her presentation, what is the most likely diagnosis?(Current p. 1381-1384) A. Secondary Syphilis B. Malignant otitis externa C. Bell's palsy D. Ramsay Hunt Syndrome E. Vestibular Schwannoma
D. Ramsay Hunt Syndrome
A 46-year-old male patient presents to the emergency department complaining of a painful, red left eye for the past few days. On exam, an erythematous left eye is noted with a slight decrease in acuity. EOMs are intact without nystagmus noted. With a fluorescein stain, branching lesions are noted. The patient is tachycardic and claims to not know what could have caused the problem. There are no known drug allergies but he states "I think I might be allergic to cats." The patient does not wear contacts. What is the best topical treatment for this patient? (Current, page 185) A. Artificial tears B. Corticosteroid C. Ciprofloxacin D. Olopatadine E. Antiviral
E. Antiviral
A 24 yo female presents to your urgent care clinic complaining of symptoms of sneezing, nasal congestion, headache, purulent sputum that have been going on for 2 weeks. On exam the patient is tender to palpation over the maxillary sinus and symptoms worsen when she leans forward. The patient is only taking oral birth control, but she does have a PCN allergy (rash). What treatment is BEST for the patient? (Pance Pearls pg 253) A. IV Clindamycin B. Augmentin C. Fluticasone propionate and reassurance D. Prednisone E. Ceftriaxone
E. Ceftriaxone
Pt is a 47yo BF presenting to the ED for an evaluation of hearing loss and ataxia. She states that she has experienced decreased hearing in her left ear over the past three days, and she reports experiencing the sound of a "ringing heartbeat" in the left ear. Additionally, she explains that she has noticed a decrease in her overall balance and has been heavily relying on handrails to walk up flights of stairs. You suspect that the patient may have a vestibular Schwannoma. What imaging study would you order to confirm your suspicion? (Ear pt2 30) A). HRCT B). CT with perfusion C). PET scan D). Head XR E). Enhanced MRI
E. Enhanced MRI
A 30 yo female presents to the ED complaining of chronic hoarseness. She states that this has been going on for about two weeks. Her PMH is insignificant and she denies ever smoking or drinking. She also denies any cough, recent cold or flu-like symptoms, and runny nose. You perform a laryngoscopy to rule out causes of abnormal vocal cord vibration. What is the most likely diagnosis? A. Ludwig's angina B. Epiglottitis C. Polypoid corditis D. Laryngeal leukoplakia E. Gastroesophageal reflux disease
E. Gastroesophageal reflux disease (Current, pg. 244, 1st para).
JT is a 9 y/o patient that presents today with anterior cervical lymphadenopathy, a fever of 99.7, and with no cough or exudates. Based on your suspicion of GABHS and with the use of Centor Criteria interpretation, what Is the FIRST appropriate action to take next? (PANCE Prep Pearls, pg. 236) A. No antibiotic or throat culture needed B. Admit the patient C. Start antibiotic therapy D. Watchful waiting E. Perform a throat culture
E. Perform a throat culture
A patient presents to the ER with a FB sensation in her left eye. Upon gross inspection there is not obvious FB present and no obvious sign of a ruptured globe. The pt is a contact lens wearer. What is your next diagnostic step. A. Fluorescein eye stain B. Refer to ophthalmology C. Administer a Antipseudomonal antibiotic D. Give steroids E. Fox shield
Somebody Ask Deep. I would assume A. Fluorescein eye stain, but I would probably blind the patient then get sued.
A 21 y/o male presents to the ER after an altercation at a bar. The pt is unremarkable except for a pen lodged in his eye. You notice that there is blood in the anterior chamber. The on-call ophthalmologist is paged and on their way in. While waiting for them to arrive which of these treatment measures do you NOT initiate? (Ophthalmology lecture, slide 43) (PANCE Prep Pearls, pg 236) A. Fluorescein dye to visualize any other lesions in the eye B. Place the patient at a 45-degree angle C. Order a CT scan D. Give the patient a tetanus shot E. Dress the patient's eye with a fox shield
A. Fluorescein dye to visualize any other lesions in the eye.
A mother brings her 12 y/o son to a family practice with a complaint of sore throat for the past week. Upon examination you see palatine petechiae, tonsillar exudate, and swollen cervical lymph nodes. He denies a cough and has a fever of 102 degrees fahrenheit. You also notice that he has minor joint swelling and pain and erythema marginatum. In association with these symptoms, what is the most likely possible additional clinical finding? (throat lecture) A. Heart murmur B. Peritonsillar abscess C. Glossodynia D. Lingual thyroid nodule E. None of the above
A. Heart murmur
A 34-year-old female presents to your clinic with complaints of her mouth burning and swollen gums. She states that she also thinks she has some bumps in her mouth but she can't see them very well. The patient has a history of hypertension, asthma, and HIV. All three seem to be well controlled at this time. On physical examination, you see signs of gingivitis and small vesicles that appear grey/yellow on her soft palate and buccal mucosa. The patient states that she's had this before a while back but can't remember what she did for it. What is the most likely diagnosis? (Current, page 238) A. Herpes stomatitis B. Erythema multiforme C. Aphthous stomatitis D. Syphilitic chancre E. Carcinoma
A. Herpes stomatitis
8y/o male presents to your office with epistaxis. The pt has a history of picking his nose. Which of the following is the most likely source of the bleed? (ENT Nose and Sinus ppt Nowak) A. Kiesselbach's plexus B. Sphenopalatine artery C. Posterior ethmoidal arteries D. Superior labial artery E. Greater palatine artery
A. Kiesselbach's plexus
52 year old male comes in to your office complaining of extreme pain and discharge from his right ear. He mentions that he has had the pain in his ear for a while, but it has gotten much worse. Patient describes the pain as feeling "deep". PMH is significant for type 2 diabetes mellitus for which he takes Metformin. You are unable to visualize the tympanic membrane on physical exam due to severe edema. You do note that there is some granulation tissue in the canal and the discharge smells foul. Patient then mentions that the has had some difficulty tasting things lately and the right side of his face is droopy. Osseous erosion on CT scan confirms your diagnosis and you appropriately admit the patient for IV antibiotics. What is your diagnosis? (CURRENT, p. 212) A. Malignant Otitis Externa B. Otitis Externa C. Cholesteatoma D. Ramsay Hunt Syndrome E. Ruptured Tympanic Membrane
A. Malignant Otitis Externa
Joyce walks into your ER complaining of right ear pain and some "gunk" coming out of it. She states her diabetes has been uncontrolled for the last few weeks because of all of the Girl Scout cookies she has been eating. Her temperature is 102.4 F and all other vitals are within normal limits. On examination she states she has a lot of pain behind the ear upon palpation and the overall impression of the external ear canal is swollen, red, and warm to the touch. Joyce has had a lot of right ear infections and states she does not desire to quit eating Girl Scout cookies anytime soon. What is your diagnosis? Sanford Guide pg. 11 A. Necrotizing otitis externa (malignant) B. Otitis externa "swimmer's ear" C. Otitis media D. Meningitis E. Cholesteatoma
A. Necrotizing otitis externa (malignant)
The pathogens Haemophilus influenzae and Streptococcus pneumoniae are common pathogens in which of the following diseases? (Current pages: 226, 245, 279, 280) A. Otitis media, community acquired pneumonia, and acute sinusitis B. Otitis media and strep pharyngitis C. Pemphigus Vulgaris, folliculitis, and hordeolum D. None of the above are correct E. Hospital acquired pneumonia, bronchitis, and erysipelas.
A. Otitis Media, community acquired pneumonia and acute sinusitis
A 19 yo male presents to your clinic concerned that he has an ear infection. He states that he began to have pain in his L ear while on vacation and returned from traveling with his family to feel building pain and pressure in the L ear. The next morning he awoke with discharge on his pillow and noticed that the pressure from the day before was gone. What complication of Otitis Media are you concerned for upon hearing this patient's progression? (Ear Disease Sheet Review Powerpoint, slide 25-26) A. Ruptured tympanic membrane B. Cholesteatoma C. Mastoiditis D. Labyrinthitis E. Chronic Otitis Media
A. Ruptured tympanic membrane
Considering MK's diagnosis of a Nasal Polyp, you choose to prescribe intranasal corticosteroids and follow up in a minimum of one month to reevaluate the mass. Especially considering the patient's history of asthma and his current diagnosis, you would want to counsel the patient to avoid using any OTC Aspirin because of concern for (Current 232-233): A. Severe bronchospasm from Triad Asthma/Samter's Triad C. Altered mental status D. Nausea and vomiting E. Foreign Body E. Acute viral rhinosinusitis
A. Severe bronchospasm from Triad Asthma/Samter's Triad
A 33yo WM presents to the walk-in clinic with a "bump on his eye." He is complaining that it is pretty painful. On inspection you note its location on the eyelid margin and that it is warm, swollen, and erythematous. What is the most likely pathogen causing this patient's issue? (Pance Prep Pearls - p 235) A. Staphylococcus aureus B. Streptococcus pyogenes C. Haemophilus influenzae D. Adenovirus E. Moraxella catarrhalis
A. Staphylococcus aureus
A 28 y/o white male comes into your urgent care clinic complaining of right ear pain for the last 3 days. The patient has no known allergies and his prior medical history is unremarkable. Upon examination of his ear, you determine he is suffering from an acute otitis externa. Due to the swelling you are unable to visualize the TM. What medication is contraindicated in this patient? A. Topical aminoglycoside (Neomycin) B. Topical FQ (Ciprofloxacin) C. Oral FQ (levofloxacin) D. Oral aminoglycoside (Tobramycin)
A. Topical amionglycoside (Neomycin)
DE is a 25-year-old male presenting to the complaining of "burning eyes". He states that for the 2 days he has had burning in his eyes with some kind of discharge and is worried he has some kind of infection. Upon examination you observe bilateral conjunctival erythema with a stringy discharge. Based on your diagnosis, what is the most appropriate treatment (Current p. 178)? A. Topical antihistamine drops B. Ciprofloxacin drops for 7 days C. Cool compresses for the eyes D. Warm compresses for the eyes E. Oral doxycycline for 10 days
A. Topical antihistamine drops
A 24-year-old male presents to your dermatology clinic stating, "my skin won't tan anymore, bro." Upon taking his history, you learn the patient works as a beach lifeguard and is an avid surfer. He states that he doesn't need to bathe because, "the ocean is my bath." Upon exam, you notice the patient has a tan skin tone with many white macules all across his chest and shoulders. You are able to visualize large, blunt hyphae and thick-walled budding spores on KOH prep. What of the following would be the best treatment to start in this patient?(Current page 122) A. Two doses of oral fluconazole, 300 mg, 14 days apart. B. Permethrin 5% topical cream. C. Topical hydrocortisone ointment. D. Oral doxycycline, 300 mg q daily, for 10 days. E. Tell him to start using SPF 80 sunscreen.
A. Two doses of oral fluconazole, 300 mg 14 days apart
A 52 y/o male patient presents to your clinic complaining of recent hemoptysis, chills, weight loss, night sweats, and malaise. Patient states hemoptysis began few weeks ago and he has had no improvement since onset. Patient has history of HTN and rheumatoid arthritis (for which he takes chronic steroids) but no other major medical problems that he is aware of but states that he does not know if he had any major illnesses as a child. Patient denies recent travel but admits to travelling to South Africa several times as a child and teenager with his parents on mission trips. Patient works in an office as an accountant and denies tobacco, alcohol use, and illicit drug use. Which of the following are you MOST likely to see on his CXR? (Current, p. 290) A. Upper lobe infiltrates B. Increased interstitial markings C. Flattened diaphragm D. Hyperinflation of the lungs E. No changes/ normal CXR
A. Upper lobe infiltrates
At patient presents with dizziness, nausea, and vomiting over the last 2 months. Patient states they had "the cold" a week before the symptoms began. The nausea is worse when moving the head. You perform a Dix-Hallpike maneuver which is negative. Patient has horizontal nystagmus. What is the most likely diagnosis. A. Vestibular Neuritis B. Meniere's Disease C. BPPV D. CN-V infection E. CN-IIV infection
A. Vestibular Neuritis
A 42 year old male comes to your clinic complaining of "dizziness and spinning" that had started the day before. During your assessment, the patient states he had acute bronchitis that had subsided "a week or 2 ago." During the PE Weber and Rinne do not show any signs of hearing impairment and the patient does not complain of hearing loss. What condition does your patient most likely have? A. Vestibular neuritis B. BPPV C. Labrynthitis D. Meniere's disease
A. Vestibular neuritis
A 54-year-old male presents to your clinic with complaints of pain in his mouth and annoying white patches covering his tongue. Upon exam curd-like white patches are easily scraped off, leaving his tongue erythematous. The KOH wet prep comes back positive. Based upon your presumed diagnosis what further testing should you consider for this patient? (Current, page 236) A. Biopsy B. HIV testing C. Rapid strep test D. CFTR genotyping E. Needle aspiration
B. HIV testing
A 20-year-old male with history of diabetes presents to the clinic complaining of severe eye pain and decreased visual acuity in his right eye. He states that he has been experiencing an increase in tearing coming from his right eye. He also states that he has a foreign body sensation in his right eye. Due to his severe pain and foreign body sensation, you decide to perform a fluorescein eye stain. Using the UV light, you notice a green spot on his cornea. You decide to culture his right eye discharge in order to definitively treat your patient. The culture results are consistent with a bacterial infection. What medication would you prescribe to treat this patient's likely diagnosis? (Sanford pg. 14) A. Trifluridine drops B. Ciprofloxacin drops C. Moxifloxacin drops D. Vidarabine ointment E. Natamycin drops
B. Ciprofloxacin Drops
A 50-year-old male presents to the emergency department with a complaint of periods of having a spinning sensation with nausea, vomiting, and a loss of balance. The patient states that these episodes typically last about an hour. He also states that he is experiencing ringing in his ears and hearing loss that seems to come and go. The patient has a history of hypertension, type 1 diabetes mellitus, and recently had syphilis. What is the best treatment for this patient? (Current, page 222) A. Corticosteroids B. Diuretics C. Nothing D. Epley maneuver E. surgery
B. Diuretics
65 y/o male w/ a PMH significant for HTN, DM presents to your clinic with chief complaint of white patches on his tongue that have been present for the last 6 months. Upon examination you notice that the patches are localized to the lateral margins of the patient's tongue. The patches are not able to be scraped off, and KOH test is negative. What is the most likely pathogen that could have caused the patient's symptoms? A. Strep pyogenes B. Epstein Barr virus C. Staph aureus D. Candida albicans E. Herpes simplex
B. Epstien Barr Virus
A 41 y/o male presents to your clinic complaining of decreased vision in his left eye. He reports recovering from a sinus infection that he had last week. On inspection, you notice the left eyelid is red and swollen. You suspect the patient has orbital cellulitis. What physical exam test would be most useful in order to verify your diagnosis? (Pance Prep Pearls p. 241) A. Fluorescein eye stain B. Extraocular movements C. Visual Fields D. Ophthalmoscopic exam E. Direct and Consensual Pupillary Light Reflex
B. Extraocular movements
A 30-year-old female presents to the emergency department complaining of changes in her vision in her right eye over the past few days. Upon examination, her extraocular movement appear to be intact, although she does complain of pain in the right eye with these movements. When testing her visual fields, she seems to have a blind spot in the right eye and has trouble differentiating between colors. You also perform a special test using a flash light, which you swing from her left eye to the right and notice there is a delayed response with pupil dilation. What is the appropriate first line treatment for your diagnosis for this patient? (Current p. 200) A. PO corticosteroid B. IV methylprednisolone C. IV acetazolamide D. Topical corticosteroid E. Latanoprost
B. IV methylprednisolone Optic neuritis
Joyce presents in your clinic stating she has had a tumor in her nose. Her medical history includes asthma and seasonal allergies. Her vitals are all within normal limits. Upon physical examination you see pink masses bilaterally. She states that she does have a decreased sense of smell. What is your treatment for Joyce? (Pance Pearls pg. 254) A. Ciprofloxacin B. Intranasal corticosteroids C. Oral antihistamines D. Augmentin E. Nasal Irrigation
B. Intranasal corticosteroids
A 7 year old male is brought to your clinic by his mother for his "stuffy nose". The patient is mildly ill-appearing, with rhinorrhea and acute nasal congestion. The patient's mother states that his symptoms began "more than a week ago", that they seemed to improve but then got worse. The patient has significant purulent nasal discharge, maxillary tooth pain, and a temperature of 102 degrees F. You decide to treat the patient for acute bacterial rhinosinusitis. After being informed by the mother that the patient has an anaphylactic reaction to penicillin, what medication will you choose for the patient? (Sanford Guide, Sinusitis) A. Doxycycline B. Levofloxacin C. Azithromycin D. Cephalexin E. Vancomycin
B. Levofloxacin
A 1 y/o female is brought into your clinic by her mother with pulling at her right ear. Mother states her daughter has had cases of two cases of otitis media previously, and she has had drainage from this ear for "weeks now." Pt also has a 101.5 fever, and mother reports she just noticed her daughter looking flushed a couple of hours ago. Upon exam, you notice that the posterior ear is erythematous and has significant edema. The pt is also very fussy when you palpate the swelling over the mastoid process. What are you most concerned for?(Ears pt 1) A. Chronic Otitis Media B. Mastoiditis C. Acoustic Neuroma D. Malignant Otitis Externa E. Foreign Body
B. Mastoiditis
A 24 y/o male patient presents to the ED c/o severe facial pain after a bar fight 2 hours ago. On examination you find that the patient has diplopia on upward gaze, decreased visual acuity and orbital emphysema. What do you suspect as the patient's diagnosis? (nose part 2 ppt Pearls pg 236) A. Globe rupture B. Orbital floor blowout fracture C. Laforte Fracture Type 1 D. Foreign Body in the eye E. Retinal Detachment
B. Orbital floor blowout fracture
A 40 yo female presents to clinic with uncharacterized vision loss in the left eye. She states that this has been very gradual, and has only affected the peripheral vision of her left eye until recently. She states that she is originally from California, and loves to be in the sun. The patient has a PMH of actinic keratosis on her hands, which is resolving. Upon eye exam you notice a triangular fleshy encroachment of the conjunctiva, and conclude that there's a marked induced astigmatism. What is the most appropriate treatment for this patient? (Current pg. 178) A. Artificial tears B. Referral to an ophthalmologist for excision C. Ciprofloxacin drops D. Assure the patient E. Warm compresses
B. Referral to an ophthalmologist for excision. The condition is a pterygium impeding vision
A 19-year-old female presents to the ER with neck pain and difficulty breathing. She states that she had a recent "bad tooth," but denies any other significant history. PE is positive for edema and erythema of her upper neck, especially under her chin. You also notice that her tongue is displaced upward. What is your first step in treating this patient? (Current, ENT chapter) A. Start her on IV penicillin and metronidazole immediately. B. Secure her airway before any other treatments are initiated. C. Get a contrast-enhanced CT to define the extent of infection. D. Start her on IV clindamycin and steroids immediately. E. None of the above.
B. Secure her airway before any other treatments are initiated.
A 45 year-old obese female presents to the ED complaining of difficulty breathing and a sharp, non-radiating pain in the R side of her chest that increases with inspiration. She states that she has been smoking a pack-per-day for the last 20 years but that she has never felt this way before. The patient also reports that she broke her leg two weeks ago and that she has "spent a lot of time on the couch" recently. While she's here, she would also like to refill her birth control medications before she runs out. Pt is slightly tachycardic with an spO2 of 88% on room air. What is the first intervention that you would perform on this patient? (PANCE Prep Pearls p. 103) A. Initiate a breathing treatment with albuterol and ipratropium B. Start the patient on supplemental oxygen C. Perform a spiral CT D. Administer IV furosemide E. Refill her birth control medications
B. Start the patient on supplemental oxygen
18yo M presents to his primary care for routine asthma follow up. Pt has 12yr history of controlled intermittent asthma, only needing an albuterol inhaler 1-2x a month. Patient history pertinent for allergic rhinitis, PCN allergy (anaphylaxis), eczema, and tonsillectomy (age 6). While pt only uses albuterol inhaler 1-2 a month, he reports increased usage last week while visiting family in rural TN (Patient lives in Arizona: dry, desert, no pollen/allergens). Pt slept with the windows open due to no AC and was awakened 4 nights in a row with SOB and had to use his rescue inhaler. It is now empty and he needs a refill. How do your counsel and treat this patient? A. Tell him TN is the allergy capital of the world and he should be fine now that he is home. Refill inhaler, no further treatment necessary. B. Tell him it was probably allergy induced asthma and should be better now that he is home. Refill inhaler, and write for a short course of oral prednisone to treat the flare up. C. Tell him that asthma can progress and due to 4x night time awakenings he now has moderate persistent asthma and needs SABA, Med ICS + LABA D. Tell him that asthma and allergies are closely related and his sx have moved him into the severe persistent stage. He needs SABA, High ICS + LABA and prescribe omalizumab for allergies.
B. Tell him it was probably allergy induced asthma and should be better now that he is home. Refill inhaler, and write for a short course of oral prednisone to treat the flare up.
A 47 y/o male presents to the clinic c/o pain to his left eye. Upon history, the patient notes that the eye is also constantly watery and sensitive to light. On examination, there is perilimbal injection with white specks floating around the eye when using a slit-lamp. The patient's vision in the left eye is 20/40. The patient does not wear glasses or use contacts. What is the best treatment for this patient's likely diagnosis? (PANCE p. 242 & slide 43 Eye I) A. Topical antibiotics B. Topical corticosteroids (Anterior Uveitis/Iritis) C. Artificial tears D. Systemic corticosteroids E. Oral antihistamines
B. Topical corticosteroids (Anterior Uveitis/Iritis)
A 21 year-old male with no past medical history presents to your clinic with the chief complaint of right eye pain. He states pain began this morning and is becoming increasingly more painful as time goes on. The patient has no known drug allergies or medical problems. On examination the patient has conjunctival erythema, reduced vision and photophobia. You decide to perform a fluorescein eye stain, and via use of a Wood's lamp, you notice what appears to be a branch-like lesion consistent with Viral keratitis. What treatment is best for this patient? (Current p. 185) A. Moxifloxacin Oral antibiotic B. Trifluridine antiviral eye drops C. Moxifloxacin eye drops D. Oral Prednisone E. Oral antihistamine
B. Trifluridine antiviral eye drops
A 35 year old female presents to your clinic complaining of excessive rhinorrhea. Upon exam, you notice the rhinorrhea is clear. After taking her history, you learn that her rhinorrhea does not follow any seasonal patterns. She has lived in Knoxville since she was 5 years old and denies any history of seasonal allergies. She admits it worsens only when she takes ibuprofen for her occasional headaches. What is the most likely cause of the patients rhinorrhea? (Nose lecture slide 37) A. Allergic rhinitis B. Vasomotor rhinitis C. Bacterial sinusitis D. Chronic sinusitis E. Rhinitis medicamentosa
B. Vasomotor rhinitis
4. After how long must a patient experience symptoms to be diagnosed with chronic sinusitis and warrant a referral to ENT? (Nose Disease Sheet Powerpoint, Slide 8) A. 5 days B. 10 days C. 3 months D. 6 months E. 1 year
C. 3 months
A 48 yo male presents to your clinic with ringing in his left ear and frequent headaches. He also mentions that he has been feeling off balance. He says that this has been going on for a few weeks now, but it does not affect his ADLs. He denies ear pain, discharge, vertigo, and any recent trauma. He has no significant medical history. During your exam, you see that the tympanic membrane is pearly gray with a normal cone of light. Weber lateralizes to the right ear, and Rinne reveals that AC>BC. All other CNs are normal. You order an MRI which reveals a lesion within the auditory canal. What is your diagnosis?(Current, page 224) A. Neurofibromatosis type 2 B. Multiple sclerosis C. Acoustic neuroma D. Perilymphatic fistula E. Presbycusis
C. Acoustic neuroma
A 4 year old male presents to the clinic with a fever of 101.1 and is complaining of a sore throat. His mother states that he has not had a cough, but just felt "crummy" overall. On physical examination his throat is erythematous and with tonsillar exudates. What additional finding would you expect? a. Nausea/vomiting b. Drooling c. Anterior cervical lymphadenopathy d. Posterior cervical lymphadenopathy e. Trismus
C. Anterior cervical lymphadenopathy
An 8 y/o female presents to the ED with her mother c/o pain to her right eye and decreased vision. Upon history, the mother mentions that they visited their pediatrician about 2 weeks ago and were given amoxicillin for an acute bacterial sinusitis. She is worried that the antibiotics did not work and she feels like her daughter is still feverish. On examination the patient complains of pain with ocular movement and has notable erythema and edema to her right eyelid. What is the best management for this patient's likely diagnosis? (CURRENT p. 202 & 227-228) A. Reassure the mother and discharge with instructions to finish the patient's course of antibiotics. B. Switch the patient's antibiotics to a 3rd generation cephalosporin for broader coverage. C. Begin appropriate IV antibiotics and admit the patient. D. Refer the patient to follow-up with an ophthalmologist within the next 7 days, and to return if her symptoms worsen. E. Instruct the patient to take Tylenol with her antibiotics to improve her fever.
C. Begin appropriate IV antibiotics and admit the patient. Orbital cellulitis
A 28-year-old female comes to your primary care office after a recent camping trip in Hawaii. She reports that she feels fine now, but when she was camping any time she laid down she experienced extreme dizziness. She says the sensation was only present when laying down, and lasted seconds to minutes. She reports that it hasn't happened since she arrived home from the trip but wants to know if it will happen again. What condition was this patient most likely experiencing? (A Comprehensive Review of the Certification and Recertification Examinations for Physician Assistants, pg 14) A. Labyrinthitis B. Vestibular Neuritis C. Benign Paroxysmal Positional Vertigo D. Ménière's Disease E. Brainstem Infarction
C. Benign Paroxysmal Positional Vertigo
A 17 y/o female presents to your family practice with complaints of eye pain. She denies any fever, fatigue, or changes in weight. She admits to being struck in the face with a softball at her game yesterday. You notice some swelling around the bridge of her nose. Visual acuity is 20/40 for the affected eye and 20/20 for the unaffected eye. When checking EOMs you find that the affected eye has difficulty looking upwards. What is the most likely diagnosis? A. Diplopia B. Globe rupture C. Blowout fracture D. Anisocoria E. None of the above
C. Blowout fracture
Patient CW presents to ER with L ear pain for one week and greenish milky discharge for two days. Patient has a history of diabetes melanous and has a current A1C of 13. During the Weber test sound was greater in the left ear. The Rinne test had air conduction greater than bone conduction in the R ear and bone conduction greater than air conduction greater in the L ear. When the discharge is cultured it is positive for pseudomonas aeruginosa. Which of the following is not an appropriate treatment for patient CW? (Ear part 1, slides 25-28) A. Hyperbaric Oxygen B. Surgical debridement C. IV Penicillin D. IV Ciprofloxacin E. IV Imipenem
C. IV Penicillin
A 41 year old male presents to the ER with a complaint of a painful L eye. You note the eye is completely swollen over and erythematous. The patient also presents with a fever. On examination you note pain on EOMs in the L eye and no obvious trauma. You decide to admit the patient and send him to get a CT without contrast. It is confirmed that the patient has orbital cellulitis of the L eye. The patient has an anaphylactic allergy to PCN. What is your course of treatment? (Sanford, Orbital Cellulitis) A. Oral Bactrim B. IV Vancomycin C. IV Vancomycin + Moxifloxacin D. IV Vancomycin + Zosyn E. IV Linezolid
C. IV Vancomycin + Moxifloxacin
Jerry has had asthma for years. He is currently prescribed a low dose ICS and a LABA, and he has a SABA for exacerbations. Jerry says that he felt like these treatments were working well until recently. For the last month, he has been waking up with difficulty breathing in the middle of the night more than once a week, and he has been using his emergency inhaler daily. Jerry says that he has never had daily symptoms until recently, and he has not changed the way that he has been taking his medications. Jerry currently shows no signs of respiratory distress. What would you like to do for Jerry? (PANCE Prep Pearls, p. 83) A. Reassurance and watchful waiting B. Prescribe oral corticosteroids along with current treatment C. Increase to a medium dose ICS along with current LABA and SABA D. Increase to a medium dose ICS and discontinue the LABA, continue the SABA E. Immediately administer albuterol and ipratropium via nebulizer mask
C. Increase to a medium dose ICS along with current LABA and SABA
15yo patient presents with a sore throat for the past 3 days. Patient recently finished a 10-day course of antibiotics for a sinus infection, and uses a daily low dose ICS inhaler for asthma. On physical exam you note white patches on the oral mucosa and tongue. You are able to scrape them off. What test do you do to determine the source of infection? (CAM Throat pt 1 lecture slides) A. Blood cultures B. Biopsy C. KOH smear D. Rapid strep test E. CBC
C. KOH smear
A 55 year old female presents to the ED complaining of severe right eye pain and sudden vision loss in the right eye. The patient is nauseous and vomits twice during the physical exam. On exam, you notice that the right pupil is mid-dilated and not reactive to light, and there is increased pressure in the right eye, which is hard on palpation. What is the DEFINITIVE treatment for this patient? (CURRENT, page 187). A. Latanoprost eye drops B. IV acetazolamide C. Laser iridotomy or surgical iridectomy D. Timolol eye drops E. IV methylprednisolone
C. Laser iridotomy or surgical iridectomy
A 21 year old college student presents to your clinic with a week and a half of ear fullness and decreased hearing in the right ear while being treated for bacterial sinusitis. Upon physical examination after conducting Weber and Rinne, it is found that the L ear is normal and the sound lateralized to the R ear during Weber and bone conduction was greater than air conduction. When using the otoscope to view the tympanic membrane, you notice air bubbles behind the tympanic membrane. What is your course of treatment? (Current P. 213) A. Antibiotics B. Reassurance of the patient C. Oral and/or intranasal decongestants D. Valsalva maneuver E. Placement of tympanostomy tubes
C. Oral and/or intranasal decongestants
AB is a 22-year-old female presenting to the clinic complaining of sinus congestion for the last 2 weeks. She reports headache, nasal discharge, and occasional dizziness when she moves her head. Her temperature is 99.1*F, blood pressure is 113/73, heart rate is 72 and normal, and respiratory rate is 15 and regular. Upon examination you see inflammation of the nasal cavity and paranasal sinuses as well as purulent nasal discharge. AB has no known drug allergies and has been on antibiotics 4 other times in the last 6 months for similar symptoms. Based on your diagnosis, what is your next step in treatment (Current p. 227-228)? A. Treat with PO Augmentin for 10 days B. Treat with PO Clindamycin for 21 days C. Order a CT of the sinuses to check for obstruction D. Prescribe oral prednisone for 10 days E. Reassure the patient
C. Order a CT of the sinuses to check for obstruction
27 y/o female patient presents to your office c/o right ear pain. Patient states she feels like she has "fluid in her ear" and describes the pain as "pressure." On exam you note a non-erythematous and non-bulging right TM with transudative fluid and air bubbles present behind the TM. Patients vitals are normal and there is no pertinent past medical history. At this time, what is your recommended best treatment of choice for the patient? (Current, p. 213-214) A. Augmentin PO B. Ciprofloxacin otic drops C. PO decongestants D. PO steroids E. Amoxicillin PO
C. PO decongestants
24yo M presents to ED with extreme HA. Pt hx pertinent for migraines with aura, contact lens wearer, ½ pack/day smoker, social drinker, T2D. Patient came out of the movies and started experiencing a headache. Rapid onset, unilateral on L side, excruciating pain centered around L eye. HA was not preceded with his normal aura. Started seeing halos of lights, then blurry vision and within 1 hour lost vision in L eye. Patient has vomited twice. Based on the history, you have 2 differential diagnoses. What is the first/fastest diagnostic test you could perform to solidify your diagnosis? A. Ophthalmic exam on R eye checking for papilledema B. Head CT to check for bleed C. Palpate the L orbit to check for IOP D. MRA to look for CVA E. Start on 15L non-rebreather to treat for Cluster HA
C. Palpate the L orbit to check for IOP
60 year old female comes into the clinic complaining of vision changes that have gradually gotten worse over the past several months. She denies any recent trauma or neurological changes. Upon performing the fundoscopic you find small, round, yellow white spots on the outer retina. What other findings would this patient most likely have? A. The patient will have tunnel vision B. Results will be normal C. Patient will have metamophopsia D. Marcus-gunn pupil E. Bitemporal heteronymous hemianopsia
C. Patient will have metamophopsia
A 9 yo male presents to urgent care with complaint of sore throat and cough. All vitals are normal aside from a temperature of 101.7 F. On exam you notice swollen anterior cervical lymph nodes, an erythematous pharynx, but no tonsillar exudates. Based on the Centor criteria, what is the NEXT appropriate action in response to these clinical findings? (Current pg. 239). A. Reassurance B. Warm saline gargles C. Throat culture or RADT D. Empiric antibiotics E. ENT consult
C. Throat culture or RADT
What diagnosis would you NOT recommend a warm compress for? (Pearls pg 240). A. Blepharitis B. Hordeolum C. Viral Conjunctivitis D. Sialadenitis E. None of the above
C. Viral Conjunctivitis
A 65 year old male patient presents to the emergency department with a chief complaint of headache. Associated symptoms include nausea/vomiting. There is no visual impairment. As an excellent physician assistant, you perform a thorough physical exam and on your fundoscopic exam, you notice bilateral swelling of the optic disk with blurred margins. CT scan of the head has ruled out any intracranial masses. Lumbar puncture was then performed and shows an increased opening pressure. You correctly diagnosis the patient with papilledema after consultation with ophthamology. What is the best pharmacologic treatment for papilledema? A. IV corticosteroids B. Watchful waiting C. Ciprodex eye drops D. Acetazolamide (diuretic) E. Decongestants
D. Acetazolamide (diuretic)
23 y/o male presents to your office c/o pain on swallowing and severe sore throat for 2 days. Patient appears in distress and is using accessory muscles to breathe. PE is normal. You order a lateral, cervical X-ray and notice a "thumb-print" sign. What is the first step in management for this patient? (CURRENT, p. 235) A. PO Corticosteroids B. IV Ceftriaxone C. Throat culture D. Airway management E. Laryngoscopy
D. Airway managment
A 40 y/o female patient presents to your clinic with hoarseness of voice x4 days. She states she is an opera singer that hasn't been able to perform since the onset of her illness. Upon examination, rhinitis and inflamed vocal folds are observed. What is NOT a likely suggestion for management of her illness? (Current Ch. 8 p. 234 online), (Pearls p. 257) A. Erythromycin B. Oral corticosteroids C. Warm saline gargles D. Ampicillin E. Vocal Rest
D. Ampicillin
46 y/o female with a PMH significant for DM, hyperlipidemia presents to the ED with a chief complaint of intermittent dizzy spells for the last 2 weeks. She states that the episodes seem to happen at random and typically last about 30 minutes. She has never experienced any symptoms like this in the past and she cannot seem to find any aggravating factors. She reports associated symptoms of nausea, ringing in her L ear and a sense of pressure in the L ear. What additional symptom would you expect to find in this patient? A. Conductive hearing loss in the R ear B. Conductive hearing loss in the L ear C. Sensorineural hearing loss in the R ear D. Sensorineural hearing loss in the L ear E. None of the above.
D. Sensorineural hearing loss in the L ear
19 y/o female presents to your office c/o a cough, extreme fatigue, and muscle aches for the past 4 days. She also mentions that she's experiencing nasal congestion, but it has been improving. Physical exam is unremarkable. Vital signs are normal except for temperature of 102.2 F. You order a rapid influenza test and it comes back positive. What treatment should you initiate? A. Tamiflu B. Augmentin C. Acyclovir D. Supportive care E. Bactrim
D. Supportive care
A 14 yo male presents to an urgent care clinic complaining of extreme sore throat and body aches x 4 days. He has notices being more tired than usual after basketball practice. Patients vitals read: T: 100.4, BP:120/80, O2: 99%, R:14, HR: 70. He has not received the flu vaccination this year and states several people at school have been ill with similar symptoms. On physical exam you notice erythematous tonsils with white exudates. Posterior cervical lymphadenopathy is noted. On palpitation you notice splenomegaly with slight hepatomegaly. He denies having a cough. Rapid strep test is negative, and culture is pending. What is the most appropriate treatment for this patient? A. Ampicillin B. Augmentin C. Doxycycline D. Supportive care with analgesics and antipyretics E. Acyclovir
D. Supportive care with analgesics and antipyretics (Current p. 239)
A mother brings in her two-year-old son to your primary care clinic because she thinks he might be cross-eyed. On exam, you note that there is significant misalignment when you perform the corneal light reflex test and binocular fixation is not present. You decide to refer because the patient's condition appears severe. What is the most likely treatment for this patient? (A Comprehensive Review of the Certification and Recertification Examinations for Physician Assistants, pg 10) A. Prescribe corrective glasses B. Reassurance, this condition will resolve as the child grows C. Watchful waiting D. Surgery E. Warm compress and improved hygiene
D. Surgery
While in your family practice clinic for their yearly physical patient DW mentions that they have mild pain in their tongue. Upon examination and palpation the patient's tongue is smooth with atrophy of the filiform papillae. Which of the following could not be a possible cause? (Throat part 1, slide 5) A. Iron deficiency B. Vitamin B12 deficiency C. Celiac Disease D. Vitamin D deficiency E. Syphilis
D. Vitamin D deficiency
A 28 yo graduate student presents to the Emergency Department with sudden onset of severe dizziness. She states she has never experienced severe dizziness in the past. Patients vitals read T: 99.2, BP:120/85, R:14, O2: 99%, HR: 76, BMI 22.1, Patient complains of nausea, vomiting, and tinnitus with decreased hearing loss in left ear. She states dizziness increases with head movement. Past medical history reveals she was seen a week ago for sore throat and runny nose. She was given an antihistamine and fluticasone. She states the medications did not improve her symptoms, but her symptoms did improve over the next 7 days. Current physical exam reveals air conduction is greater than bone conduction and Weber lateralizes to the right ear. Cranial nerves 3, 4, and 6 are intact, but horizontal nystagmus is noted. Positive Romberg and unsteady gait is seen on neuro exam. Physical exam is otherwise normal. Based on presentation and physical findings, what is the most appropriate treatment? (Current, p.222) A. Augmentin B. Acyclovir C. Long term benzodiazepines D. Epley maneuver E. Supportive care if afebrile
E. Supportive care if afebrile
A 4 year old male presents to the clinic with a fever of 101.1 and is complaining of a sore throat. His mother states that he has not had a cough, but just felt "crummy" overall. Past medical history states an allergy to penicillin resulting in anaphylaxis. On physical examination his throat is erythematous and with tonsillar exudates. You perform a rapid strep test, and it is negative. What is your next step? a. Repeat strep test in 48 hours b. Perform a throat culture c. Treat empirically with IM ceftriaxone d. Recommend salt water gargle e. X-ray
F. Ask Corey Thompson why he didn't put an answer to his question.
