MSN 620 Possible Questions And Answers With
Verified Solutions
A 4-year-old girl presents with a history of recurrent otitis media requiring antibiotics. She has no significant history,
though both parents had recurrent ear infections as children. She had 4 episodes of otitis media this year and 4
episodes in the prior year. Her language development is appropriate for her age. What is the next best step in
management?
1. Myringotomy tubes
2. Observation
3. Three weeks of antibiotics
4. Ototopical antibiotics ANS 1. Myringotomy tubes
A 17-year-old boy presents with purulent discharge from his right ear for 3 days. He is recovering from a recent
upper respiratory illness, with no fever over the past 3 days. His ear was painful initially but is not currently. The
tympanic membrane appears to have a small perforation with copious purulent discharge. The external auditory
canal shows very faint erythema. There is no tragus tenderness and no nasopharyngeal mass. What is the most
appropriate management for this patient?
1. Ear wick
2. Culture of the discharge
3. Oral antibiotics
4. Ototopical corticosteroids ANS 3. Oral antibiotics
A 6-year old boy presents to the clinician with his mother. The mother says that the child has been complaining
about pain in the left ear and is unable to sleep well for eight days. He has not been febrile. Upon further
questioning, the mother reveals that his younger brother and the patient recovered recently from the "flu" they had
last week. He is in daycare. On examination, the child is uncooperative but oral examination reveals no dental
pathology. There is no overt otorrhea, and both tympanic membranes appear erythematous. He has no history of
drug allergies. Which of the following is the best choice of therapy to alleviate his condition?
1. Symptomatic management with analgesics only
2. Cephalexin
3. Amoxicillin
4. Doxycycline ANS 3. Amoxicillin
A 3-year-old child was brought in by her mother with complaints of right ear discharge and fever. The child has a
history of recurrent otitis media. Which of the following would be the appropriate technique for assessing the
tympanic membrane in this patient?
1. Pull the pinnae of the ear upward and forward.
,2. Pull the pinnae of the ear upward and backward.
3. Pull the pinnae of the ear downward and forward.
4. Pull the pinnae of the ear downward and backward. ANS 2. Pull the pinnae of the ear upward and backward.
A 9-year-old male is brought by his mother, who states that he has had a stuffy and runny nose for around eight
months. The patient admits to occasional sneezing and congestion to the point that he has to breathe through his
mouth. He denies fever, wheezing, or ear discomfort. On physical examination, he is noted to have mild darkening
under both eyes, a small crease above the tip of his nose, clear rhinorrhea bilaterally, mild turbinate swelling with
pale blue mucosa, and some cobblestoning in the posterior pharynx. His lungs are clear on auscultation. Which of
the following physical signs of his condition is commonly found in children but not adults?
1. Darkening around the eyes
2. Cobblestoning of the posterior pharynx
3. Nasal supratip crease
4. Mouth breathing ANS 3. Nasal supratip crease
A 46-year-old man presents with symptoms consistent with allergic rhinitis. He has a history of depression and is
treated with a selective serotonin reuptake inhibitor. He works as a school bus driver. Which of the following should
be used to treat his symptoms?
1. Fexofenadine
2. Hydroxyzine
3. Diphenhydramine
4. Chlorpheniramine ANS 1. Fexofenadine
A 38-year-old male patient complains of chronic nasal allergies. He has used over-the-counter antihistamines
without much success. He believes he is allergic to ragweed but has had no testing. His past medical history is
remarkable for hypertension that is controlled on hydrochlorothiazide. He does not drink, smoke, or use illicit drugs.
He works in a relatively new office, but he lives in a 60-year-old house with his family. They have carpets, drapes,
and a cat. Exam shows pale and boggy nasal mucosa and cobblestoning of the posterior pharynx. Lungs are clear on
auscultation. Skin prick testing shows allergies to cat dander, dust mites, ragweed, and tree pollen. Which of the
following would be an appropriate step to take?
1. Intranasal corticosteroids
2. Send carpet fiber for analysis
3. Immunotherapy for cat dander
4. Wash and keep carpets and drapes ANS 1. Intranasal corticosteroids
,A 17-year-old male patient presents with a complaint of watery discharge from his eyes for the past three days. He
also complains of itching and redness associated with it. Upon further questioning, he reveals a history of upper
respiratory tract infections. His vital signs show blood pressure of 120/80 mmHg, heart rate of 80 beats per minute,
respiratory rate of 14 breaths per minute, and temperature of 98.6 F (37 C). Ocular examination findings are shown
in the image. A polymerase chain reaction (PCR) performed confirms the diagnosis. What is the most common
causative organism?
(Click Image to Enlarge)
1. Adenovirus
2. Herpes simplex
3. Herpes zoster
4. Enterovirus ANS 1. Adenovirus
A 17-year-old female patient presents with a complaint of thick discharge from her eyes that started five days ago.
She also complains of redness and a feeling of dirt in her eyes. On further questioning, she reveals that her eyes are
usually matted in the morning. A detailed medical history reveals that she has had multiple similar episodes
previously. She has been using contact lenses for the past two years. Her vital signs show blood pressure 120/80
mmHg, heart rate 88/min, respiratory rate 14 breaths/min, and temperature 37 C (98.6 F). An ocular examination
reveals hyperemia and elevated yellow-white lesions at the lower cul-de-sac. What is the most appropriate next step
in the management of her condition?
1. Topical neomycin
2. Topical bacitracin
3. Topical ciprofloxacin
4. Oral azithromycin ANS 3. Topical ciprofloxacin
A 28-year-old male patient with a history of asthma presents complaining of eye discharge, morning matting, and
redness. He denies eye itching, burning, or recent upper respiratory symptoms. On examination, there is a bilateral
diffuse conjunctival injection, purulent discharge, and conjunctival papillae. What is the most likely etiological agent
for this patient's presentation?
1. Neisseria gonorrhoeae
2. Staphylococcal aureus
3. Herpes simplex virus
4. House dust mite ANS 2. Staphylococcal aureus
A 7-year-old African American male presents with his mother complaining of redness in the left eye. The redness
has been present for two days and is associated with pain and itching. The patient's mother reports that this morning,
his eye was matted and crusted, and there has been a white discharge. He has never had a similar episode previously.
, No fever is reported. Which of the following elements of the history would best indicate a non-bacterial etiology of
his disease?
1. Matting and crusting of the eye
2. Pruritus
3. Purulent discharge
4. No previous episodes of conjunctivitis ANS 2. Pruritus
A 10-year-old male presents to the provider with complaints of left eye tearing. He states that when he woke up this
morning, his left eye was crusted with his eyelids glued together. He adds that he had noticed some redness and mild
discomfort over the previous two days. The patient also reports left ear pain and fullness. On further examination,
his visual acuity is 20/25 on the right and 20/90 in the left eye. There is left-sided conjunctival erythema and clear
discharge, but there does not appear to be any corneal involvement. On otoscopic examination, there is bulging and
redness of the left tympanic membrane. Which of the following factors best indicates the need for an
ophthalmologic referral?
1. Mild pain
2. Concurrent otitis media
3. History of glued eyelids
4. Decreased visual acuity ANS 4. Decreased visual acuity
A 24 month old is seen in the clinic for the third time in 6 months with AOM. In addition, an effusion is discovered
because the tympanic membrane has restricted mobility and appears opaque. Choose the correct statement below.
1. This child is at risk for tympanic membrane perforation
2. This child is not a candidate for tympanostomy because he is too young
3. A short trial of corticosteroids is appropriate
4. Myringotomy without tube placement is most appropriate ANS 1. This child is at risk for tympanic membrane
perforation
A 2-year-old male presents with a fever of 102 F (38.9 C). His physical examination reveals bilateral otitis media
with effusion with noted erythema on the right side. His parents state that this is his sixth diagnosis of otitis media in
the past twelve months. His parents also note that he only has two words that are intelligible to them. Following the
treatment of this patient for his acute otitis media, which of the following is an appropriate management strategy?
1.
Tympanostomy tube placement
2.
Antibiotics administered for prophylaxis
3.
