NR511 Midterm_
. Martin, age 13, just started taking amoxicillin for otitis media. His mother said that he woke
up this morning with a rash on his trunk. What is your first action? . - correct answer-Stop the
amoxicillin.
A 10-year-old male in 5th grade presents to the pediatric office with his mother complaining
of itchy and red eyes for 1 day. The patient complains of watery drainage in both eyes,
associated with repetitive itching. On physical exam, he has no fever or constitutional
symptoms. His vision is normal, with no decrease in extraocular movements. The patient has
a sibling that just started day care recently. He also has bilateral preauricular lymph nodes
that are inflamed. What is the patient's diagnosis? - correct answer-Viral conjunctivitis.
A 16-year-old male presents to your office. He was sent by an orthopedist. He has recently
had surgical fixation of a humerus fracture. The patient has been going to physical therapy
and has been developing a rash on his arm after therapy that disappears shortly after
returning home. He does not have the rash prior to therapy. The patient denies fevers and
chills, and his incision is well healed, with no signs of infection. Of note, the patient has been
experiencing more hand edema than the average patient and has had edema wraps used at
the end of therapy to help with his swelling. The wraps are made of a synthetic plastic
material. The rash the patient gets is erythematous and blotchy, not raised; it is on the
operative upper extremity. What is the most likely diagnosis? - correct answer-Contact
dermatitis.
A 20-year-old male presents to your primary care clinic. This patient is a college student. He
complains of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has
a temperature of 100.7°F. His ear exam is normal. His nose and throat exam shows mild
erythema of the nasal mucosa and edematous, enlarged tonsils bilaterally, with erythema of
the pharyngeal wall and tonsillar exudates. He has inflamed posterior cervical lymph nodes.
He has a mild nonproductive cough and clear lung exam. What is his most likely diagnosis? -
correct answer-Mononucleosis.
A 22-year-old African American female presents to your family practice office complaining of
progressive skin discoloration. She is adopted and has no known family history of skin
problems. The patient notes nonpalpable patches of skin loss and blanching of her forehead
and both hands and feet. It has developed over a period of 6 months and appears to have
stopped. It is not pruritic, and there is no erythema or sign of infectious etiology. What is the
most likely diagnosis? - correct answer-Vitiligo.
A 22-year-old college student presents to your urgent care clinic complaining of a rash. She
was recently on spring break and spent every night in the hot tub at her hotel. On physical
exam, she has multiple small areas of 1- to 2-mm erythematous pustules that are present
mostly where her bathing suit covered her buttocks. What is the most likely pathogen
causing these lesions - correct answer-Pseudomonas aeruginosa.
,A 25-year-old client who plays in a band complains that he finds it difficult to understand his
fellow musicians at the end of a night of performing, a problem that is compounded by the
noisy environment of the club. These symptoms are most characteristic of which of the
following? - correct answer-Sensorineural loss.
A 25-year-old male presents with "bleeding in my eye" for 1 day. He awoke this morning with
a dark area of redness in his eye. He has no visual loss or changes. He denies constitutional
symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as
a dark red area in the patient's sclera of the right eye only and takes up less than 50% of the
eye. The patient's remaining sclera is clear and white. He also notes he was drinking alcohol
last night and vomited afterward. What is the best treatment? - correct answer-Reassurance
that this lesion will resolve without any treatment in 2 to 4 weeks.
A 27-year-old female comes in to your primary care office complaining of a perioral rash. The
patient noticed burning around her lips a couple days ago that quickly went away. She awoke
from sleep yesterday and noticed a group of vesicles with erythematous bases where the
burning had been before. There is no burning today. She is afebrile and has no difficulty
eating or swallowing. What test would confirm her diagnosis? - correct answer-Tzanck
smear.
A 3-year-old patient presents to your pediatric office with her mother. She has recently been
started in day care. Her mother noted slight perioral erythema on the right side of the
patient's mouth prior to bed last night. The patient awoke today with 3 small, superficial,
honey-colored vesicles where the erythema was last night. The patient has no surrounding
erythema. She had no difficulty eating this morning and is active and energetic and doesn't
appear lethargic or fatigued. She is also afebrile. How would you treat this child? - correct
answer-Local debridement and mupirocin for 5 days.
A 4-year-old male presents to your pediatric clinic with his mother complaining of an itchy
rash, mostly between his fingers. This has been going on for multiple days and has been
getting worse. The patient recently started at a new day care. On physical exam, the patient
is afebrile and has multiple small (1-2 mm) red papules in sets of 3 located in the web
spaces between his fingers. He also has signs of excoriation. What is the treatment for this
problem? - correct answer-Permethrin lotion for the patient and also his family members.
A 44-year-old banker comes to your office for evaluation of a pulsating headache over the
left temporal region, and he rates the pain as an 8 on a scale of 1 to 10. The pain has been
constant for the past several hours and is accompanied by nausea and sensitivity to light. He
has had frequent, though less severe, headaches for many years, and they are usually
relieved by over-the-counter medicines. He is unclear as to a precipitating event but notes
that he has had visual disturbances before each headache and he has been under a lot of
stress in his job. Based on this description, what is the most likely diagnosis of this type of
headache? - correct answer-Migraine.
A 6-year-old female presents to your pediatric office with her mother complaining of right ear
pain for 3 days. This pain resolved with Tylenol. The patient has also had noted fevers of
101.3°F over the last 2 nights. The patient had a nonproductive cough for 7 days prior to the
ear pain. On physical exam, the patient has tenderness with tugging on the auricle of the ear.
, The tympanic membrane is not mobile with pneumatic otoscopy and is erythematous and
full. The patient has no drainage from the ear and no mastoid tenderness. What is the next
step? - correct answer-Amoxicillin 80 to 90 mg/kg/d.
A 62-year-old woman presents to your clinic with a sudden right-sided headache that is
worse in her right eye. She states that her vision seems blurred, and her right pupil is dilated
and slow to react. The right conjunctiva is markedly injected, and the eyeball is firm. You
screen her vision and find that she is 20/30 OS and 20/30 OD. She most likely has: - correct
answer-angle-closure glaucoma
A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3
weeks. She states that "some foods get stuck" and she has been having "heartburn" at night
when she lies down, especially if she has had a heavy meal. Occasionally, she awakes at
night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel
movements or color of stools. She denies alcohol and tobacco use. There is no pertinent
family history or findings on review of systems (ROS). Physical examination is normal, with
no abdominal tenderness, and the stool is occult blood (OB) negative. What is the most likely
diagnosis? - correct answer-Gastroesophageal reflux disease (GERD).
A 70-year-old client with herpes zoster has a vesicle on the tip of the nose. This may
indicate: - correct answer-Ophthalmic zoster.
A 75-year-old African American male presents to your family practice office complaining of
visual impairment. He has worn corrective lenses for many years but has noticed that his
vision has gotten progressively worse the past 6 months. He denies pain. He states his
vision is worse in both eyes in the peripheral aspects of his visual field. He also notes trouble
driving at night and halos around street lights at night. You test his intraocular pressure, and
it is 23 mm Hg. What is his most likely diagnosis? - correct answer-Open-angle glaucoma.
A 75-year-old female presents to your office complaining of dizziness and hearing loss. The
patient states she awoke yesterday with dizziness, which she described as feeling the room
spinning. She also notes intermittent ringing in her ears. On physical exam, the patient has
lateralization of her hearing loss to the unaffected ear. Rinne test shows air conduction lasts
longer than bone conduction. What is the next step in helping this patient's symptoms? -
correct answer-Start the patient on a low-salt, low-caffeine diet and give her meclizine for
vertigo attacks.
A biopsy of a small, yellow-orange papulonodule on the eyelid will probably show - correct
answer-Lipid-laden cells.
A mother complains that her newborn infant, while lying on his side, appears red on the
dependent side of the body and pale on the upper side. When she picks up the baby, this
coloring disappears. You explain to her about which of the following? - correct
answer-Harlequin sign.
Aaron, age 4, is brought in to the clinic by his father. His tympanic membrane is perforated
from otitis media. His father asks about repair of the eardrum. How do you respond? - correct
answer-"The eardrum, in most cases, heals within several weeks.
