1
Q
- A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis?
a. Vertigo with changes in head position
b. Spontaneous horizontal nystagmus
c. Facial palsy and vertigo
d. Fluctuating hearing loss and tinnitus
A
Spontaneous horizontal nystagmus
2
Q
- A provider performs a nasal speculum examination on a patient who sustained nasal trauma in a motor vehicle accident. The provider notes marked swelling of the nose, instability and crepitus of the nasal septum with no other facial bony abnormalities and observes a rounded bluish mass against the nasal septum. Which action is necessary at this time?
a. Surgery to reduce the nasal fracture
b. CT scan of facial structures
c. Ice packs to reduce facial swelling
d. Urgent drainage of the mass
A
d. Urgent drainage of the mass
3
Q
- A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues without discharge. Which is the initial course of action by the provider?
a. Prescribe amoxicillin and refer to dentist in 2 to 3 days
b. Refer to an oral surgeon for emergency surgery
c. Recommend oral antiseptic rinses and follow-up in one week
d. Perform an incision and drainage of the edematous tissue
A
Prescribe amoxicillin and refer to dentist in 2 to 3 days
4
Q
- A 93 year old demented adult has been recently treated for an upper respiratory infection but drainage from the right nostril persists. What should the NP suspect?
a. Presence of foreign body
b. Allergic rhinitis
c. Unresolved URI
d. Dental Caries
A
Presence of foreign body
5
Q
- A 58 year old farmer presents with a wedge shaped, pinkish, clear growth on the nasal side of his eye. He states that it has been present for a while, but only recently began to feel as if a foreign body was in his eye. This is probably a:
a. Xanthelasma
b. Pinguecula
c. Pterygium
d. Stye
A
Pterygium
6
Q
- A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues without discharge. Which is the initial course of action by the provider?
a. Recommend oral antiseptic rinses and follow up in one week
b. Prescribe amoxicillin and refer to a dentist in 2 to 3 days
c. Perform an incision and drainage of the edematous tissue
d. Refer to an oral surgeon for emergency surgery
A
Prescribe amoxicillin and refer to a dentist in 2 to 3 days
7
Q
- A patient reports ear pain after being hit in the head with a baseball. The provider notes a large perforated tympanic membrane. What is the recommended treatment?
a. Prescribe analgesics and follow up in 1 to 2 days
b. Refer the patient to an otolaryngologist for evaluation
a. Reassure the patient that this will heal without problems
b. Order antibiotic ear drops if signs of infection occur
A
b. Order antibiotic ear drops if signs of infection occur
8
Q
- A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis?
a. Facial palsy and vertigo
b. Vertigo with changes in head position
c. Spontaneous horizontal nystagmus
d. Fluctuating hearing loss and tinnitus
A
c. Spontaneous horizontal nystagmus
9
Q
- A 32-year-old patient is a newly diagnosed diabetic. She has developed a sinus infection. Her symptoms have persisted for 10 days. 6 weeks ago, she was treated with amoxicillin for a URI. It cleared without incident. Which be recommended today?
a. Prescribed amoxicillin–clavulanate today
b. Prescribe a decongestant and an antihistamine
c. Do not prescribe an antibiotic, only a decongestant as indicated
d. Prescribed amoxicillin again
A
a. Prescribed amoxicillin–clavulanate today
10
Q
- Acute otitis media can be best diagnosed by identifying which otic characteristic(s)?
a. Marked redness of the tympanic membrane
b. Decreased mobility of the tympanic membrane
c. Opacity and erythema of the tympanic membrane
d. Cloudy, bulging TM with impaired mobility
A
d. Cloudy, bulging TM with impaired mobility
11
Q
- A child is hit with a baseball bat during a game and sustains an injury to the nose, along with a transient loss of consciousness. A health care provider at the game notes bleeding from the child’s nose and displacement of the septum. What is the most important intervention at his time?
a. Apply ice to the injured site to prevent airway occlusion
b. Immobilize the child’s head and neck and call 911
c. Turn the child’s head to the side to prevent aspiration of blood
d. Place nasal packing in both nares to stop the bleeding.
A
b. Immobilize the child’s head and neck and call 911
12
Q
- The patient presents with complains of morning eyelash crusting and itchy red eyes. It began on the left and now has become bilateral. Based on the most likely diagnosis what should the NP tell the caregivers about this condition?
a. Pain is normal in the affect eye
b. This usually begins as a viral infection
c. It produces blurred vision in the affected eye.
A
b. This usually begins as a viral infection
13
Q
- An adolescent has fever, chills, and severe sore throat. On exam, the provider notes foul-smelling breath and muffled voice with marked edema and erythema of the peritonsillar tissue. What will the primary care provider do?
a. Perform a rapid strep and throat culture
b. Prescribing empirical oral antibiotic
c. Refer the patient to an otolaryngologist
d. Evaluate for possible epiglottitis
A
c. Refer the patient to an otolaryngologist
14
Q
- A patient who has acute suppurative parotitis has been taking amoxicillin-clavulanate for 4 days without improvement in symptoms. The provider will order an antibiotic for Methicillin resistant S. Aureus. Which other measure may be helpful?
a. Discourage chewing gum
b. Surgical drainage
c. Topical corticosteroids
d. Cool compresses
A
b. Surgical drainage
15
Q
- During a routine physical examination, a provider notes a shiny, irregular, painless lesion on the top of one ear auricle and suspects skin cancer. What will the provider tell the patient about the lesion?
a. It is benign and will not need intervention
b. This is most likely malignant
c. Immediate surgery is recommended
d. A biopsy should be performed
A
d. A biopsy should be performed
16
Q
- During a routine physical exam of an elderly women, a triangular thickening of the bulbar conjunctiva on the temporal side is noted to be encroaching on the cornea. She denies any eye pain or visual changes. Which of the following is most likely?
a. Chalazion
b. Pterygium
c. Pinguecula
d. Corneal arcus
A
Pterygium
17
Q
- A 70 year old make has a yellowish, triangular nodule near the iris. This is probably
a. A pinguecula
b. A stye
c. A chalazion
d. Subconjunctival hemorrhage
A
A pinguecula
18
Q
- A patient is concerned about frequent nasal stuffiness and congestion that begins shortly after getting out of bed in the morning. The patient denies itching and sneezing. A physical examination reveals erythematous nasal mucosa with scant watery discharge. what treatment will the provider recommend for this patient?
a. Oral antihistamine each morning
b. Oral decongestants as needed
c. Consultation for immunotherapy
d. Daily intranasal steroids
A
daily intranasal steroids
19
Q
A kindergarten teacher was diagnosed with acute streptococcal pharyngitis. On exam, her throat is bright red color with no tonsillar exudate, and clear mucus is seen on the lower nasal turbinates. The urinalysis shows a large amount of white blood cells and is positive for nitrates. The patient has a significant sulfa allergy and thinks she is also allergic to penicillin. Which is the best treatment choice?
a. trimethoprim-sulfamethoxazole
b. amoxicillin-clavulanic acid
c. clarithromycin
d. levofloxacin
A
d. levofloxacin
20
Q
A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea and vomiting. What is part of the initial workup for this patient?
a. audiogram and MRI
b. electrocardiogram
c. vestibular testing
d. auditory brainstem testing
A
a. audiogram and MRI
21
Q
a patient has recurrent sneezing, alterations in taste and smell, watery, itchy eyes, and thin, clear nasal secretions. The provider notes puffiness around the eyes. The patient’s vital signs are normal. What is the most likely diagnosis for this patient?
a. viral rhinitis
b. allergic rhinitis
c. chronic sinusitis
d. acute sinusitis
A
b. allergic rhinitis
22
Q
a 17 y/o has a complaint of ear pain. if he has otitis external, which complaint is most likely/most common?
a. concurrent UTI
b. fever
c. tragal pain
d. difficulty hearing TV
A
c. tragal pain
23
Q
While checking for the red reflex on a 3-year-old boy during a well-child visit, the NP notes a white reflection on the child’s left pupil. What of the following condition should be ruled out?
a. unilateral strabismus
b. retinoblastoma of the left eye
c. unilateral cataracts
d. color blindness of the left eye
A
b. retinoblastoma of the left eye
24
Q
A patient has two palpable, tender, left preauricular nodes that are about 0.5cm in diameter. What condition might this be associated with?
a. conjunctivitis
b. ulceration on the tongue
c. sore throat
d. ear infection
A
a. conjunctivitis
25
A 61 year old male presents with a 12 hour history of extremely painful left red eye. The patient complains of blurred vision, halos around lights, and vomiting. It began yesterday evening. On exam, the eye is red, tender and inflamed. The cornea is hazy and pupil reacts poorly to light. The most likely diagnosis in this patient is:
acute angle glaucoma
26
A patient has an initial episode otitis external associated with swimming. The patient's ear canal is mildly inflamed and the tympanic membrane is not involved. Which medication will be ordered?
Cipro HC
27
Which physical examination finding suggests viral rather than bacterial parotitis?
Clear discharge from Stensen's duct
28
A patient presents with findings of pain, warmth, redness, and swelling below the inner canthus toward nose. Tearing is present and when pressure is applied to the lacrimal sac, purulent discharge from the puncta is noted. This is suggestive of:
Dacryocystitis
29
A patient has painful oral lesions and the provider notes several white, verrucous lesions in clusters throughout the mouth. What is the recommended treatment for this patient?
Surgical excision
30
A pediatric Pt has otalgia, fever 38.8C & recent h/o of URI. The examiner is unable to visualize the tympanic membrane in the Rt ear b/c of cerumen in the ear canal. The Lt ear tympanic is dull gray w/ fluid present. What is correct course of action?
Remove cerumen & visualize tympanic membrane.
31
A 70 yr old male Pt c/o a bright red spot that has been present on his Lt eye for 2 days. He denies eye pain, or visual changes or HA's. He has new onset of cough from recent UPR & he takes 1 ASA a day.
Advise the Pt that the condition is benign and will resolve spontaneously. This question was on both practice quizzes.
32
During an eye exam of 50-year-old with HTN, Pt c/o severe HA. The borders of the disc margins on both eyes are blurred. What is the name of this clinical finding?
Papilledema
33
A 70 yr old male Pt c/o a bright red spot that has been present on his Lt eye for 2 days. He denies eye pain, or visual changes or HA's. He has new onset of cough from recent UPR & he takes 1 ASA a day.
Advise the Pt that the condition is benign and will resolve spontaneously. This question was on both practice quizzes.
34
Child is hit w/ baseball bat during game & sustains injury to nose along w/ transient loss of consciousness. A healthcare provider at the game notes bleeding from nose & displacement of septum. What is the most important intervention at this time?
Immobilize the child's head and call 911.
35
A Pt has nasal congestion, fever, purulent nasal d/c, HA, fever & pain and begins treatment with Amox-Clav. At f/u 10-days later, Pt still has purulent d/c, congestion & pain but no fever. What is next course of action?
2nd course of Amox-Clav.
36
A Pt has recurrent epistaxis without signs of localized irritation. Which lab tests may be performed at this time to evaluate his condition?
PT, PTT, PT/INR, CBC Platelets.
37
A 32-yr-old is newly dx DM, She has developed a sinus infection. She has had symptoms for 10 days. 6-weeks ago she got amoxicillin for URI. It was cleared up without incident. What's next?
Prescribe Amoxicillin-Clavulanate today.
38
Swimmer's ear question on practice test
Prescribe Cipro HC
39
A Pt reports a feeling of fullness & pain in both ears & the practitioner elicits pain when manipulating the external ear structures. What is likely diagnosis?
Acute otitis externa.
40
Which symptoms in children are evaluated using a parent-reported scoring system to determine the severity of pain in children with otitis media?
Tugging on ears, difficulty sleeping, and appetite.
41
A 70 year old male has a yellowish, triangular nodule near the iris this is probably a
pinguecula.
42
A 20 year old make of hispanic descent who reports a history of cold that resolved 2 weeks ago except for a dry cough and pain over right cheek that worsens when he bends down. The patient denies fever. The Pt tells you he is very allergic to keflex, and erythromycin. VSS except temp is 99.2 F.
Acute sinusitis.
43
During routine physical exam of an elderly woman, a triangular thickening of the bulbar conjunctiva on the temporal side is noted to be encroaching on the cornea. She denies any eye pain or visual changes. Which of the following is most likely?
Pterygium.
44
Previous quiz question about 32 diabetic patient w/ sinus infection.
During routine physical exam of an elderly woman, a triangular thickening of the bulbar conjunctiva on the temporal side is noted to be encroaching on the cornea. She denies any eye pain or visual changes. Which of the following is most likely?
Pterygium.
Previous quiz question about 32 diabetic patient w/ sinus infection.
Prescribe Amoxicillin-Clavulanate today. Rationale: Amoxicillin is not indicated when a beta-lactamase producing organism and suspected, this is the case as patient took antibiotics 6 weeks ago. Amoxicillin-clavulanate is a good choice as it covers a beta-lactamase producers. And bacteria etiology is suspected as symptoms have persisted for 10 days. A decongestant can be added, however this does not substitute antibiotics in this case
45
A 12-year-old complains of itching in his right ear and pain when the pinna is pulled or the tragus is pushed. Examination reveals slight redness in the ear canal with a clear odorless fluid. This is suggestive of:
Otitis Externa.
46
A patient has painful oral lesions and the provider notes several white, verrucous lesions in clusters throughout the mouth. What is the recommended treatment for this patient?
Surgical excision
A patient reports ear pain after being hit in the head with a baseball. The provider notes a large perforated tympanic membrane. What is the recommended treatment?
Refer patient to an otolaryngologist for evaluation
47
A patient who has acute suppurative parotitis has been taking amoxicillin-clavulanate for 4 days without improvement in symptoms. The provider will order an antibiotic for Methicillin-resistant S. aureus. Which other measure may be helpful?
Surgical drainage
48
The patient presents with complaints of morning eyelash crusting and itchy red eyes. It began on the left and now has become bilateral. based on the most likely diagnosis, what should the NP tell the caregivers about this condition?
This usually begins as a viral infection
49
A NP preforms a fundoscopic exam. He identifies small areas of dull, yellowish-white coloration in the retina. What might these be?
Cotton wool spots
50
A 70 year old male patient complains of a bright red colored spot that has been present in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He ha a new onset cough from a recent URI. The only medicine he is taking is aspirin 1 tablet daily. Which of the following is most likely?
Subconjunctival hemorrhage
51
During routine physical exam of an elderly woman, a triangular thickening of the bulbar conjunctiva on the temporal side is noted to be encroaching on the cornea. She denies any eye pain or visual changes. Which of the following is most likely?
Pterygium
52
A screening audiogram on a patient is abnormal. Which test may the primary provider perform next to further evaluate the cause of this finding?
Tympanogram
53
A patient has seasonal rhinitis symptoms and allergy testing reveals sensitivity to various trees and grasses. What is the first-line treatment for this patient?
Intranasal steroids
54
The provider sees a child with a history of high fever and sore throat. When entering the exam room, the provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety. What is the initial action for this patient?
Obtain an immediate consultation with an otolaryngologist
55
A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis?
The provider sees a child with a history of high fever and sore throat. When entering the exam room, the provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety. What is the initial action for this patient?
Obtain an immediate consultation with an otolaryngologist
A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis?
Spontaneous horizontal nystagmus
56
A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea and vomiting. What is part of the initial diagnostic workup for this patient?
Audiogram and MRI
Acute otitis media can be best diagnosed by identifying which otic characteristic(s)?
Cloudy, bulging TM with impaired mobility
57
Group A strep pharyngitis:
Can be accompanied by abdominal pain
58
Which are risk factors for developing otitis externa? (Select all that apply.)
Having underlying diabetes mellitus
Use of ear plugs and hearing aids
Vigorous external canal hygiene
59
A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues without discharge. Which is the initial course of action by the provider?
Prescribe amoxicillin and refer to a dentist in 2 to 3 days
60
The NP preforms a fundoscopic exam on a patient who has recently been diagnosed with hypertension. What is the significant of AV nicking?
This is indicative of longstanding hypertension
N675
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