Acute Care Exam 1

Week 1 – EENT

A primary care provider notes painless, hard lesions on a patient’s external ears that expel a white

crystalline substance when pressed. What diagnostic test is indicated?

Rheumatoid factor

Endocrine studies

Biopsy of the lesions

Uric acid chemical profile

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?

Oral hygiene measures

Nystatin oral suspension

Surgical excision

Oral acyclovir

A patient has sore throat, a temperature of 38.5° C, tonsillar exudates, and cervical lymphadenopathy.

What will the provider do next to manage this patient’s symptoms?

Prescribe empiric penicillin

Perform a rapid antigen detection test

Refer to an otolaryngologist

Order an antistreptolysin O titer

A 61 year old male presents with a 12 hour history of extremely painful left red eye. The patient

complains of blurred vision, haloes 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:

Macular degeneration

Acute angle glaucoma

Increased intracranial pressure

Detached cornea

A patient has recurrent epistaxis without localized signs of irritation. Which laboratory tests may be

performed to evaluate this condition? (Select all that apply.)

CBC with platelets

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BUN and creatinine

PT and PTT

Liver function tests

PT/INR

A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain

when manipulating the external ear structures. What is the likely diagnosis?

Chronic otitis externa

Acute otitis externa

Otitis media with effusion

Acute otitis media

Patient has been diagnosed with acute rhinosinusitis. Symptoms began 3 days ago. Based on the most

likely etiology, how should this patient be managed?

Azithromycin and decongestant

Decongestant and analgesic

Levofloxacin

Amoxicillin with clavulanate

The vast majority of rhinosinusitis is of viral etiology, antibiotics would not be helpful and

would only lead to continued antibacterial resistance. If symptoms persist for longer than 10

days, reevaluation is necessary with possible antibiotics at that time

A 20-year-old male of Hispanic descent who reports a history of a cold that resolved 2 weeks ago except

for a dry cough and pain over his right cheek that worsens when he bends down. The patient denies

fever. The patient tells you that he is very allergic to Keflex and erythromycin. Vital signs are stable

except temperature is 99.2°F. Which showed the following conditions is most likely?

Fever secondary to previous viral URI

Acute sinusitis

Acute bronchitis

Hay fever

Patient's symptoms match most closely to acute sinusitis which includes cough, facial pain, lowgrade fever

An adult patient has epiglottitis secondary to a chemical burn. Which medication will be given initially to

prevent complications?

 Chloramphenicol biopsyrecu

 Dexamethasone

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 Metronidazole

 Clindamycin

What are factors associated with acute suppurative parotitis? (Select all that apply.)

 Anticholinergic medications

 Diabetes mellitus

 Radiotherapy

 Hypervolemia

 Allergies

A 39 year old has a sudden onset of painful right red eye. He reports sensitivity to light and the

sensation of a foreign body, though his history for a foreign body is negative. He does not wear contact

lenses. How should the NP manage this?

 Observe for 24 hours if visual acuity is normal

 Treat for bacterial conjunctivitis

 Treat for viral conjunctivitis

 Refer to ophthalmology

No clear diagnosis can be made from signs/symptoms, but there are several red flags.

collectively the red flags necessitate a referral. There is no mention of eye discharge

necessary for conjunctivitis. Red flags present point more towards active corneal process

although glaucoma should also be a differential.

A 17-year-old has a complaint of ear pain. If he has otitis externa, which complaint is most likely/most

common?

 Concurrent URI

 Fever

 Difficulty hearing TV

 Tragal pain

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

Neomycin

Fluconazole

Vinegar and alcohol

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A patient has gingival inflammation with several areas of separate ulceration and a small amount of

purulent discharge. What is required to diagnose this condition?

Culture and sensitivity

 Tzank smear

 Physical examination

 Microscopic exam of oral scrapings

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?

Recommend oral antiseptic rinses and follow up in one week

Perform an incision and drainage of the edematous tissue

 Prescribe amoxicillin and refer to a dentist in 2 to 3 days

 Refer to an oral surgeon for emergency surgery

A patient presents to your clinic with a painless red eye. Her vision is normal, but her sclera has a blood

red area. What is this termed?

Conjunctivitis

Glaucoma

Acute iritis

Subconjunctival hemorrhage

Which physical examination finding suggests viral rather than bacterial parotitis?

 Unilateral edema of parotid glands

 Enlargement and pain of affected glands

 Gradual reduction in saliva production

 Clear discharge from Stensen’s duct

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 this time?

 Immobilize the child’s head and neck and call 911

 Turn the child’s head to the side to prevent aspiration of blood

 Place nasal packing in both nares to stop the bleeding

 Apply ice to the injured site to prevent airway occlusion

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