MSN 620 Primary care Quiz Questions and Answers (100% Graded)

MSN 620 Primary care Quiz

MSN 620 Primary care Quiz

Question 1 1 / 1 pts

During an eye examination, the provider notes a red light reflex in one eye but not the other. What is the significance of this finding?

Ocular disease requiring referral

Potential infection in the “red” eye

Normal physiologic variant

Potential vision loss in one eye

The red reflex should be elicited in normal eyes. Any asymmetry or opacity suggests ocular disease, potentially retinoblastoma, and should be evaluated immediately.REF: Posterior Segment

Question 2 1 / 1 pts

A provider performs an eye examination during a health maintenance visit and notes a difference of 0.5 mm in size between the patient’s pupils. What does this finding indicate?

Probable benign, physiologic anisocoria

A relative afferent pupillary defect

Likely underlying neurological abnormality

Indication of a difference in intraocular pressure

A difference in diameter of less than 1 mm is usually benign. Afferent pupillary defects are paradoxical dilations of pupils in response to light. This does not indicate differences in intraocular pressure. A difference of more than 1 mm is more likely to represent an underlying neurological abnormality.REF: Pupil Response

Question 3 1 / 1 pts

MSN 620 Primary care Quiz

A primary care provider may suspect cataract formation in a patient with which finding?

Corneal opacification

Injection of conjunctiva

Excessive tearing

Asymmetric red reflex

An asymmetric red reflex may be a finding in a patient with cataracts. Corneal opacification, excessive tearing, and corneal injection are not symptoms of cataracts.REF: Physical Examination

IncorrectQuestion 4 0 / 1 pts

A patient has a gradually enlarging nodule on one upper eyelid and reports that the lesion is painful. On examination, the lesion appears warm and erythematous. The provider knows that this is likely to be which type of lesion?

Meibomian

Blepharitis

Chalazion

Hordeolum

Although hordeolum and chalazion lesions both present as gradually enlarging nodules, a hordeolum is usually painful, while a chalazion generally is not. Blepharitis refers to generalized inflammation of the eyelids. Meibomian is a type of gland near the eye.REF: Clinical Presentation

IncorrectQuestion 5 0 / 1 pts

A patient reports has been using artificial tears for comfort because of burning and itching in both eyes, but reports worsening symptoms. The

MSN 620 Primary care Quiz

provider notes redness and discharge along the eyelid margins with clear conjunctivae. What is the recommended treatment?

Oral antibiotics given prophylactically for several months

Reassurance that this is a self-limiting condition

Compresses, lid scrubs, and antibiotic ointment

Antibiotic solution drops four times daily

This patient has symptoms of blepharitis without conjunctivitis. Initial treatment involves lid hygiene and antibiotic ointment may be applied after lid scrubs. Antibiotic solution is used if conjunctivitis is present. Oral antibiotics are used for severe cases. This disorder is generally chronic.REF: Clinical Presentation/Management

Question 6

1 / 1 pts

A patient reports bilateral reports burning and itching eyes for several days. The provider notes a boggy appearance to the conjunctivae, along with clear, watery discharge. The patient’s eyelids are thickened and discolored. There are no other symptoms. Which type of conjunctivitis is most likely?

Allergic

Viral

Chemical

Bacterial

Allergic conjunctivitis generally presents simultaneously in both eyes with itching as a predominant feature. Discharge is generally clear or stringy and white and the patient will have lid discoloration, thickening, and erythema.

Bacterial conjunctivitis is characterized by acute inflammation of the conjunctivae along with purulent discharge. Chemical conjunctivitis will not have purulent discharge. Viral conjunctivitis is usually in association with a URI.REF: Clinical Presentation/Acute Allergic Conjunctivitis

MSN 620 Primary care Quiz

Question 7 1 / 1 pts

A patient with allergic conjunctivitis who has been using a topical antihistamine-vasoconstrictor medication reports worsening symptoms. What is the provider’s next step in managing this patient’s symptoms?

Refer the patient to an ophthalmologist for further care

Determine the duration of treatment with this medication

Prescribe a non-sedating oral antihistamine

Consider prescribing a topical mast cell stabilizer

Antibiotic-vasoconstrictor agents can have a rebound effect with worsening symptoms if used longer than 3 to 7 days, so the provider should determine whether this is the cause. Topical mast cell stabilizers are useful as prophylaxis for recurrent or persistent allergic conjunctivitis and results do not occur for several weeks. Oral antihistamines may be the next step if it is determined that the cause of worsening symptoms is related to the allergy. It is not necessary to refer to ophthalmology at this time.REF: Management

Question 8 1 / 1 pts

A patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while sanding a piece of wood and now has copious tearing, redness, and light sensitivity in the affected eye. On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the practitioner’s next step?

Administration of antibiotic eye drops

Irrigation of the eye with normal saline

Application of topical fluorescein dye

Instillation of cyclopegic eye drops

MSN 620 Primary care Quiz

The practitioner must determine if there is a corneal abrasion and will instill fluorescein dye in order to examine the cornea under a Wood’s lamp. Antibiotic eye drops are not indicated as initial treatment. Cyclopegic drops are used occasionally for pain control, but should be used with caution. Irrigation of the eye is indicated for chemical burns.REF: Management

IncorrectQuestion 9

0 / 1 pts

A patient has chronically dry eyes, sometimes with a foreign body sensation, burning, and itching. A Schirmer test is abnormal. What is the suspected cause of this patient’s symptoms based on this test finding?

Poor eyelid closure

Corneal abrasion

Aqueous-deficiency

Evaporative disorder

An abnormal Schirmer test, which assesses aqueous production, indicates aqueous-deficient dry eye. A corneal abrasion usually causes excessive tearing. An evaporative disorder is determined by an evaluation of tear breakup time. Poor eyelid closure causes increased corneal exposure and increased evaporation of tears.REF: Diagnostics

IncorrectQuestion 10 0 / 1 pts

A patient has dacryocystitis. The provider notes a painful lacrimal sac abscess that appears to be coming to a head. Which treatment will be useful initially?

Incision and drainage

Topical antibiotic ointment

Eyelid scrubs with baby shampoo

Lacrimal bypass surgery

MSN 620 Primary care Quiz

When an abscess is present and coming to a head, incision and drainage may be useful. Definitive treatment with lacrimal bypass surgery will be performed once the acute episode has resolved. Eyelid scrubs and topical ointments are not effective.REF: Management

IncorrectQuestion 11

0 / 1 pts

An adult patient with a history of recurrent sinusitis and allergic rhinitis reports chronic tearing in one eye, ocular discharge, and eyelid crusting. The provider suspects nasolacrimal duct obstruction. Which initial treatment will the provider recommend?

Antibiotic eye drops

Systemic antibiotics

Warm compresses

Nasolacrimal duct probing

This is most likely acquired nasolacrimal duct obstruction. Initial treatment should include warm compresses. Antibiotics are only used if infection is present. Nasolacrimal duct probing is not useful for acquired conditions; definitive treatment usually requires surgery.REF: Clinical Presentation/Management

Question 12 1 / 1 pts

Which is the most common cause of orbital cellulitis in all age groups?

Inoculation from local trauma or bug bites

Paranasal sinus inoculation

Bacteremic spread from remote infections

Local spread from the ethmoid sinus

MSN 620 Primary care Quiz

Because the membrane separating the ethmoid sinus from the orbit is literally paper-thin, this is the most common source of orbital infection in all age groups. Bacteremic spread, inoculation from localized trauma, and paranasal sinus spread all may occur, but are less common.REF: Pathophysiology

Question 13 1 / 1 pts

A patient has an elevated, yellowish-white lesion adjacent to the cornea at the 3 o’clock position of the right eye. The provider notes pinkish inflammation with dilated blood vessels surrounding the lesion. What will the provider tell the patient about this lesion?

Spontaneous bleeding is likely

Artificial tear drops are contraindicated

UVB eye protection is especially important

Visine may be used for symptomatic relief

This patient has a pinguecula which has become inflamed. Wide-brimmed hats and sunglasses with UVB protection should be advised since UVB light will make this worse. Artificial tear drops are recommended to reduce irritation. These types of lesions typically do not bleed spontaneously. Visine is contraindicated because chronic vasoconstriction may lead to rebound inflammation.REF: Clinical Presentation/Management

Question 14 1 / 1 pts

A patient suffers a penetrating injury to one eye caused by scissors. The provider notes a single laceration away from the iris that involves the anterior but not the posterior segment. What is the prognosis for this injury?

Because the posterior segment is not involved, the prognosis is good

Retinal detachment is almost certain to occur

Blindness is likely with this type of eye injury

MSN 620 Primary care Quiz

Massive hemorrhage and loss of intraocular contents is likely

Mechanical energy imparted from sharp objects generally results in lacerations, with disruption that is more localized. The prognosis is better if the posterior segment is not involved. The other complications are more common with globe ruptures.REF: Mechanical Injuries

Question 15 1 / 1 pts

Which is an important protective precaution in a metal fabrication workshop?

Eyewash stations

Glasses with UVB protection

2 mm polycarbonate safety glasses

Polycarbonate goggles

Polycarbonate goggles, which have better side protection, will protect from foreign bodies that can reach around other lenses and should be used in very high risk activities, such as hammering metal on metal or grinding. 2 mm polycarbonate safety glasses are a minimum safety precaution. Glasses with UVB protection are used in occupations where sunlight exposure is high. Eyewash stations are necessary where splash injuries or chemical exposures are possible.REF: Education and Health Promotion

Question 16 1 / 1 pts

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 this lesion?

A biopsy should be performed.

Immediate surgery is recommended.

This is most likely malignant.

MSN 620 Primary care Quiz

It is benign and will not need intervention.

This lesion is characteristic of basal cell carcinoma, which is a slow-growing cancer least likely to metastasize. A biopsy should be performed to evaluate this. Immediate surgery is not necessary. Until a biopsy is performed, the provider cannot determine whether it is benign.REF: Definition and Epidemiology/Management

Question 17

1 / 1 pts

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?

Biopsy of the lesions

Uric acid chemical profile

Endocrine studies

Rheumatoid factor

These lesions are consistent with gout and uric acid deposits. The provider should evaluate this by ordering a uric acid chemical profile. Biopsy is indicated for any small, crusted, ulcerated, or indurated lesion that doesn’t heal. Rheumatoid nodules indicate a need for rheumatoid profiles. Endocrine studies are ordered for patients with calcification nodules.REF: Definition and Epidemiology/Diagnostics

Question 18 1 / 1 pts

A provider is recommending a cerumenolytic for a patient who has chronic cerumen buildup. The provider notes that the patient has dry skin in the ear canal. Which preparation is FDA approved for this use?

Carbamide peroxide

Mineral oil

MSN 620 Primary care Quiz

Liquid docusate sodium

Hydrogen peroxide

Any preparation with carbamide peroxide is FDA approved as a cerumenolytic. Patients with dry skin in the ear canal should not use any product containing hydrogen peroxide. Liquid docusate sodium and mineral oil are often used, but do not have specific FDA approval.REF: Management

Question 19

1 / 1 pts

A patient complains of otalgia and difficulty hearing from one ear. The provider performs an otoscopic exam and notes a dark brown mass in the lower portion of the external canal blocking the patient’s tympanic membrane. What is the initial action?

Use a curette to attempt to dislodge the mass

Prescribe a ceruminolytic agent for that ear

Irrigate the canal with normal saline

Ask the patient about previous problems with that ear

Before attempting to remove impacted cerumen, the provider must determine whether the TM is intact and should ask about pressure equalizing ear tubes, a history of ruptured TM, and previous ear surgeries. Once the TM is determined to be intact, the other methods may be attempted, although the curette should only be used if the mass is in the lateral third of the ear canal.REF: Management

Question 20 1 / 1 pts

A screening audiogram on a patient is abnormal. Which test may the primary provider perform next to further evaluate the cause of this finding?

Impedance audiometry

Pure tone audiogram

MSN 620 Primary care Quiz

Speech reception test

Tympanogram

A screening tympanogram may be performed by a primary provider to determine tympanic membrane mobility and may help in identifying the presence of infection, fluid, or changes in middle ear pressure. The other tests are performed by audiologists, not primary care providers.REF:

Diagnostics

IncorrectQuestion 21

0 / 1 pts

A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis?

Facial palsy and vertigo

Vertigo with changes in head position

Spontaneous horizontal nystagmus

Fluctuating hearing loss and tinnitus

Many patients with vestibular neuritis will exhibit spontaneous horizontal or rotary nystagmus, away from the affected ear. Facial palsy with vertigo occurs with Ramsay Hunt syndrome, caused by herpes zoster. Fluctuating hearing loss with tinnitus is common in Meniere’s disease. Tinnitus may occur with vestibular neuritis, but hearing loss does not occur. Patients with benign paroxysmal positional vertigo will exhibit vertigo associated with changes in head position.REF: Vestibular Neuritis/Physical

Examination/Differential Diagnosis

Question 22

1 / 1 pts

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?

Electrocochleography

Auditory brainstem testing

Vestibular testing

Audiogram and MRI

An audiogram and MRI are part of basic testing for Meniere’s disease. The other testing may be performed by an otolaryngologist after referral.REF: Meniere’s Disease/Diagnostics

Question 23

1 / 1 pts

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

Otitis media with effusion

Acute otitis externa

Acute otitis media

This patient’s symptoms are classic for acute otitis externa. Chronic otitis externa more commonly presents with itching. Acute otitis media is accompanied by fever and tympanic membrane inflammation, but not external canal inflammation. Otitis media with effusion causes a sense of fullness but not pain.REF: Clinical Presentation/Box 85-1: Differential Diagnosis

Question 24 1 / 1 pts

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

Fluconazole

Neomycin

Vinegar and alcohol

In the absence of a culture, the provider should choose a medication that is effective against both P. aeruginosa and S. aureus. Cipro HC covers both organisms and also contains a corticosteroid for inflammation. Fluconazole is an oral anti-fungal medication used when fungal infection is present. Neomycin alone does not cover these organisms. Vinegar and alcohol is used to treat mild fungal infections.REF: Management

Question 25

1 / 1 pts

Which patient may be given symptomatic treatment with 24 hours follow-up assessment without initial antibiotic therapy?

A 4 year old, afebrile child with bilateral otorrhea

A 5 year old with fever of 38.0° C, severe otalgia, and red, bulging TM

A 36 month old with fever of 38.5° C, mild otalgia, and red, non-bulging TM

A 6 month old with fever of 39.2° C, poor sleep and appetite and bulging TM Children older than 24 months with fever less than 39° C and non-severe symptoms may be watched for 24 hours with symptomatic treatment. Children with otorrhea, those with severe AOM, and any children with fever greater than 39° C should be given antibiotics.REF: Management

Question 26 1 / 1 pts

A patient reports ear pain and difficulty hearing. An otoscopic examination reveals a small tear in the tympanic membrane of the affected ear with purulent discharge. What is the initial treatment for this patient?

Prescribe antibiotic ear drops

Irrigate the ear canal to remove the discharge

Insert a wick into the ear canal

Refer the patient to an otolaryngologist

This perforation is most likely due to infection and should be treated with antibiotic ear drops. Wicks are used for otitis externa. The ear canal should not be irrigated to avoid introducing fluid into the middle ear. It is not necessary to refer unless the perforation does not heal.REF: Clinical Presentation and Physical Examination/Management

Question 27 1 / 1 pts

A patient reports ear pain after being hit in the head with a baseball. The provider notes a perforated tympanic membrane. What is the recommended treatment?

Order antibiotic ear drops if signs of infection occur

Reassure the patient that this will heal without problems

Prescribe analgesics and follow up in 1 to 2 days

Refer the patient to an otolaryngologist for evaluation

Patients with traumatic or blast injuries causing perforations of the tympanic membranes should be referred to specialists to determine whether damage to inner ear structures has occurred. For an uncomplicated perforation, the other interventions are all appropriate.REF: Complications and Indications for Referral

Question 28 1 / 1 pts

A patient reports persistent nasal blockage, nasal discharge, and facial pain lasting on the right side for the past 4 months. There is no history of sneezing or eye involvement. The patient has a history of seasonal allergies and takes a non-sedating antihistamine. What does the provider suspect is the cause of these symptoms?

Autoimmune vasculitides

Chronic rhinosinusitis

Allergic rhinitis

Rhinitis medicamentosa

Chronic rhinosinusitis is present when symptoms occur longer than 3 months. Sneezing and itchy, watery eyes tend to occur with allergic rhinitis. Autoimmune vasculitides affects upper and lower respiratory tracts as well as the kidneys. Rhinitis medicamentosa occurs with use of nasal decongestants and not oral antihistamines.REF: Clinical Presentation/Differential Diagnosis/Table 88-1: Comparison of Clinical Presentations of Chronic Rhinosinusitis and Allergic Rhinitis

Question 29 1 / 1 pts

A provider determines that a patient has chronic rhinosinusitis without nasal polyps. What is the first-line treatment for this condition?

Systemic corticosteroids

Intranasal corticosteroids

Topical decongestants

Oral decongestants

Intranasal corticosteroids are the mainstay of treatment for CRS. Oral decongestants should be used sparingly, only when symptoms are intolerable. Topical decongestants can cause rebound symptoms. Systemic steroids are not indicated.REF: Management

Question 30 1 / 1 pts

A pregnant woman develops nasal congestion with chronic nasal discharge. What is the recommended treatment for this patient?

Saline lavage

MSN 620 Primary care Quiz

Prophylactic antibiotics

Intranasal corticosteroids

Topical decongestants

Saline lavage is recommended for pregnancy rhinitis; the condition will resolve after delivery. There is no human data on the safety of intranasal corticosteroids during pregnancy. Prophylactic antibiotics are not indicated; this is not an infectious condition. Topical decongestants can cause rebound symptoms.REF: Management

Quiz Score: 24 out of 30