A 12-year-old complains of itching in his right ear and pain when the pinna is pulled or the tragus is pushed. Examination revealed slight redness in the ear canal with a clear odorless fluid. This could be suggestive of:

• Otitis externa. (Correct answer: This condition involves inflammation of the external ear canal, often associated with pain when the ear is manipulated.)

A patient has been diagnosed with mononucleosis. Which statement is correct?

• Cervical lymphadenopathy may be prominent. (Correct answer: Swollen lymph nodes, particularly in the neck, are a common feature of mononucleosis.)

An older adult has a common cold. She calls your office to ask for advice for an agent to help her runny nose and congestion. What agent is safe to use?

• Guaifenesin. (Correct answer: Guaifenesin is an expectorant that helps clear mucus, making it safe for older adults.)

A 70-year-old female states that she sees objects better by looking at them with her peripheral vision. She is examined and found to have a loss of central vision, normal peripheral vision, and a normal lens. This best characterizes:

• Macular degeneration. (Correct answer: Macular degeneration affects the central vision while sparing peripheral vision.)

A 20-year-old patient presents with complaints of a sore throat and cough that began this morning. His oral temperature is 101.2 °F. He has the following laboratory results. What is his most likely diagnosis?

• Viral pharyngitis. (Correct answer: The symptoms and lab findings are typical of viral pharyngitis, a common cause of sore throat.)

In a patient who is diagnosed with mastoiditis, which of the following is most likely?

• Displaced pinna. (Correct answer: Mastoiditis can lead to the displacement of the ear due to inflammation and infection.)

A patient is diagnosed with thrush. What might be found on microscopic exam?

• Budding yeasts, pseudohypha. (Correct answer: These are typical findings in oral thrush, a fungal infection.)

A 4-year-old was diagnosed and treated for acute otitis media in the left ear 4 weeks ago. She is here today for a well-child visit. There is an effusion in the left ear. She denies complaints. How should this be managed?

• This should be monitored. (Correct answer: The presence of effusion without symptoms often resolves on its own and can be monitored.)

Group A Strept pharyngitis: can be accompanied by:

• Abdominal pain. (Correct answer: Group A Streptococcus infections can cause abdominal pain, particularly in children.)

A 2-year-old has a sudden onset of high fever while at daycare. The daycare attendant describes a seizure in the child. The child is brought to the clinic; neurologically he appears normal. His body temperature is 99.9° F after receiving ibuprofen. He is diagnosed with otitis media. How should the nurse practitioner manage this?

• Treat the otitis media and give education about fever management. (Correct answer: Managing the underlying infection and providing fever management education is crucial.)

A 70 year-old male has a yellowish, triangular nodule near the iris. This is probably:

• A pinguecula. (Correct answer: A pinguecula is a common, benign growth on the eye that can be triangular in shape.)

Which long-acting antihistamine listed below is sedating?

• Cetirizine. (Correct answer: Cetirizine can cause sedation, though it is less sedating than some older antihistamines.)

A patient presents to your clinic with a painless red eye. Her vision is normal, but her ocular surface has a blood red area. What is this termed?

• Subconjunctival hemorrhage. (Correct answer: This is a common and typically benign condition caused by a small blood vessel breaking.)

An otherwise healthy 6-year-old male has been diagnosed with otitis media. His mother reports that he has not had an ear infection since he was 3 years old. How long should he be treated with an antibiotic?

• 5-7 days. (Correct answer: A typical course of antibiotics for otitis media in children is 5-7 days.)

At what age should oral health risk assessment begin?

• 6 months. (Correct answer: Oral health assessments should begin around the time the first teeth erupt, usually by 6 months of age.)

A 1-week-old infant has a bilateral mucopurulent eye discharge. What explains the etiology of the discharge?

• The mother probably has an STD. (Correct answer: Neonatal conjunctivitis can be caused by maternal sexually transmitted infections.)

The most common cause of acute pharyngitis in children is:

• Respiratory viruses. (Correct answer: Viral infections are the most common cause of sore throat in children.)

Epstein-Barr virus is responsible for:

• Mononucleosis. (Correct answer: Epstein-Barr virus is the primary cause of infectious mononucleosis.)

A patient reports a penicillin allergy. What question regarding the allergy should the nurse practitioner ask to determine whether a cephalosporin can be safely prescribed?

• What kind of reaction did you have? (Correct answer: Understanding the nature of the allergic reaction helps determine if cephalosporins are safe.)

A rapid strep test was negative in a 12-year-old female with tonsillar exudate, fever, and sore throat. Which statement is true regarding this?

• A throat swab should be collected and sent to microbiology. (Correct answer: A negative rapid strep test in the presence of symptoms warrants a confirmatory throat culture.)

A 70-year-old presents urgently to the nurse practitioner clinic with angioedema. This began less than an hour ago. He is breathing without difficulty. What medication may have caused this?

• Fosinopril. (Correct answer: ACE inhibitors like Fosinopril are known to cause angioedema.)

A patient with diarrhea has a positive enzyme immunoassay for C. difficile. He is on clindamycin for a tooth abscess. How should he be managed?

• Stop the clindamycin if possible, give metronidazole. (Correct answer: Metronidazole is a treatment for C. difficile infection, and stopping the offending antibiotic is advised.)

A 61-year-old male presents with a 12-hour history of an extremely painful left red eye. The patient complains of blurred vision, halos around lights, and vomiting. It began yesterday evening. On examination, the eye is red, tender, and inflamed. The cornea is hazy and the pupil reacts poorly to light. The most likely diagnosis in this patient is:

• Acute angle glaucoma. (Correct answer: The symptoms described are characteristic of acute angle-closure glaucoma, a medical emergency.)

Most commonly, epistaxis occurs:

• At Kiesselbach’s plexus. (Correct answer: This is the most common site of nosebleeds, particularly in the anterior septum.)

What is the usual age for vision screening in young children?

• 3 years. (Correct answer: Vision screening is typically recommended to start at age 3.)

A 3-year-old has fluid in the middle ear that does not appear infected. The eardrum appears normal. This is referred to as:

• Middle ear effusion. (Correct answer: This condition involves non-infected fluid in the middle ear, often following an ear infection.)

A patient with mononucleosis would most likely have:

• Lymphocytosis. (Correct answer: An elevated lymphocyte count is a common finding in mononucleosis.)

A patient who presents with a complaint of sudden decreased visual acuity has a pupil that is about 4 mm, fixed. The affected eye is red. What might be the etiology?

• Glaucoma. (Correct answer: This description is indicative of acute angle-closure glaucoma.)

A patient who is otherwise healthy states that he woke up this morning and has been unable to hear out of his left ear. The Weber and Rinne tests were performed. What is the primary reason for doing this?

• It helps differentiate conductive from sensorineural hearing loss. (Correct answer: These tests are used to distinguish between different types of hearing loss.)

A patient who is 65 years old states that she has “hay fever” and has had this since childhood. What agent could be safely used to help with rhinitis, sneezing, pruritis, and congestion?

• Nasal steroid. (Correct answer: Nasal steroids are effective and safe for long-term management of allergic rhinitis.)

An NP examines a screaming 2-year-old. A common finding is:

• Pink tympanic membranes. (Correct answer: The increased vascularity during crying can make the tympanic membrane appear pink.)

A patient presents with severe toothache. She reports sensitivity to heat and cold. There is visible pus around the painful area. What is this termed?

• Pulpitis. (Correct answer: Pulpitis involves inflammation of the dental pulp, often leading to pain and sensitivity.)

How should the class effect of the nasal steroids be described?

• There are no significant systemic effects with these. (Correct answer: Nasal steroids have minimal systemic absorption and are generally safe for long-term use.)

A patient diagnosed with Strep throat received a prescription for azithromycin. She has not improved in 48 hours. What course of action is acceptable?

• A penicillin or cephalosporin with beta-lactamase coverage should be considered. (Correct answer: Switching to a beta-lactam antibiotic may be necessary if there is no response to initial therapy.)

An infant is brought to the nurse practitioner because his gaze is asymmetrical. Which finding indicates a need for referral to ophthalmology?

• He has persistent strabismus. (Correct answer: Persistent strabismus requires evaluation by an ophthalmologist to prevent vision problems.)

A patient presents to the clinic with a complaint of a red eye. Which assessment below rules out the most worrisome diagnoses?

• Normal fundoscopic exam. (Correct answer: A normal fundoscopic exam helps rule out serious conditions such as retinal detachment or optic neuropathy.)

A 6-day-old has bilateral mucopurulent eye discharge. Which historical finding explains the etiology of the discharge?

• Mother has chlamydia. (Correct answer: Neonatal conjunctivitis due to chlamydia is a common cause of eye discharge in newborns.)

A 4-year-old child with otitis media with effusion:

• Probably has just had acute otitis media. (Correct answer: Effusion often follows an episode of acute otitis media.)

The hearing loss associated with aging involves:

• Sensorineural hearing loss. (Correct answer: Age-related hearing loss typically affects the inner ear and is sensorineural in nature.)

A 4-month-old infant has thrush. The mother is breastfeeding. She reports that her nipples have become red, irritated, and sensitive. What should the nurse practitioner advise the mother of this baby to treat thrush?

• Treat the infant with an oral antifungal suspension and the mother’s nipples with a topical antifungal agent. (Correct answer: Both the infant and mother need treatment to prevent reinfection.)

Arcus senilis is described as: