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The diagnosis and treatment of various common medical conditions, including allergic conjunctivitis, otitis media, acute bacterial rhinosinusitis, hypertension, and hyperlipidemia. It provides information on appropriate treatment options, diagnostic criteria, and management strategies for these conditions. The document could be useful for healthcare professionals, such as nurses and nurse practitioners, who need to stay up-to-date on the latest evidence-based practices in the management of these common medical problems. The content covers a range of topics, including the use of topical and systemic medications, the differentiation of various types of ear and eye infections, and the management of chronic conditions like hypertension and hyperlipidemia.
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In treating a patient with allergic conjunctivitis, the most appropriate treatment option is: a) Bacitracin-polymyxin b) Corticosteroid ophthalmic drops c) Ophthalmological antihistamines d) Cromolyn ophthalmic drops - c) Ophthalmological antihistamines The clinician is assessing a patient complaining of hearing loss. The clinician places a tuning fork over the patient's mastoid process, and when the sound fades away, the fork is placed without restriking it over the external auditory meatus. The patient is asked to let the clinician know when the sound fades away. This is an example of which type of test? a) Auditory Brainstem Response (ABR) test b) Schwalbach test c) Rinne test d) Weber test - c) Rinne test As diabetic retinopathy progresses, the presence of "cotton wool" spots can be detected. Cotton wool spots refer to: a) Venous beading. b) Retinal hemorrhage. c) Nerve fiber layer infarctions. d) Blood vessel proliferation. - c) Nerve fiber layer infarctions. One distinguishing characteristic between conjunctivitis and iritis is: a) No change in or slightly blurred vision b) Slow progression c) Eye discomfort d) A ciliary flush - d) A ciliary flush An acutely presenting, erythematous, tender lump within the eyelid is called: a) Blepharitis
b) Iritis c) Hordeolum d) Chalazion - c) Hordeolum The antibiotic of choice for beta-lactamase coverage of otitis media is: a) Amoxicillin b) Prednisone c) Azithromycin d) Amoxicillin and potassium clavulanate - d) Amoxicillin and potassium clavulanate
In assessing a client with bacterial conjunctivitis, the nurse practitioner finds: a) Minimal itching, moderate tearing, and mucoid exudate. b) Severe itching, moderate tearing, and minimal discharge. c) Minimal tearing, moderate itching, and profuse exudate. d) Minimal itching, moderate tearing, and profuse exudate. - d) Minimal itching, moderate tearing, and profuse exudate. Acute otitis media is diagnosed when there is: a) Fluid in the middle ear accompanied by otalgia and fever. b) Fluid in the middle ear without signs or symptoms of an ear infection. c) A diagnosis of three or more episodes of otitis media within 1 year. d) Fluid in the middle ear for at least 3 months. - a) Fluid in the middle ear accompanied by otalgia and fever. What is the easiest way to differentiate between otitis externa and otitis media? a) With otitis media, tender swelling is usually visible. b) With otitis media, there is usually bilateral pain in the ears. c) With otitis externa, movement or pressure on the pinna is extremely painful. d) With otitis media, there is usually tenderness on palpation over the mastoid process.
b) Mono is rarely contagious. c) Convalescence is usually only a few days and John should be back to normal in a week. d) The offending organism is bacteria and should be treated with antibiotics. - a) John should avoid contact sports and heavy lifting. Matthew, age 52, has chronic allergic rhinitis and would like some medicine to relieve his symptoms. He is taking cimetidine (Tagamet) for gastroesophageal reflux disease. Which medication would you not order? a) A first-generation antihistamine b) A second-generation antihistamine c) A decongestant d) A topical nasal corticosteroid - b) A second-generation antihistamine A 25 - year-old woman who has seasonal allergic rhinitis likes to spend time outdoors. She asks you when the pollen count is likely to be the lowest. You respond: a) "Early in the morning." b) "After a rain shower." c) "When the sky is overcast." d) "During breezy times of the day." - b) "After a rain shower." You prescribe nasal corticosteroid spray for a patient with allergic rhinitis. What is the anticipated onset of symptom relief with its use? a) Immediately with the first spray b) 1 to 2 days c) A few days to a week d) 2 or more weeks - c) A few days to a week Which of the following medications is most appropriate for allergic rhinitis therapy in an acutely symptomatic 24 - year-old machine operator? a) Loratidine b) Diphenhydramine c) Nasal cromolyn d) Flunisolide nasal spray - a) Loratidine Oral decongestants should be discouraged in patients with: a) Chronic bronchitis b) Migraine headache c) Allergic rhinitis d) Cardiovascular disease - d) Cardiovascular disease Which of the following findings is most consistent with the diagnosis of acute bacterial rhinosinusitis? a) Preauricular lymphadenopathy b) Marked eyelid edema c) Upper respiratory tract infections persisting or worsening after 7 - 10 days
d) Mild midfacial fullness and tenderness - c) Upper respiratory tract infections persisting or worsening after 7 - 10 days Which of the following represents a therapeutic option for ABRS in a patient with no recent antimicrobial care with treatment failure after 72 hours of appropriate-dose first line antimicrobial therapy? a) High-dose amoxicillin w/ clavulante b) Clarithormycin c) Ofloxacin d) Clindamycin - a) High-dose amoxicillin w/ clavulante Which of the following class of drugs is preferred treatment for a diabetic with stage II hypertension? a) Calcium channel blockers b) Angiotensin converting enzyme inhibitor c) Alpha blockers d) Loop diuretics - b) Angiotensin converting enzyme inhibitor You are caring for a 30 - year-old white male in your office with a BP of 144/90. He has never had a diagnosis of hypertension. He doesn't check his blood pressure at home. He has a family history of hypertension. What are your recommendations? a) Instruct to purchase a BP cuff, record blood pressures, call if over 140's over 90's, low salt diet, return in 2 weeks. b) Start HCTZ 12.5mg daily, purchase a blood pressure cuff, and return to your office in 1 mth. c) Order a cardiac stress test and lipid panel. d) Order EKG, CMP, CBC, and lipid panel, and refer to cardiology. - a) Instruct to purchase a BP cuff, record blood pressures, call if over 140's over 90's, low salt diet, return in 2 weeks. You are treating a young adult female with HTN and migraine headaches. Which class of medications could you choose to treat both? a) Ace inhibitors b) Calcium channel blockers c) Angiotensin receptor blockers d) Beta blockers - d) Beta blockers A 42 - year-old male presents with the following lipid profile. He is not on any medications for cholesterol or herbal supplements. Total: 210 LDL: 145 TG 162 HDL 52 What medication would you recommend? a) Fish oil
b) Low dose fibrate c) Low dose statin d) Low dose bile acid sequestrant - c) Low dose statin You are caring for a 68-year-old male who has been taking atorvastain (Lipitor) for 8 weeks. He complains of fatigue, muscle aches, and dark-colored urine. Which of the following is the most appropriate treatment plan? a) Order lipid level and serum creatine phosphokinase (CPK, creatine kinase). b) Order a CBC and CMP. c) Recommend increasing his fluids and rest. d) Order a 24 hr urine. - a) Order lipid level and serum creatine phosphokinase (CPK, creatine kinase). What would you advise this patient regarding taking his atrovastatin (Lipitor)? a) Take atorvasatin every other day until labs are available. b) Take half of the atorvastatin daily until labs are available. c) Continue taking the medications until the labs are available. d) Stop taking atorvastatin until the labs are available. - d) Stop taking atorvastatin until the labs are available. A 58 year old male presents to your office with an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved with rest. Which of the following does this best describe? a) Acute myocardial infarction b) Gastroesophageal reflux disease c) Angina pectoris d) Acute costochondritis - c) Angina pectoris Which of the following antihypertensive medications would you avoid prescribing for an elderly white female with the comorbid diagnosis of osteoporosis? a) Calcium channel blockers b) Ace inhibitors c) Beta blockers d) Diuretics - a) Calcium channel blockers What is the most common cause of left ventricular hypertrophy in the United States? a) Mitral valve prolapse b) Pulmonary hypertension c) Chronic atrial fibrillation d) Chronic hypertension - d) Chronic hypertension Which of the following heart sounds is associated with heart failure? a) S1, S2, and S b) S c) S1, S2, and S d) Still's murmer and S4 - b) S
While performing a routine physical exam on a 60-year-old hypertensive male, you notice a bruit over the carotid area on the left side of the neck. There is no induration of the skin. This patient is at higher risk for: a) Dizziness and headaches b) Temporal arteritis and brain aneurysms c) Abdominal aneurysm and congestive heart gailure d) Stroke and coronary heart disease - d) Stroke and coronary heart disease A 72-year-old female presents to your office with gradual difficulty breathing, non- productive cough, bilateral swelling of her feet, and a 10 pound weight gain. Upon examination you hear crackles and rhonchi with an S3 heart sound. What is the most likely diagnosis? a) COPD b) Asthma c) Congestive heart failure d) Renal hypertension - c) Congestive heart failure What is your treatment plan for this patient with difficulty breathing, cough, weight gain, edema, and S3 heart sounds? a) Anti-coagulation and cardiology evaluation b) Diuretics, digoxin, and anti-hypertensive medications c) Rest and increase fluids d) Nebulized albuterol and prednisone - b) diuretics, digoxin, and anti-hypertensive medications You are treating a 49 - year-old female who presents with fatigue and palpitations. You check her apical pulse and she is irregular and tachycardic. You obtain an EKG and it reveals afib with rapid ventricular response. What is your treatment plan? a) You order a cardiology consult. b) You order a 2D echo. c) You perform cardiac massage and have her relax. d) You admit her to the hospital for new onset afib. - d) You admit her to the hospital for new onset afib Upon examination of a 17 - year-old during a sports physical, you hear a split S2 during inspiration that disappears during expiration. The patient denies chest pain and dyspnea. What will you tell the mother and patient regarding your findings? a) Educate the mother and patient that this is a benign finding. b) You advise the patient to avoid strenuous physical activity until further investigation. c) You recommend a referral to cardiology. d) Due to the patient being an athlete, you recommend a stress echo. - a) Educate the mother and patient that this is a benign finding