Exam 1: Quizzes Flashcards
TG presents with L eye pain. States it is difficult to open or move the eye due to pain and it feels like there is something in the eye. On exam you note excessive tearing and photophobia. What is the most likely diagnosis for TG?
a. Dry eye syndrome
b. Viral conjunctivitis
c. Corneal abrasion
d. Giant papillary conjunctivitis
c. Corneal abrasion
For which of the following patients will you provide an urgent/STAT referral to ophthalmology?
a. 33 y/o using lubricant eye drops 8-10 times daily when working on their computer
b. 74 y/o presents with sudden loss of sight in their L eye
c. 29 y/o not responding to antihistamine drops for allergic conjunctivitis
d. 26 y/o experiencing flashes of light with a headache
b. 74 y/o presents with sudden loss of sight in their L eye
ST is a 32 y/o who presents with c/o a 2-day history of waking with their eye “stuck shut”. Which of the following additional symptoms will most strongly support a diagnosis of bacterial conjunctivitis?
a. swollen upper eyelid, blurred vision
b. sensation of something in the eye, photophobia
c. consistent thick, creamy/yellow discharge, injection
d. intermittent watery discharge, pruritus, injection
c. consistent thick, creamy/yellow discharge, injection
Which of the following will you include when educating your patient who has a pinguecula?
a. wear sunglasses and a wide-brimmed hat outside, use lubricant eye drops generously
b. use antihistamine and lubricant drops generously, flush eye with saline as needed
c. apply cool compresses and use lubricant drops generously, avoid contact lens use
d. use mast cell stabilizer drops and lubricant drops generously, avoid sun exposure
a. wear sunglasses and a wide-brimmed hat outside, use lubricant eye drops generously
Which of the follow will you include in your management plan for you 68 y/o patient with dry eye syndrome?
a. avoid sun exposure, apply warm compresses 4x/day, wash lashes vigorously
b. use antihistamine drops 2x/day, apply cold compresses 2x/day, take omega-3 fatty acids
c. limit computer use, blink frequently, use lubricant drops frequently (up to hourly)
d. wear sunglasses whenever outside, avoid use of mascara, take AREDS vitamins
c. limit computer use, blink frequently, use lubricant drops frequently (up to hourly)
Your patient presents with a painful, red, swollen R eye/eyelid. You are concerned about periorbital cellulitis. Which of the following additional features aligns with a diagnosis of periorbital cellulitis?
a. pain with EOMs, afebrile, recent trip across the country
b. vision impairment, diplopia, intact and painless extraocular movements
c. recent sinusitis, pain with extraocular movements, fever
d. proptosis, no vision impairment, intact and painless extraocular movements
c. recent sinusitis, pain with extraocular movements, fever
Which of the following symptom clusters do you expect in your patient with blepharitis?
a. mucoid discharge, pruritis, flaking near eyelashes
b. hazy cornea, pain with blinking, loss of ‘red reflex’
c. tender eyelid, subQ lid nodule, lid erythema on affected side
d. burning/foreign body sensation, lid erythema, lid crusting
d. burning/foreign body sensation, lid erythema, lid crusting
Your 64 y/o M patient has diabetes and is asking how to prevent eye problems. You advise:
a. follow the medical nutrition diet you were prescribed
b. exercise daily
c. have a dilated eye exam with an ophthalmologist at least once/year
d. maintain you A1C below 7%
d. maintain you A1C below 7%
You expect the following symptoms in a patient with acute close angle glaucoma:
a. diplopia, reduced peripheral vision, headache, tearing
b. central vision loss, eye pain, pupillary constriction, tearing
c. slow onset visual disturbance, headache, injection
d. sudden blurry vision with halos, eye pain, injection
d. sudden blurry vision with halos, eye pain, injection
Mr. Tessler is a 68 y/o M who presents reporting difficulty with reading and using road maps. Based on this information alone, which of the following diagnoses is most likely?
a. retinal detachment
b. age-related macular degeneration
c. open angle glaucoma
d. closed angle glaucoma
b. age-related macular degeneration
Which of the following patients meets guideline criteria for a diagnosis of bacterial sinusitis?
a. 58-year-old with 9 days of nasal congestion, headache, low grade temperature, cough.
b. 48-year-old with 7 days of nasal congestion, productive cough, sneezing, no fever.
c. 38-year-old with 5 days of nasal congestion, slight cough, no fever.
d. 68 y/o with 11 days of nasal congestion, facial pain, slight cough, low grade fever
d. 68 y/o with 11 days of nasal congestion, facial pain, slight cough, low grade fever
Carol is a 34-year-old married mother of 2 school aged kids. She presents with a 3-day history of acute sore throat. She says it is hard to swallow. She has been feeling feverish at home; however, she has not measured her temperature. She has a slight cough, a poor appetite mostly due to pain with swallowing, and feels tired. She has a slight headache. On exam you note a beefy red posterior pharynx with 2+ tonsillar hypertrophy and scattered exudate. She has tender anterior cervical and tonsillar adenopathy. What is your most likely diagnosis?
a. Post nasal drip
b. Beta hemolytic streptococcus, group A
c. Herpetic tonsillitis
d. Acute HIV infection
b. Beta hemolytic streptococcus, group A
Sophia is a 22-year-old Black female who presents with complaint of left ear discomfort. In gathering the history, you learn that she had an upper respiratory infection (common cold) last week and her ear discomfort began last night. She occasionally hears popping sounds, especially with swallowing. She has not noticed any drainage from the ear and has not taken any medications for it. She does not smoke. On exam you note clear canals with fluid level and bubbles behind the pearly grey left tympanic membrane (TM). What is the most appropriate conservative treatment for Sophia’s symptoms?
a. Antibiotics
b. Antihistamines
c. Decongestants
d. Steroid otic drops
c. Decongestants
In treating your primary care patient who has tested positive for covid (coronavirus), you will select an appropriate antiviral medication based on specific criteria established by the Centers for Disease Control and Prevention (CDC). Considering those criteria, which of the following patients is highest priority for receiving a prescription for an antiviral medication?
a. 44-year-old with onset of symptoms 5 days ago and has a BMI of 38kg/m2.
b. 59-year-old onset of symptoms 3 days ago and has rheumatoid arthritis.
c. 22-year-old with onset of symptoms 1-2 days ago and is planning a pregnancy soon.
d. 72-year-old with onset of symptoms 4 days ago and has asthma.
d. 72-year-old with onset of symptoms 4 days ago and has asthma.
Which antibiotic will you prescribe first line to a patient with bacterial sinusitis? The patient has no medication allergies, takes no other medications, is mildly ill, and has not had antibiotics in the prior 6 months.
a. Azithromycin (Azithromax) 500mg PO on day 1 then 250mg PO daily on days 2-5
b. Moxifloxicin (Avelox) 400mg PO daily x 7 days
c. Amoxicillin/clavulanate (Augmentin) 875/125mg PO BID x 7 days
d. Doxycycline (Doxycycline) 100mg PO BID x 7 days
c. Amoxicillin/clavulanate (Augmentin) 875/125mg PO BID x 7 days
Sophia is a 22-year-old Black female who presents with complaint of left ear discomfort. In gathering the history, you learn that she had an upper respiratory infection (common cold) last week and her ear discomfort began last night. She occasionally hears popping sounds, especially with swallowing. She has not noticed any drainage from the ear and has not taken any medications for it. She does not smoke. On exam you note clear canals with a fluid level and bubbles behind the pearly grey left tympanic membrane (TM). What is the most likely diagnosis for Sophia?
a. Otitis externa
b. Perforated TM
c. Serous otitis
d. Acute otitis media
c. Serous otitis
Stephen is a 24-year-old healthy appearing male. He presents with complaint of upper respiratory “cold” symptoms that have persisted for 3 weeks. He describes clear nasal discharge, intermittent sore throat, sneezing, and nasal congestion. He has tried several different over-the-counter cold preparations; however, they made him sleepy and caused him difficulty in focusing at work. On physical exam you note that his turbinates have bluish streaks on the mucosa. What is your most likely diagnosis?
a. Allergic rhinitis
b. Sinusitis
c. Pharyngitis
d. Common cold
a. Allergic rhinitis
Jessie returns for a repeat visit 2 days after being seen for ear pain. She was initially treated with conservative therapy and reports that the treatment did not work; her ear is now more painful. Her temperature is 101o F. On exam her left TM has a cloudy fluid level approximately halfway up; the right TM is bulging, has a whitish discoloration at one side, and is erythematic and injected. What is the most likely diagnosis for Jessie?
a. Perforate TM
b. Otitis externa
c. Acute otitis media
d. Serous otitis
c. Acute otitis media
You have diagnosed your patient with infectious mononucleosis. Which of the following will you include in your patient education?
a. OTC nasal steroid, fever management, STI testing
b. STI testing, fever management, mucolytic use
c. saline gargles for sore throat, mucolytic use, OTC nasal steroid
d. saline gargles for sore throat, fever management, avoid contact sports
d. saline gargles for sore throat, fever management, avoid contact sports
Which one of the following has information true of cerumen impaction?
a. get audiometry twice yearly, treat with OTC mast cell stablizer
b. antihistamine drops help prevent, treat by washing canals with warm soapy water
c. avoid exposure to repeated loud noise, use carbamide (Debrox) as needed
d. avoid use of ear plugs, treat with regular auto-insufflation
c. avoid exposure to repeated loud noise, use carbamide (Debrox) as needed
MC is a 24-year-old Black female (she/her) who presents to primary care with complaint of increasing wheezing, chest tightness, and cold symptoms. She has mild intermittent asthma, which is usually well managed with an albuterol inhaler 2 puffs 4 x daily as needed. She reports using the inhaler daily this week. On exam, she has nontender sinuses; patent nares with +erythema, +edema, and clear to milky colored mucus; mild post cervical lymphadenopathy; lungs with expiratory wheezes, L > R. She does not smoke. Which test is appropriate?
a. Office peak flow measure
b. Arterial blood gases
c. Chest x-ray
d. Pre- and post-bronchodilator spirometry
a. Office peak flow measure
Your 54-year-old patient (they/them) tested positive for coronavirus (Covid). They are using over-the-counter medications you recommended to manage their symptoms, which began 3 days ago. They are generally healthy with well-managed hypertension and well-managed diabetes type 2. Which of the following medications would be appropriate to prescribe?
a. casirivimab/imdevimab (REGEN-COV)
b. remdesivir (Veklury)
c. nirmatrelvir/ritonavir (Paxlovid)
d. tixagevimide/cilgavimab (Evusheld)
c. nirmatrelvir/ritonavir (Paxlovid)
You see the following four patients in your primary care practice. Which one is at the lowest risk for sleep apnea?
a. A 65-year-old postmenopausal female (she/her).
b. A 35-year-old female (she/her) with controlled hypertension.
c. A 25-year-old female (she/her) with goiter whose partner complains about her snoring.
d. A 45-year-old male (he/him) with waist circumference of 35 inches.
d. A 45-year-old male (he/him) with waist circumference of 35 inches.
Mr. K is a 67-year-old Hispanic male (he/him) who presents with shortness of breath that has been increasing over the past 3 months. He describes feeling tired and having trouble catching his breath sometimes at rest but especially upon exertion. He coughs up whitish phlegm frequently. He has a +30-pack year history of smoking. His BP is 144/84, P 94, RR 24, T 98.7F, resting O2
sat 95% (RA). Lungs have diminished breath sounds at both bases with occasional expiratory wheezes. What diagnostic test will you order for Mr. K to confirm your diagnosis?
a. Spiral computed tomography
b. Pulmonary function test
c. Arterial blood gas
d. Chest X-ray
b. Pulmonary function test
