Week 3 Quiz Differential Diagnosis

Week 3 Quiz NR511 Blue Correct Question 1 1 / 1 pts A 25-year-old male presents with “bleeding in my eye” for 1 day. He awoke this morning with a dark area of redness in his eye. He has no visual loss or changes. He denies constitutional symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as a dark red area in the patient’s sclera of the right eye only and takes up less than 50% of the eye. The patient’s remaining sclera is clear and white. He also notes he was drinking alcohol last night and vomited afterward. What is the best treatment? Cold compresses and frequent handwashing. Sending the patient to the emergency department for immediate ophthalmology consult. Correct! Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks. Topical steroids and close follow-up with an ophthalmologist. This is the classic presentation of a subconjunctival hemorrhage. It will resolve without treatment in 2 to 4 weeks. Vomiting probably caused his hemorrhage. Question 2 1 / 1 pts A 27-year-old female comes in to your primary care office complaining of a perioral rash. The patient noticed burning around her lips a couple days ago that quickly went away. She awoke from sleep yesterday and noticed a group of vesicles with erythematous bases where the burning had been before. There is no burning today. She is afebrile and has no difficulty eating or swallowing. What test would confirm her diagnosis? Sterile culture sent for aerobic and anaerobic bacteria. Correct! Tzanck smear. Potassium hydroxide (KOH) prep. Exam under a Wood lamp. This would show giant cells consistent with herpes simplex virus. KOH and wood's lamp are used to diagnose fungal infections. Cultures can be sent to diagnose bacterial infections but it will not detect HSV. Question 3 1 / 1 pts Mary, age 82, presents with several eye problems. She states that her eyes are always dry and look “sunken in.” What do you suspect? Correct! Normal age-related changes. A detached retina. Hypothyroidism. Cushing syndrome. Dryness of the eyes and the appearance of “sunken” eyes are normal age-related changes. Question 4 0 / 1 pts A 20-year-old male presents to your office in the summer complaining of chest discoloration. He is a lifeguard and has been out in the sun without a shirt on for long periods of time. His physical exam shows small, flat, circular, hypopigmented macules on his chest that he states are mildly pruritic. What is the treatment of choice for this diagnosis? You Answered Hydrocortisone cream 1%. Oral fluconazole. Correct Answer Selenium sulfide shampoo. Ketoconazole shampoo. Selenium sulfide shampoo is the treatment of choice for tinea versicolor. Ketaconozole is not the treatment for tinea versicolor but it can be used for recurrence prevention in resolved cases. Oral fluconazole is only the treatment in severe cases that are resistant to topical treatments. Question 5 1 / 1 pts A 22-year-old college student presents to your urgent care clinic complaining of a rash. She was recently on spring break and spent every night in the hot tub at her hotel. On physical exam, she has multiple small areas of 1- to 2-mm erythematous pustules that are present mostly where her bathing suit covered her buttocks. What is the most likely pathogen causing these lesions? Correct! Pseudomonas aeruginosa. Klebsiella. Staphylococcus aureus. Streptococcus. This is a common cause of hot tub folliculitis. Staph and Strep can cause folliculitis but it is not the most common pathogens in hot tubs. Klebsiella can cause folliculitis in the immunocompromised patient. Question 6 0 / 1 pts A 10-year-old male presents to the office with his mother with complaints of itchy and red eyes for 1 day. He reports watery drainage in both eyes, associated with repetitive itching. He has no fever or constitutional symptoms. The patient has a sibling that just started day care recently. Upon examination, vision is 20/20 OU with glasses. He has mild to moderate conjunctival hyperemia with bilateral preauricular lymph nodes that are inflamed. What is the patient’s diagnosis? Correct Answer Viral conjunctivitis. Blepharitis. You Answered Allergic conjunctivitis. Bacterial conjunctivitis. This is the classic presentation of viral conjunctivitis. The patient also has exposure to kids at school and a sibling with day care exposure. Question 7 1 / 1 pts A rash that looks like the patient was slapped on the cheeks of the face is the hallmark characteristic for which disease? Rubeola. Rubella. Rocky Mountain spotted fever. Correct! Erythema infectiosum (fifth disease). Erythema infectiosum (fifth disease) usually starts on the cheeks and spreads to the arms and trunk. Question 8 1 / 1 pts A 25-year-old male presents to your urgent care clinic complaining of genital pruritus. On physical exam, the patient has small, erythematous, excoriated papules in his pubic hair. No mites are identified. There is no penile discharge, and the patient has no constitutional symptoms. He is sexually active but wears condoms during all sexual experiences. What is the most likely diagnosis? Correct! Pediculosis. Scabies. Gonorrhea. Chlamydia. This is a common presentation of genital lice. Question 9 1 / 1 pts Henry, 64 years old, is having difficulty getting rid of a corneal infection. He asks why. How do you respond? “Systemic antibiotics have difficulty getting to that area of the eye.” “Because the infection was painless, it was not treated early enough.” Correct! “Because the cornea doesn’t have a blood supply, an infection can’t be fought off as usual.” “We can’t determine the causative agent.” Because the cornea is an avascular organ, immune defenses have difficulty fighting off infections. Question 10 1 / 1 pts A 4-year-old male presents to your pediatric clinic with his mother complaining of an itchy rash, mostly between his fingers. This has been going on for multiple days and has been getting worse. The patient recently started at a new day care. On physical exam, the patient is afebrile and has multiple small (1-2 mm) red papules in sets of 3 located in the web spaces between his fingers. He also has signs of excoriation. What is the treatment for this problem? Correct! Permethrin lotion for the patient and also his family members. Cold compresses and hydrocortisone cream 1% twice a day. Ketoconazole cream. Over-the-counter Benadryl cream. This is the treatment for scabies. Question 11 0 / 1 pts Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red eye without discharge. You should suspect: You Answered Bacterial conjunctivitis. Allergic conjunctivitis. Correct Answer Iritis. Viral conjunctivitis. In a client with iritis, there is rarely a discharge. Question 12 1 / 1 pts A 3-year-old patient presents to your pediatric office with her mother. She has recently started in day care. Her mother noted slight perioral erythema on the right side of the patient’s mouth last night before bed. The patient awoke today with 3 small, superficial, honey-colored vesicles where the erythema was last night. The patient has no surrounding erythema presently. She had no difficulty eating this morning and is active and energetic and doesn’t appear lethargic or fatigued. She is also afebrile. How would you treat this child? Oral Keflex for 7 days. Local debridement and topical compress with Burow solution and close follow-up. Topical compress with Burow solution and follow-up in 2 to 3 days. Correct! Local debridement and mupirocin for 5 days. This is the treatment of choice for impetigo. Question 13 1 / 1 pts Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for a red eye. You are trying to decide between a diagnosis of conjunctivitis and iritis. One distinguishing characteristic between the two is: Slow progression. Correct! A ciliary flush. Eye discomfort. No change in or slightly blurred vision. When trying to decide between a diagnosis of conjunctivitis and iritis, one distinguishing characteristic is the ciliary flush present in iritis. Photophobia is not usually present in conjunctivitis, but it is always present with iritis. Photophobia occurs with corneal inflammation, iritis, and angle-closure glaucoma. Question 14 1 / 1 pts Which of the following patients does not have an increased risk of Candida infection? A patient using a steroid regimen for asthma control. A diabetic patient. A patient requiring home antibiotics while recovering from an operation for an infected hernia. Correct! A patient with a history of coronary artery disease. Coronary artery disease doesn’t increase the risk of Candida infection. Question 15 1 / 1 pts You diagnose 46-year-old Mabel with viral conjunctivitis. Your treatment should include: Ciprofloxacin ophthalmic drops. Correct! Supportive measures and lubricating drops (artificial tears). Gentamicin ophthalmic ointment. Oral erythromycin for 14 days. Viral conjunctivitis is treated with supportive measures, including cold compresses and lubricating eye drops. Preventive measures, such as frequent handwashing, are important, as viral conjunctivitis is highly contagious.