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For c/o acute onset severe eye pain, photophobia, tearing, and blurred vision in one eye. Which condition most likely? A)Optic neuritis B)Herpes keratitis C)Corneal abrasion D)Retinal detachment - correct answer>>B)Herpes keratitis For c/o abrupt onset difficulty speaking, unilateral hemiparesis, dizziness, vertigo, weakness and poor balance. Slurred speech (aphasia). Which condition most likely? A)Transient ischemic attack B)Trigeminal neuralgia C)Polymyalgia rheumatica D)Stroke - correct answer>>A)Transient ischemic attack For c/o itchy, watery and red eyes, with rope-like yellow discharge. May have chemosis (fluid on eye), eyelid edema, and/or allergic shiners. Which condition most likely? A)Allergic rhinitis B)Sjogren's Syndrome C)Allergic conjunctivitis D)Suppurative conjunctivitis - correct answer>>C)Allergic conjunctivitis
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For c/o acute onset severe eye pain, photophobia, tearing, and blurred vision in one eye. Which condition most likely? A)Optic neuritis B)Herpes keratitis C)Corneal abrasion D)Retinal detachment - correct answer>>B)Herpes keratitis For c/o abrupt onset difficulty speaking, unilateral hemiparesis, dizziness, vertigo, weakness and poor balance. Slurred speech (aphasia). Which condition most likely? A)Transient ischemic attack B)Trigeminal neuralgia C)Polymyalgia rheumatica D)Stroke - correct answer>>A)Transient ischemic attack For c/o itchy, watery and red eyes, with rope-like yellow discharge. May have chemosis (fluid on eye), eyelid edema, and/or allergic shiners. Which condition most likely? A)Allergic rhinitis B)Sjogren's Syndrome C)Allergic conjunctivitis D)Suppurative conjunctivitis - correct answer>>C)Allergic conjunctivitis For c/o facial paralysis progressing rapidly within 24h, difficulty chewing and swallowing food on same side, unable to fully close eyelids and tear production may stop. Which condition most likely? A)Multiple sclerosis B)Trigeminal neuralgia C)Bell's palsy D)Polymyalgia Rheumatica - correct answer>>C)Bell's palsy For c/o acute onset severe eye pain with tearing, and reports feeling of foreign body sensation on surface of eye. Which condition most likely? A)Herpes keratitis B)Corneal abrasion C)Orbital cellulitis D)Suppurative conjunctivitis - correct answer>>B)Corneal abrasion For c/o unilateral facial pain following one of the branches of the trigeminal nerve. Pain usually located close to the nasal border and the cheeks triggered by chewing, eating cold foods or cold air lasting few seconds. Which condition most likely? A)Multiple sclerosis B)Trigeminal neuralgia C)Migraine D)Rhinosinusitis - correct answer>>B)Trigeminal neuralgia For c/o new onset red eye. May report r/t coughing, sneezing, heavy lifting, vomiting, and/or local trauma. On exam, blood trapped underneath the conjunctiva & sclera r/t broken arterioles. No vision change or other clinical abnormalities. Which condition most likely? A)Optic neuritis B)Corneal abrasion C)Suppurative conjunctivitis D)Subconjunctival hemorrhage - correct answer>>D)Subconjunctival hemorrhage
For c/o HA "bandlike" or "squeezing", dull and constant; may follow tensing of neck muscles and last several days. Which condition most likely? A)Migraine HA B)Tension HA C)Cluster HA D)Rebound HA - correct answer>>B)Tension HA Elderly c/o acute onset severe eye pain, with redness & vision changes, associated HA, N/V, halos around lights, & decreased vision. On exam, oval shaped & mid-dilated pupil, cornea appears cloudy, and fundoscopic cupping. Which condition most likely? A)Macular degeneration B)Orbital cellulitis C)Retinal detachment D)Angle closure glaucoma - correct answer>>D)Angle closure glaucoma For c/o symmetrical, burning, weakness & sensory loss, variable course, rapid progression, lower extremity more common with symptoms distal to the trunk. Which condition most likely? A)Transient ischemic attack B)Polymyalgia rheumatica C)Polyneuropathy D)Bell's palsy - correct answer>>C)Polyneuropathy The NP assesses gag reflex. Which CN is tested? A)Oculomotor CN III B)Trigeminal CN V C)Facial CN VII D)Glossopharyngeal CN IX E)Vagus CN X - correct answer>>D)Glossopharyngeal CN IX For acute crusty rashes that follow ophthalmic branch (CN V) of trigeminal nerve, so one side forehead, eyelids, & tip of nose, which can result in blindness. Which condition most likely? A)Herpes keratitis B)Herpes Zoster Ophthalmicus C)Impetigo D)Sjogren's Syndrome - correct answer>>B)Herpes Zoster Ophthalmicus For young adult with c/o abnormal limb sensation, visual loss, motor symptoms, diplopia, gait disturbance, acute motor symptoms. Which condition most likely? A)Multiple sclerosis B)Transient ischemic attack C)Temporal arteritis D)Cluster headache
enough can press on cornea and cause blurred vision. Which condition most likely? A)Chalazion B)Blepharitis C)Corneal abrasion D)Hordoleum - correct answer>>A)Chalazion For bilateral morning stiffness and aching of shoulders, neck, hips, & torso. Common c/o difficulty putting on bra. Which condition most likely? A)Rheumatoid arthritis B)Osteoarthritis C)Multiple sclerosis D)Polymyalgia rheumatica - correct answer>>D)Polymyalgia rheumatica For c/o red, irritated eye with eyelids that were "stuck together" upon awakening. On exam, injected palpebral and bulbar conjunctiva. Which condition most likely? A)Allergic conjunctivitis B)Suppurative conjunctivitis C)Sjogren's Syndrome D)Allergic rhinitis - correct answer>>B)Suppurative conjunctivitis For middle aged male c/o abrupt one-sided HA, marked by recurrent episodes of brief "ice-pick" pain behind one eye, with tearing & clear rhinitis. May have ptosis. Can have episodes several times a day, & resolve spontaneously. Which condition most likely? A)Temporal arteritis B)Tension HA C)Cluster HA D)Migraine HA - correct answer>>C)Cluster HA For c/o sudden onset of shower of floaters associated with photopsia (sensation of looking through a curtain sensation with sudden flashes of light). May have symptoms such as unilateral photophobia, wavy distortion of an object. Which condition most likely? A)Angle closure glaucoma B)Temporal arteritis C)Open angle glaucoma D)Retinal detachment - correct answer>>D)Retinal detachment For c/o spinning, swaying, tilting, N&V, postural instability, as either single episode or recurrent. May have severe N/V, recurring & lasts < 1 minute; or prolonged nystagmus & impaired gait/mobility, as a single episode & lasts minutes to hours. Which condition most likely? A)Syncope B)Vertigo C)Transient ischemic attack D)Meniere's disease - correct answer>>B)Vertigo For c/o raised yellow to white small growth in the bulbar conjunctiva, skin covering eyeball, next to the cornea. Which condition most likely? A)Herpes keratitis B)Pterygium C)Pinguecula D)Chalazion - correct answer>>C)Pinguecula Elderly c/o gradual HA with cognitive impairment such as apathy, somnolence, confusion. Hx head trauma common. Which condition most likely? A)Chronic subdural hematoma B)Delirium C)Dementia D)Migraine HA - correct answer>>A)Chronic subdural hematoma
For s/s decreased function of lacrimal and salivary glands with persistent daily dry eyes and mouth, called xerostomia, for > 3 months. Eyes have sandy or gritty sensation and uses OTC artificial tears TID. Which condition most likely? A)Optic neuritis B)Herpes Zoster Ophthalmicus C)Sjogren's Syndrome D)Herpes keratitis - correct answer>>C)Sjogren's Syndrome For c/o daily HA with irritability, depression, & insomnia. Hx of abortive medications such as NSAIDs, aspirin, narcotics. Which condition most likely? A)Migraine HA B)Rebound HA C)Chronic subdural hematoma D)Tension HA - correct answer>>B)Rebound HA Elderly, may report a gradual change in peripheral vision then central vision, tunnel vision, and/or c/o missing portions of words when reading. Usually asymptomatic during early states. Gradual onset of increased IOP greater than 22 r/t blockage of drainage of aqueous humor inside eye. If cupping of optic disc, then IOP is too high. Which condition most likely? A)Angle closure glaucoma B)Optic neuritis C)Temporal arteritis D)Open angle glaucoma - correct answer>>D)Open angle glaucoma The NP assesses sensation to forehead and cheeks. Which CN is tested? A)TrochlearCN IV B)Trigeminal CN V C)Facial CN VII D)Vagus CN X - correct answer>>B)Trigeminal CN V For c/o gradual onset of numbness & tingling on thumb, index finger & middle finger, affecting hand grip and problems lifting objects with affected hand. Often acroparethesia, awakening at night with numbness & burning pain in fingers. Hx of hobby or occupation involving frequent wrist movement. On exam, positive Tinel's sign, tap anterior wrist briskly elicits pins and needles" sensation; &/or positive Phalen's sign, full flexion of wrist for 60 sec elicits tingling. Which condition most likely? A)Polymyalgia rheumatica B)Trigeminal neuralgia C)Multiple sclerosis D)Carpal tunnel syndrome - correct answer>>D)Carpal tunnel syndrome For yellow triangle wedge-shaped thickening of conjunctiva that extends across the cornea on the nasal side. Can be red or inflamed at times. May c/o foreign body sensation on the eye. Non-cancerous. AKA surfer's eye. Which condition most likely? A)Chalazion B)Pterygium C)Suppurative conjunctivitis D)Pinguecula - correct answer>>B)Pterygium For c/o HA that lasts 4-72h, with 2 s/s unilateral pulsating quality, mod to severe intensity, or aggravated by routine activity; and 1 s/s N/V, photophobia, or phonophobia; hx of 5 or more episodes, with no other reason for HA.
For c/o sore throat, fever, muffled voice, drooling, stridor, hoarseness "hot potato", "thumb sign" Which condition most likely? A)Epiglottitis B)Peritonsillar abscess C)Strep throat D)Bell's palsy - correct answer>>A)Epiglottitis Which tests assess cerebellar function (select all)? A)Tandem B)Stereognosis C)Rapid alternative movement D)Kernig's E)McMurray F)Graphesthesia G)Heel to shin H)Brudzinski's - correct answer>>A, B, C, F, & G - A)Tandem B)Stereognosis C)Rapid alternative movement F)Graphesthesia G)Heel to shin For c/o HA that is unilateral pulsating quality, mod to severe intensity, & or aggravated by routine activity, usually lasting 60min, and preceded by visual, sensory, &/or motor s/s lasting about 5-20min. Which condition most likely? A)Tension HA B)Cluster HA C)Migraine with aura D)Rebound HA - correct answer>>C)Migraine with aura For c/o otalgia, popping noises, muffled hearing. Hx recent cold or allergies more common. On exam, moderate or severe bulging of TM or new onset otorrhea not r/t external ear pain; or erythema, mild bulging of TM and recent onset of ear pain. Which condition most likely? A)Otitis externa B)Bullous myringitis C)Chholesteatoma D)Acute otitis media - correct answer>>D)Acute otitis media For elderly c/o chronic & progressive tremor at rest with pill rolling tremor, bradykinesia, & rigidity. Which condition most likely? A)Alzheimer's dementia B)Parkison's C)Chronic subdural hematoma D)Delirium - correct answer>>B)Parkison's For unilateral hearing loss. May have hx chronic ear infections. On exam, cauliflower like growth with foul smelling ear discharge, no TM visible. Mass is not cancerous but can erode into bones of face & damage facial nerve (CN VII). Which condition most likely? A)Bell's palsy B)Trigeminal Neuralgia C)Otitis externa D)Cholesteatoma - correct answer>>D)Cholesteatoma On exam, the NP assesses shoulder shrug. Which CN is tested? A)CN I B)CN V C)CN IX D)CN XI - correct answer>>D)CN X For c/o unilateral facial pain or upper molar pain for 10 days or longer with purulent nasal or post nasal drip. May have head congestion, fever, sore throat, cough. Self- treatment with OTC provided no relief. Which condition most likely? A)Trigeminal Neuralgia B)Temporal arteritis C)Rhinosinusitis D)Dental abscess - correct answer>>C)Rhinosinusitis (viral or bacterial)
For c/o new onset difficulty performing purposeful movements. Which term matches this finding? A)Apraxia B)Stereognosis C)Graphesthesia D)Aphasia - correct answer>>A)Apraxia For c/o severe sore throat with difficulty swallowing, odynophagia (pain on swallowing) & "hot potato voice" often with malaise, fever, & chills. On exam, unilateral swelling & appears as bulging red mass with uvula displaced away from mass. Which condition most likely? A)Mononucleosis B)Epiglottitis C)Peritonsillar abscess D)Strep throat - correct answer>>C)Peritonsillar abscess The NP assesses "stick out tongue" on exam. Which CN evaluated (select all)? A)Trigeminal CN V B)Facial CN VII C)Glossopharyngeal CN IX D)Vagus CN X E)Accessory CN XI F)Hypoglossal CN XII - correct answer>>D & F - D)Vagus CN X and F)Hypoglossal CN XII For c/o external ear pain, swelling, discharge, pruritus, & hearing loss. Hx of recent activities that involve swimming or getting the ear wet. On examine, ear pain with manipulation of external ear or tragus, purulent green discharge, & erythematous ear canal. Which condition most likely? A)Otitis externa B)Otitis media C)Bullous myringitis D)Meniere's disease - correct answer>>A)Otitis externa Which are common abortive HA treatments (select all)? A)Ergots B)TCAs C)Analgesics D)NSAIDs E)antiseizure F)Triptans - correct answer>>C, D, & F - C)Analgesics D)NSAIDs F)Triptans For c/o malaise & fatigue, with fever, pharyngitis, & lymphadenopathy. Hx of sore throat, fatigue for several weeks. On exam, enlarged posterior cervical nodes, and may have abdominal pain. Which condition most likely? A)Strep throat B)Epiglottitis C)Systemic lupus erythematosus D)Mononucleiosis - correct answer>>D)Mononucleiosis (EBV) Elderly c/o insidious onset, decline in cognition, including complex attention, executive function, learning memory, perceptual motor, &/or social cognition; with deficits severe enough to interfere with function & independence. Which differential diagnoses must the NP rule out (select all)? A)Depression B)Parkinson's C)Delirium D)Dementia E)Stroke
The NP assesses the neck passively flexed/bended toward chest and finds this elicits flexing of the hips and knees to relieve pressure/pain. Which term matches this test? A)Tandem B)Kernig's C)Brudzinski's D)Nuchal rigidity - correct answer>>C)Brudzinski's For c/o brief, recurrent, spinning, swaying, tilting, N&V, &/or postural instability, with reproducible symptoms, attributed to calcium debris in semicircular canals. On exam, change in position precipitates symptoms and positive Dix-Hallpike maneuver. Which condition most likely? A)Syncope B)Transient ischemic attack C)Benign paroxysmal positional vertigo D)Meniere's disease - correct answer>>C)Benign paroxysmal positional vertigo The NP exam finds dysfunctional speech, including comprehension or motor. How will the NP document this finding? A)Brudzinski's sign B)Graphesthesia C)Ataxia D)Aphasia - correct answer>>D)Aphasia For slow growing white plaque with firm to hard surface, slightly raised on tongue, floor of mouth, or inside cheek. Which condition most likely? A)Candidiasis oral B)Leukoplakia C)Apthous stomatitis D)Squamous cell carcinoma - correct answer>>B)Leukoplakia