A 15-year-old boy presents with an exudative tonsillitis. Anterior and posterior cervical lymph nodes are enlarged and tender. The rapid antigen test for strep is negative for group A β-hemolytic streptococcus. What is the most appropriate step in treating this disease?
treat presumptively with penicillin
check for a history of recurrent tonsillitis
wait for confirmation of the disease with a formal culture
assume it is viral, and therefore, self-limited
perform a serum assay for mononucleosis
A febrile, 18-year-old boy presents with a 4-day history of sore throat that has suddenly become much worse. He complains of pain when attempting to eat or drink and has difficulty opening his mouth. He has a “hot potato” voice. On the basis of this clinical presentation, what is your diagnosis?
A 19 year old patient presents with a sore throat, low grade fever, fatigue, and cervical lymphadenopathy. When you do a blood smear you would find an increase in which of the following?
After reviewing your patient's blood smear you find an increase of atypical lymphocytes. Which of the following diagnostic tests would be the most appropriate next step?
CBC with differential
heterophile antibody test
rapid antigen testing for GABHS
None of the above
Your patient has tested positive for group A beta-hemolytic streptococcus infection, and also tested positive for heterophile agglutination test. Which of the following is the best treatment option?
Symptomatic OTC treatment
A rapid strep test is 97% sensitive and if your patient tests positive for strep, you should prescribe antibiotics.
Which of the following is a complication of streptococcal pharyngitis?
local abscess formation
all of the above
Which of the following antibiotics would you prescribe for treatment of streptococcal pharyngitis?
None of the above can be used to treat streptococcal pharyngitis
All of the above can be used to treat streptococcal pharyngitis
Your patient is a 15 year old female complaining of a sore throat. P/E findings include fever, tender cervical lymphadenopathy, and pharyngotonsillar exudate. Patient denies fatigue and cough. What organism is most likely causing these symptoms.
Group A beta-hemolytic streptococcus
Epstein Barr Virus
A 10 year old boy was playing outside for recess and was stung by a bee. He ran to a teacher nearby and expressed that he felt like he couldn’t breathe and appeared to be in a state of panic. What condition is this patient experiencing?
A patient was given penicillin and 1 hour later developed puritic, erythematous cutaneous lesions on her chest. What condition is this patient experiencing?
Your patient went out to a seafood restaurant and consumed shrimp, lobster, and crab. Her husband noticed her face begin to swell, particularly around her eyes and lips. What condition is this patient experiencing?
Your patient is a 32 year old male that you have just diagnosed with epiglotitis. What is the next appropriate course of action?
Admit pt, start IV antibiotics (cefuroxime), give a steroid bolus (dexamethasone), and continuously monitory pulse oximetry
Intubate patient as their airway is likely to close at any moment
Immediately send the patient to the OR
Admit this patient for observation but no treatment is necessary at this time
Your patient complains of hoarseness following a URI. You diagnosis this as acute laryngitis. Which of the following is the most appropriate treatment option?
Instruct patient to avoid vigorous use of their voice until laryngitis subsides
Prescribe oral corticosteroids
None of the above
Your patient is a 32 year old male who comes to the ER complaining of a rapidly developing sore throat with odynophagia. Indirect laryngoscopy shows a red, swollen, epiglottis. What is your diagnosis?
Your patient is a 45 year old male who comes to the ER presenting with extreme edema, erythema, and pain of the upper neck under the chin. The floor of the mouth is also edematous, erythematous and pustulent. The patient’s tongue is displaced upward and backward. Which of the following is the most appropriate course of treatment?
Secure the airway via intubation or tracheotomy
Start IV antibiotics (penicillin + metronidazole)
Incise and drain the abscess (send for C/S)
All of the above should be conducted
80% of salivary tumors appear in the parotid gland.
Your patient is a 45 year old man who complains of a sore throat. He presents with a low grade fever and gray tonsillar pseudomembrane. He admits to having alcoholism. What is the most likely diagnosis?
Your patient presents with a red, painful sore throat. Which of the following would be included in your differential diagnosis?
Pharyngitis, Peritonsilar Abscess, GERD
Pharyngitis, Peritonsilar Abscess, Trench Mouth
Peritonsilar Abscess, Erythroplakia, GERD
Pharyngitis, GERD, Glossitis
Which of the following organisms may be responsible for viral pharyngitis?
All of the above
Which of the following organisms may be responsible for bacterial pharyngitis?
Gaba A beta-hemolytic streptococcus
Your patient presents with a red, very painful sore throat. P/E findings include erythematous, edematous tonsils with peritonsillar exudate and cervical lymphadenopathy. Rapid strep test comes back negative and you sent the other swab out for culture. You order a CBC with differential and find increased WBCs with a left shift. Which of the following would be the best treatment choice at this point?
Ancillary treatment with OTC medications
Your patient is complaining of a sore throat. P/E findings include an erythematous pharynx with intraoral white papules. You patient is currently using oral inhalational steroids quite frequently. Based on this information, what is the most likely diagnosis?
Your patient is a 15 year old female complaining of extreme fatigue and sore throat. P/E findings include fever, erythematous and edematous pharynx and tonsils, palatal petechiae, lymphadenopathy, and splenomegaly. What is the most likely diagnosis?
Your patient is 50 year old man who is complaining of bleeding in the mouth. Patient admits to frequent smoking and alcohol consumption. P/E findings include erythematous tongue, an ulcerative lesion under the tongue which measures at 6 mm deep and 7 mm in diameter, and marked lymphadenopathy. What is the most likely diagnosis?
Squamous Cell Carcinoma
Oral Lichen Planus
Your patient is complaining of discoloration of his tongue. P/E findings include an erythematous lesion on the tongue that cannot be rubbed off. It is measured at 2 mm deep and 2 mm in diameter. Based on this information, what is the most likely diagnosis?
Oral lichen planus
Squamous cell carcinoma
Your patient presents with white lesions on the lateral border of their tongue. Hx includes dentures. Using a gauze pad, you are unable to rub the lesion off of the mucosal surface. What is the most likely diagnosis?
Squamous Cell Carcinoma
Your patient is in the hospital receiving chemo therapy and complains of oral discomfort. P/E findings include erythema of the oral cavity and white fluffy patches covering the tongue. With a gauze pad you are able to remove the white patches off of the mucosal surface by gentle rubbing. Below the white patches the tongue appears "beefy red." What is your diagnosis?
You just diagnosed your patient with oral candidiasis. Which of the following is the most appropriate course of treatment?
You just diagnosed your patient with erythroplakia, what is the most appropriate next step in treatment?
Incisional biopsy and refer to oncologist
Tell pt to come back if lesion gets larger
Tell pt to come back if mouth begins to bleed
Erythroplakia is usually benign and no further treatment is necessary
Your patient has oral candida albicans. Which of the following would you use to treat this condition?
Nystatin mouth rinses
All of the above are effective treatments
Your patient is a 30 year old male complaining of burning/tingling pain in the mouth. Patient is HIV positive. P/E findings include presence of multiple ulcers (~7) on both the buccal mucosa and tongue. What is your diagnosis?
Your patient presents with burning/tingling pain in the oral cavity. Your patient is HIV positive and has been diagnosed with herpetic stomatitis several times before. You suspect herpes vesicles will begin to appear soon. What is the most appropriate next course of action?
Wait until vesicles or ulcers appear for accurate diagnosis
Your patient presents with an erythematous, edematous tongue that is smooth-surfaced and lacks filiform papillae. Your patient denies having any pain. What is the most likely diagnosis?
Your patient complains of burning pain of the tongue. Which of the following best represents this complaint?
Your patient is complaining of a painful sore in their mouth. P/E findings include the presence of an ulcer on the buccal mucosa that is small, round, with a yellow-gray center surrounded by a red halo. What is your diagnosis?
Oral lichen planus
Your patient complains that they frequently get apthous ulcers. What treatment would you recommend for them?
Topical Steroids (triamcinolone acetonide or flucinonide ointment)
Your patient presents with what appears to be lacy leukoplakia but after biopsy, you determine it to be oral lichen planus. Which of the following best describes the etiology and treatment plan for this condition?
chronic inflammatory autoimmune disease - treat with oral or systemic corticosteroids
Squamous cell carcinoma - refer to oncologist
Candida Albicans - treat with fluconazole
Herpes Simplex - treat with acyclovir
Necrotizing ulcerative gingivitis is also called Trench Mouth, or Vincent's infection.
Your patient is a 23 year old PA student that is quickly approaching a "hell week" (multiple exams) in school. She complains of painful gingiva. P/E findings include gingival inflammation and necrosis, bleeding, halitosis, fever, and cervical lymphadenopathy. What is your diagnosis?
You diagnosed your patient with Trench Mouth. Which of the following best describes the etiology and treatment plan for this condition?
spirochetes and fusiform bacilli - penicillin and oral peroxide rinses
candida albicans - fluconazole
herpes simplex - acyclovir
Your patient complains of a persistently runny nose, occasional epistaxis, sinus pain, malaise, and hemoptysis. What is the most likely diagnosis and treatment?
Wegener’s granulomatosis - corticosteroids
Vincent’s Infection - penicillin and peroxide rinses
Oral Lichen Planus - corticosteroids
Herpetic Stomatitis - acyclovir