MSN 620 Final Study Guide
A 17-year-old boy presents with a sore throat that started yesterday afternoon. He denies any congestion
or cough but reports a temperature of 102° F (38.8° C) and generalized fatigue. He has pain with
swallowing but can speak normally and manage his saliva. On physical examination, the clinician sees
yellow-white plaques on his tonsils and anterior cervical lymphadenopathy that is tender to palpation.
What is the most appropriate next step in care?
1. Weight-based dosing of ibuprofen
2. Weight-based dosing of azithromycin for a 5-day treatment
3. Point-of-care streptococcal antigen testing
4. Bacterial culture of the throat
A 17-year-old boy presents to the hospital with a severe sore throat and fatigue that has been ongoing for
3 days. He has a high-grade fever for which he has been taking ibuprofen at home. The pain in his throat
has been making it difficult for him to swallow, though he can take cold drinks with care, which helps
with the pain. He does not feel throat congestion and does not have a cough. On physical examination, the
clinician notes exudates and tender cervical lymphadenopathy. The clinician treats him empirically for
strep throat with amoxicillin 500 mg twice daily for 10 days. The patient returns two 2 days later,
reporting a full-body, blotchy, bumpy rash and no change in his symptoms. He stopped taking the
antibiotics after the rash began. What is the most appropriate next step in care?
1. Send a throat swab for culture and record the patient's allergy to ampicillin.
2. Send a throat swab for culture and order a complete blood count and heterophile antibodies.
3. Send a throat swab for culture and take a punch biopsy of the patient's rash.
4. Provide supportive care, and no additional testing is required.
An 8-year-old girl presents with a 4-day history of fever and sore throat. A review of systems is negative
for cough. Her past medical and family history is insignificant. She is allergic to penicillin. Vital signs
are temperature 101 °F (38.3 °C), heart rate 88 bpm, and blood pressure 110/70 mm Hg. On physical
examination, some exudates are seen on the posterior pharyngeal wall, and tender anterior cervical nodes
are palpated. Findings on heart and lung examination are normal. Which of the following is the
recommended treatment?
1. Amoxicillin
2. Clindamycin
3. Linezolid
4. Vancomycin
A 17-year-old boy presents with a sore throat. Associated symptoms include fever and chills, difficulty in
swallowing, referred ear pain, headache, and muscle aches. The vital signs are temperature 39 °C (102.2
°F), heart rate 105 bpm, and respiratory rate 22 breaths/min. The physical examination reveals a dry
tongue, erythematous enlarged tonsils, pharyngeal exudate, and tender cervical lymphadenopathy. Which
of the following is the diagnostic test of choice?
1. ASO titer
2. CRP
3. Rapid antigen detection test (RADT)
4. Throat culture