The advanced practice registered nurse (APRN) is seeing a 6 year old in the urgent care with complaints of a sore throat. The APRN is concerned for streptococcal tonsilitis. What physical exam findings suggest streptococcal tonsilitis? Select All That Apply.
Beefy-red uvula
White or yellow exudates on the tonsils
Palatal petechiae
Asymmetric protrusion of one tonsil
The Correct Answer is ["A","B","C"]
A. Beefy-red uvula is correct because streptococcal infection causes inflammation of the oropharynx, leading to erythema of the tonsils and uvula. This is a common finding in bacterial pharyngitis and supports the suspicion of strep throat.
B. White or yellow exudates on the tonsils is correct because streptococcal tonsillitis often produces purulent exudates, which appear as white or yellow patches on the tonsillar surface. This differentiates bacterial pharyngitis from viral infections, which usually cause less prominent exudate.
C. Palatal petechiae is correct because tiny red spots on the soft or hard palate are a classic sign of streptococcal pharyngitis, particularly Group A Streptococcus. These petechiae result from capillary hemorrhage due to inflammation.
D. Asymmetric protrusion of one tonsil is incorrect because asymmetry suggests peritonsillar abscess or another localized mass, not uncomplicated streptococcal tonsillitis. Classic strep infections usually produce bilateral, symmetric tonsillar enlargement.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Heart failure is incorrect because heart failure primarily affects ventricular filling and ejection, leading to extra heart sounds like S3 or S4 gallops, not a systolic click. S3 occurs due to rapid ventricular filling, often in systolic dysfunction, while S4 is related to stiff ventricles in diastolic dysfunction. Neither produces the characteristic high-pitched mid-systolic click of MVP.
B. Ventricular volume overload is incorrect because while it can cause systolic murmurs from regurgitant lesions or S3 gallop, a click is not a feature of volume overload alone. The click is specific to valvular leaflet motion rather than increased volume.
C. Decreased myocardial contractility is incorrect because reduced contractility typically produces weak or low-output heart sounds, S3, or systolic murmurs related to ventricular dilation, but not a systolic click.
Correct Answer is B
Explanation
A. Pain distant from the site used to check rebound tenderness is incorrect because this describes referred pain or peritoneal irritation, but not the obturator sign specifically. The obturator sign is localized to the hypogastric or pelvic region.
B. Right hypogastric pain with the right hip flexed and the hip internally rotated is correct because the obturator sign is elicited by flexing the patient’s hip and knee at 90° and then internally rotating the hip. Pain in the right hypogastric or pelvic area indicates irritation of the obturator internus muscle, often due to an inflamed appendix in a pelvic position or other pelvic pathology. This is a classic sign in appendicitis when the appendix is located in the pelvis.
C. Pain with extension of the right thigh while the patient is on their left side is incorrect because this describes the psoas sign, which tests for irritation of the iliopsoas muscle and is also used to detect appendicitis, but specifically for a retrocecal appendix.
D. Pain that stops inhalation in the right upper quadrant is incorrect because this describes Murphy’s sign, which is indicative of cholecystitis, not appendiceal or pelvic irritation.
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