A 44-year-old woman with Ludwig’s angina is intubated and managed in the ICU. Initial computed tomography of the neck shows bilateral submandibular space involvement without mediastinal extension. On hospital day 2, she develops worsening oxygen requirements and new chest pain. Repeat imaging demonstrates air and fluid extending into the superior mediastinum.Which of the following best explains the anatomical pathway of spread for this complication?

A 68-year-old man with diabetes mellitus presents with 2 days of right submandibular pain, swelling, and fever. He has been NPO following recent surgery. Examination reveals a tender, indurated submandibular gland, and purulent material is expressed from the duct with massage.Which of the following is the most appropriate initial management?

A 19-year-old male presents with 4 days of sore throat, fever, and malaise. Examination reveals bilateral tonsillar exudates, posterior cervical lymphadenopathy, and mild hepatosplenomegaly. Rapid strep test is negative. A CBC shows lymphocytosis with 25% atypical lymphocytes. Shortly after, his roommate presents with an identical syndrome. Which of the following organisms is most likely responsible and what associated disorder should be considered?

A 71‑year‑old woman with a history of hypertension and hyperlipidemia presents with sudden, painless loss of vision in her right eye that began one hour ago. She denies eye pain or redness. Funduscopic examination reveals retinal pallor with a cherry‑red spot at the macula. Which of the following actions is most appropriate?

A 31-year-old man undergoes needle aspiration of a peritonsillar abscess and is started on intravenous ampicillin-sulbactam. After 12 hours, his fever has resolved, trismus has improved, and he is tolerating oral intake. The team is considering discharge.Which of the following is the most appropriate discharge plan?

A 47-year-old immunocompetent man is admitted to the ICU with confirmed epiglottitis and has been successfully intubated. Blood cultures are pending.Which of the following is the most appropriate empiric antibiotic regimen?

A 58‑year‑old patient with a 15‑year history of type 2 diabetes presents for routine follow‑up. He reports no visual complaints. Fundoscopic examination reveals microaneurysms, intraretinal hemorrhages, venous beading, and cotton‑wool spots, but no neovascularization. Based on the underlying pathophysiology and stage of disease, which management strategy is most appropriate?

A 72-year-old patient with metastatic pancreatic cancer is admitted to the ICU with sepsis. He is receiving disease-directed chemotherapy and states that his goal is to continue treatment while improving symptom control, particularly pain and dyspnea. His family asks whether “hospice” has been consulted. As the AGACNP, which response most accurately explains the most appropriate consult at this time?

A 26-year-old male presents with worsening throat pain 5 days after starting amoxicillin 500 mg three times daily for group A beta-hemolytic streptococcal pharyngitis confirmed by rapid antigen test. He reports persistent fever, severe odynophagia, and a muffled “hot potato” voice. He has no known drug allergies. Physical examination reveals marked unilateral peritonsillar bulging with contralateral uvular deviation and trismus. What is the most appropriate next step in management?

A 38-year-old immunocompetent man with Ludwig’s angina is intubated and started on ampicillin-sulbactam. Blood cultures were obtained prior to antibiotics. After 48 hours, he remains febrile with persistent leukocytosis and no improvement in neck swelling.Which of the following is the most appropriate next step in management?