Question 1: G.M. is a 45-year-old female who is of Middle Eastern decent, who presents to her local primary care provider with a productive cough due to a postnasal drip, that is worsened at nighttime, with nasal congestion, for the past 5 days. She has been taking Mucinex 500mg Q12H, since her symptoms started, but has been ineffective.
Vital Signs: T 101.9, BP 112/70, Pulse 88, RR 21, Pain level 5/10
Physical examination findings: Lungs CTA, no nasal flaring or accessory muscle usage. Tenderness to bilateral maxillary and ethmoid sinuses. Yellowish-Green nasal discharge, erythematous and edematous (hypertrophy) nasal turbinates, and headache
Diagnosis: Acute Maxillary Sinusitis
What anti-infective would you prescribe to treat it and why? Discuss the indications, as well as provide patient education.
Question 2: Discuss options for medication therapy for Streptococcus pharyngitis for a patient allergic to Penicillin.
Question 3: A.P. is a 21-year-old American Indian male who presents to his primary care provider with a throbbing pain in his left ear X 5 days. The patient reports "stuffiness" and "pressure" to his left ear.
Medical History:
Past Surgical History - None
Social History- 1 PPD cigarette smoker X 3 years
Current medication: Cetirizine 10mg PO QD
Vital signs: T 101.4 F, P 90, RR 18, BP 118/70
Physical Exam Findings:
Left ear: moderate bulging and erythema to the Left tympanic membrane with effusion to the middle ear.
Diagnosis: Left Otitis Media
What is the first-line treatment for your diagnosis? Give your complete treatment plan, to include medication (dosage, frequency, etc.). Include patient education.
Question 4: J.T. a 45-year-old Caucasian female presents to her primary care provider with chief complaints of swelling and redness to her right lower extremity after she cut her leg on the edge of her glass coffee table, while at home 5 days ago.
Vital signs: T 100.4 F, P 75, RR 15, BP 109/77, Pain 6/10
Physical examination: poorly demarcated area of erythema to right lower extremity near shin area, warm to touch, 1mm blisters surrounding the area.
Labs: WBC count 17,600 μl
Diagnosis: Cellulitis
What is the first-line treatment for your diagnosis? Give your complete treatment plan, to include medication (dosage, frequency, etc.). Include patient education.
Question 5: Discuss the pharmacokinetics and mechanism of action of fluconazole and include pertinent patient education.
Question 6: M.A, a 25-year-old Hispanic female presents to the local clinic with the chief complaint of "an itchy rash" to her bilaterally forearms that has been worsening for the past 2 weeks. She reports that it initially started on her right forearm and then spread to her left forearm. She reports using Benadryl cream to "help with the itching", but it has been ineffective.
Her younger brother had a similar rash 2 weeks prior, but his has since resolved.
Vital signs: T 98.4 F, P 69, RR 19, BP 117/80, Pain 0/10
Allergies: NKDA, No food or environmental allergens
Physical examination: red pruritic, inflamed patches that are annular and raised with central clearing to her bilateral forearms.
What is your diagnosis? What testing / labs are needed (if any)? What is the first-line treatment for your diagnosis? Give your complete treatment plan, to include medication (dosage, frequency, etc.). Include patient education.
Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.