A patient presents complaining of a 5 day history of upper respiratory symptoms
including nasal congestion and drainage. On the day the symptoms began he had a
low-grade fever that has now resolved. His nasal congestion persisted and he has had
yellow nasal drainage for three days associated with mild headaches. On exam he is
afebrile and in no distress. Examination of his tympanic membranes and throat are
normal. Examination of his nose is unremarkable although a slight yellowish-clear
drainage is noted. There is tenderness when you lightly percuss his maxillary sinus.
What would your treatment plan for this patient be?
Give this one a try later!
Observation and reassurance
A 76-year-old patient with a 200-pack year smoking history presents with complaints
of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2
months. The physical exam reveals decreased breath sounds and dullness to
, percussion over the left lower lung field. The chest X-ray demonstrates shift of the
mediastinum and trachea to the left. These are classic signs of:
Give this one a try later!
Lung cancer
A previously healthy 24 year old man presents at a clinic in Southern New England
ten days after a weekend camping trip. He reports the appearance of a painless skin
lesion on his right thigh five days previously. He now notes malaise, low-grade fever,
and migrating joint pain of 48 hours duration. Careful questioning fails to elicit any
recent history of an insect bite. The lesion on the thigh had begun to fade, but you
recognize an area of central clearing with an erythematous margin. Further
examination reveals a second, similar lesion near the right axilla. Question: The patient
referred to in the scenario returns three days later complaining of worsening
weakness and lightheadedness. His pulse is 42 and his pressure in the supine position
is 90/40. You quickly obtain an EKG, which reveals third degree heart block. The best
management at this point would include:
Give this one a try later!
Admit the patient for cardiac monitoring and begin intravenous ceftriaxone
2g per day
The following criterion is considered a positive finding when determining whether a
patient with asthma can be safely monitored and treated at home:
Give this one a try later!
Tachypnea greater than 30 breaths/minute
including nasal congestion and drainage. On the day the symptoms began he had a
low-grade fever that has now resolved. His nasal congestion persisted and he has had
yellow nasal drainage for three days associated with mild headaches. On exam he is
afebrile and in no distress. Examination of his tympanic membranes and throat are
normal. Examination of his nose is unremarkable although a slight yellowish-clear
drainage is noted. There is tenderness when you lightly percuss his maxillary sinus.
What would your treatment plan for this patient be?
Give this one a try later!
Observation and reassurance
A 76-year-old patient with a 200-pack year smoking history presents with complaints
of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2
months. The physical exam reveals decreased breath sounds and dullness to
, percussion over the left lower lung field. The chest X-ray demonstrates shift of the
mediastinum and trachea to the left. These are classic signs of:
Give this one a try later!
Lung cancer
A previously healthy 24 year old man presents at a clinic in Southern New England
ten days after a weekend camping trip. He reports the appearance of a painless skin
lesion on his right thigh five days previously. He now notes malaise, low-grade fever,
and migrating joint pain of 48 hours duration. Careful questioning fails to elicit any
recent history of an insect bite. The lesion on the thigh had begun to fade, but you
recognize an area of central clearing with an erythematous margin. Further
examination reveals a second, similar lesion near the right axilla. Question: The patient
referred to in the scenario returns three days later complaining of worsening
weakness and lightheadedness. His pulse is 42 and his pressure in the supine position
is 90/40. You quickly obtain an EKG, which reveals third degree heart block. The best
management at this point would include:
Give this one a try later!
Admit the patient for cardiac monitoring and begin intravenous ceftriaxone
2g per day
The following criterion is considered a positive finding when determining whether a
patient with asthma can be safely monitored and treated at home:
Give this one a try later!
Tachypnea greater than 30 breaths/minute
