Ivan, a 69-year-old, presents with three days of feeling tired and productive cough of yellow-tinged phlegm. He reports he had a URI a week ago that has resolved. PMH: smoker 2 ppd x 48 years, COPD, Type 2 DM well-controlled with metformin, and has a permanent pacemaker. His exam reveals skin pale, crackles in LLL, positive tactile fremitus and egophony in LLL, normal S1S2, abdomen non-tender. You discuss with Ivan that you would like for him to get a CXR but he refuses because he says he does not have the money to pay for that. Your next best plan would be:

Don is a 74-year-old male, with past medical history of recurring bronchitis, chronic obstructive pulmonary disease, previously smoked 1 ppd X 60 years, type 2 diabetes, hypertension, and hyperlipidemia who presents today in clinic with symptoms of a common cold.  You know it’s a cold, your patient Don knows it is a cold, but he tells you he is going up north in less than 48 hours to golf with a bunch of his buddies and he is asking for an antibiotic, because he knows it will make him feel better for his big golf trip.  Select the best response.

Frank is an 81-year male patient of yours that lives in an assisted living facility.  You diagnosed Frank with influenza 4 days ago.  You call the facility to see how Frank is doing. Which set of symptoms would concern you that Frank needs further evaluation?

In the community setting, the most common organism associated with pneumonia is: (1 point)

Haley is a 31-year-old who presents with complaints of a cough for the last three days.  Cough is productive of some clear, occasionally yellow tinged mucous.  She denies fever, chills, nausea, vomiting or diarrhea.  She has some nasal congestion, runny nose with clear mucous.  No fever or chills.  PMH:  No chronic health conditions, No surgeries, no routine medications.  VS show Temp 97.8, Resp 12, Pulse 64, Resp 12, Pulse ox 99%.  Exam is unremarkable.  What is your plan of care for Haley? Select all that apply. 

Tyler is a 28-year-old male who presents with complaints of fever and cough for the last 10 days.  PMH:  No chronic issues.  PSH:  Femur fracture repair 10 years prior.  Splenectomy 10 years prior.  Non-smoker.  Chest x-ray reveals a consolidation in the right middle lobe.  What is your best treatment option? 

Santiago is a 24-year-old who presents with complaints of left ear pain that is worse with movement. He tells you friends just put in a new swimming pool and he has been swimming a lot.  You diagnose an otitis externa.  What would you advise him about this issue?  Please select all that apply. 

What is the drug of choice for community acquired pneumonia in a patient with no-comorbidities?

Akemi is a 34-year-old who presents with complaints of intermittent ear pain that seems to radiate down her jaw and sometimes is hearing a crinkling sound in her ear.  She tells you that the pain typically lasts a few minutes at most and then will improve.  She says “I feel like I need to pop my ears”.  What is your plan of care?  Select all that apply. 

Anna is a 21-year-old who presents to your practice with a 48 hour history of a very sore throat with a fever as high as 102.3 degrees, fatigue, and myalgias.  Her exam reveals a beefy red pharynx, 3+ tonsils with white exudate, prominent anterior and posterior cervical nodes and mild bilateral upper abdominal tenderness without organomegaly.  Your most likely diagnosis is: