Austin is a 19-year-old who presents to clinic first thing Monday morning.  He was involved in a fight Friday night and developed a large hematoma to his right ear.  He has self treated with ice and ibuprofen but since it continued to enlarge he decided he better come and have it looked at.  Exam reveals a 3.5 cm hematoma covering the upper 2/3 of his right ear.  What is your best plan of care?

Sam is a 52-year-old who presents with complaints of left ear pain.  He just returned from a weeklong trip to Jamaica.  He states “I hate to fly, I always get sick”.  On exam, he has pain with left pinna movement and you are unable to fully visualize the TM secondary to purulent exudate in the canal.  Portion of TM visible is without erythema. The canal is also reddened and swollen.  What is your most likely diagnosis?

Please select all options that are appropriate for treatment of otitis externa.  Select all that apply. 

Colin is a 25-year-old who you evaluate in the office with a three-day history of cough and congestion.  He has not had any fever, and he is feeling a bit better since he awakened this morning in comparison to the first few days.  “I’m only here because my wife made me come in to be tested.”.  He also needs a note saying it’s okay for him to return to work. Testing completed in the office is positive for COVID-19.  What is the best advice to offer Colin?

The APRN receives a lab throat culture report showing a positive Group A beta streptococcus. The patient’s history indicates an allergy to penicillin – Type 1 reaction (anaphylaxis). Which antibiotic is most appropriate to prescribe? 

Which history or exam findings would prompt a clinician to have an increased suspicion of Group A beta hemolytic strep infection?  Please select all that apply.

Deiondre is a 22-year-old who presents with complaints of having recent ear pain and loss of normal hearing to right ear.  He tells you he started with a cold about a week ago and then about two days ago began having right ear pain.  States in the night last night it was unbearable and he was getting ready to get up to go to the ER when he had sudden intense pain, but then it felt better.  He decided to come into the office today because he can’t hear out of that ear now and he still has a lot of sinus pressure and drainage.  When you examine the right ear, you see a large cerumen impaction.  What is your plan of care?  Please select all that apply. 

Kayla is a 28-year-old who presents with complaints of red, painful, swollen, right ear.  She has history of multiple piercings and has never had an issue until recently.  She received new piercing to the auricle and has developed erythema, edema, pain and crusting.  She denies itching or peeling of skin.  She has removed all piercings hoping this would help the issue, but it hasn’t.  What is your best working diagnosis and plan of care? 

What would you expect to see on a CXR with an individual with streptococcus pneumonia?

Bud Lancaster is an 82-year-old who presents with complaints of  problems concentrating and just not feeling well.  He has had a recent upper respiratory infection that he thought was improving, but has lingered on for a few weeks now. His wife, who accompanies him today, is concerned that for the last few days, Bud has been more forgetful, short of breath, and just doesn’t seem to be himself.  His appetite is diminished and he is sleeping very restlessly the last few nights as well. He is routinely on a low dose ACE inhibitor for hypertension (well controlled) and has NKDA.  PMH:  hypertension. VS: Temp 98.9, Pulse 96, Resp 24, BP 110/68, pulse ox 92%.  Exam is unremarkable except for some post nasal drip. What is the best plan of care for Mr. Lancaster?