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?

What are expected radiology findings for a person with mycoplasma pneumonia?

 Melissa is a 67-year-old female patient with past medical history of emphysema, lymphoma, arthritis, cirrhosis, gout, and coronary artery disease who presents today with abrupt onset of fever (101.2 degrees), cough, body aches, and overall fatigue that began yesterday afternoon.   Other vitals:  BP 124/76, HR 76, RR 18, O2 sat 97%.  Melissa is diagnosed with influenza.  What is your best plan of care for this patient?

A 22-year-old presents with fever for 24 hours, temp max 101.8 Fahrenheit.   She has recently returned from vacation in France. Patient is current with both COVID and influenza vaccinations. Medical history is significant for mild persistent asthma. Allergies: Pollen. VS:  T 101.0 Fahrenheit, Pulse 82, Resp 16, BP 110/70.  Other than her fever and that she does not appear to feel well, her exam is normal.  What is the best diagnostic approach for this patient?

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: