A 15 years old high school student with a mild sore throat and low-grade
fever that has persisted for about 3 weeks. She reports general
... [Show More] malaise,
fatigue,
and loss of appetite. The NP suspects mononucleosis. Which of the
following is
the LEAST appropriate intervention?
a. Palpate the lymph nodes and spleen
b. Examine the posterior oropharynx for petechiae
c. Obtain a CBC, throat culture, and heterophil
antibody test. d. Obtain an urinalyses and serum for
LFTs and amylase
Explanation: mononucleosis is a symptomatic infection caused by the
Epstein-Bar
virus. Common is people 15-24 years of age. Common signs and symptoms
following incubation period (1-2 months) include fatigue, chills, malaise,
anorexia,
white tonsillar exudates and lymphadenopathy or posterior cervical region.
Splenomegaly can be present. A maculopapular or occasionally a petechial
rash
occurs in less than 15% of patients. A diagnosis is usually made using the
Monospot. In addition, neutropenia and lymphocytosis are usually detected
in the
CBC.
A 32 years old male patient complaint of urinary frequency and burning
on
urination for 3 days. Urinalyses reveals bacteriuria and positive nitrites. He
denies
any past hx. Of urinary tract infections. The initial treatment should be:
a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day
b. ciprofloxacin (Cipro) for 3-5 days
c. Trimethoprim-Sulfamethoxazole for 3 days
d. 750 mg ciprofloxacin as a one-time dose
Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n appropriate
medication to treat urinary tract infections in most patients. In the case of
community resistance to TMPS
>20%^, another medication should be substituted. In men, the appropriate length
of time is 7-10 days. Women may be treated for 3 days for uncomplicated UTI
• Which agent is most effective for the treatment of nodulocystic acne?
a. Benzoyl peroxide (Benzac)
b. Retinoic acid (Retin A)
c. Topical
tetracycline d.
Isotretinoin)
Explanation: Isotretinoin (Accutane) is a systemic agent indicated for treatment
with severe inflammatory acne. Guidelines for its use must be clearly understood
by the patient. A woman of childbearing age must use an effective method of
contraception because isotretinoin is teratogenic. There are many restrictions in
prescribing this medication because of the teratogenic effects is given during
pregnancy. Therefore, it is a pregnancy category X.
• An 18 y/o woman is taking a combined hormonal oral contraceptive.
She should be instructed to use a backup method for the prevention of
pregnancy
a. Throughout the week of placebo pills
b. If prescribed topiramate (Topamax) for the treatment of migraines.
c. If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection
d. if she forgets to take a single dose of the contraceptive
Explanation: Anticonvulsant including phenytoin (Dilantin), carbamazepine
(Tegretol), primidone (Mysoline), topiramate (Topamax) and oxcarbazepine
(Trileptal) reduce the effectiveness of contraceptives. Depo-medroxyprogesterone
acetate injections or levonorgestrel- releasing intrauterine devices would be a
better method of contraceptive for patients taking anticonvulsants. Most commonly
used antibiotics have not been proven to reduce the effectiveness of contraceptives.
Rifampin is an exception, and additional …. Be used by women taking this drug
and using oral contraceptives, transdermal, or vaginal ring preparations.
Additional backup contraception should be used if taking antifungal agents. No
additional protection is needed thought the week of placebo pills. Missing one
single dose of contraceptive does not require additional protection, missing more
than one doses does [Show Less]