A patient was seen in a local emergency department and was ...

[silviawilliams41]

A patient was seen in a local emergency department and was treated empirically for pharyngitis with ampicillin and comes to the clinic 2 days later with an urticarial rash.
 
  The patient has no previous history of atopy and does not have respiratory symptoms. The primary care NP should suspect: a. scarlatina.
  b. mononucleosis.
  c. serum sickness.
  d. penicillin allergy.

Question 2

A patient reports frequent headaches to the primary NP. The patient describes the headaches as unilateral and moderate in intensity, accompanied by nausea, vomiting, and photophobia. There is no aura, and the headaches generally last 24 to 48 hours.
 
  The NP should: a. prescribe dihydroergotamine (D.H.E. 45).
  b. prescribe topiramate (Topamax) as migraine prophylaxis.
  c. recognize these as classic migraines and order sumatriptan (Imitrex).
  d. suggest treatment with acetaminophen because these are probably tension headaches.

[irishcancer18]

Answer to Question 1

B
A nonallergic urticarial rash occasionally occurs with ampicillin and is common in patients with mononucleosis. This patient has pharyngitis, which was not diagnosed by throat culture. The NP should suspect mononucleosis and a nonallergic rash. Serum sickness and penicillin allergy are possible but less likely. A scarlatiniform rash is not urticarial.

Answer to Question 2

C
This patient has symptoms of classic migraine with repeated episodes. Sumatriptan is a first-line medication. Ergotamines are second-line medications. Topiramate is used as migraine prophylaxis in patients who have increasingly frequent migraine episodes. These symptoms are not characteristic of tension headaches.

[silviawilliams41]

Excellent

[bimper21]

TYSM