A patient comes to the clinic concerned about possible migraine ...

[karen]

A patient comes to the clinic concerned about possible migraine headaches.
 
  The primary care NP conducts a history and physical examination, and the patient describes vise-like pressure in the back of the head that occurs almost daily during the work week. The NP should recommend: a. acetaminophen.
  b. topiramate.
  c. sumatriptan.
  d. ergotamine.

Question 2

A patient has recently returned from travel in Central America and reports having seven to eight liquid stools each day with severe tenesmus. The primary care NP notes a temperature of 102 F.
 
  A stool specimen is Hemoccult positive with leukocytes present. The NP will: a. order tests for Clostridium difficile.
  b. prescribe tinidazole 2000 mg for 3 days.
  c. give 750 mg of ciprofloxacin one time only.
  d. order a stool culture and begin therapy with a fluoroquinolone.

[14vl19]

Answer to Question 1

A
This patient is describing symptoms typical of tension headaches. The NP should recommend acetaminophen, not migraine medications.

Answer to Question 2

D
By history, this patient likely has traveler's diarrhea. The NP should obtain a culture and should start a fluoroquinolones antibiotic empirically. C. difficile is suspected in patients who have been taking antibiotics, which is not true in this case. Tinidazole is used for amebiasis or giardiasis. Ciprofloxacin may be given as a single dose for mild traveler's diarrhea.

[karen]

TYSM

[Perkypinki]

Gracias!