A 35 year old presents with chief complaint of “my sinus infection is not getting better”, with continued nasal and sinus congestion, yellow to white nasal discharge, and a feeling of sinus pressure particularly when he bends over. He denies sore throat headache, and GI symptoms, and previously reported fever prior to treatment is now resolved. The EMR documentation notes a prescription for dose-appropriate amoxicillin with clavulanate written 2 1/2 days ago when seen for a sick visit. Patient states he has taken the antibiotic as advised, staring the medicine on the day of his sick visit, and has not missed any doses. Physical exam reveals a no acute distress, mild tenderness to sinus palpation, and no fever. The next most appropriate step in this patient's treatment plan is to:

A. Advise the patient to continue his current course of therapy.
B. Switch his antimicrobial to moxifloxacin.
C. Order a CT of the sinuses.
D. Perform a posterior pharyngeal culture and sensitivity.
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YouTube: https://www.youtube.com/watch?v=U328N8YjNs8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=68

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Joseph is a 14 year-old, generally well and up-to-date with health maintenance, who presents for a sick visit, stating, “My stomach has not been right for about 4 days. The illness began with a 36 h hx of gradual onset nausea, vomiting and loose stools, reporting “I’m not sure how many times I threw up or had diarrhea.” He last vomited about 24 h ago, last stool was around 4 h ago, reported as yellow-brown in color, small volume and without blood. He has been tolerating clear liquids for the past 24 h and voided a small amount around 2 h ago. He feels “a little bit hungry but I am afraid to eat or I might throw up again. I still feel a little bit sick to my stomach.” Joesph reports that he is on the wresting team at his high school and that, “For the past week, one guy after another got this same thing.” VS are within normal limits and denies dizziness with position change from supine to sit or stand. His mucous membranes are slightly dry, with intact skin turgor, and mild diffuse abdominal tenderness without rebound. With a working diagnosis of viral gastroenteritis, which of the two following clinical actions should be taken?

A. Obtain stool for culture and sensitivity.
B. Order a chem panel.
C. Provide information about a slowly progressive diet as tolerated.
D. Prescribe an antiemetic.
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YouTube: https://www.youtube.com/watch?v=_P1Ff1fWzJI&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=67

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Joseph is a 14 year-old, generally well and up-to-date with health maintenance, who presents for a sick with a 36 h hx of gradual onset nausea, vomiting and loose stools, reporting “I’m not sure how many times I threw up or had diarrhea.” He last vomited about 4 h ago, last stool was around 2 h ago, reported as yellow brown in color, small volume and without blood. He has been tolerating a sips of clear liquids for the past 3 h and voided a small amount around 2 h ago. Joesph reports that he is on the wresting team at his high school and that, “For the past week, one guy after another got this same thing.” VS are within normal limits and his mucous membranes are slightly dry. The most likely cause of Joseph’s clinical condition is:

A. Staphylococcal food poisoning
B. Clostridium difficile (C. diff) enteritis
C. Viral gastroenteritis
D. Gastric ulcer
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YouTube: https://www.youtube.com/watch?v=_n_b1BfwfUc&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=66

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