Pediatrics
1. A 7 year old female presents to the clinic with a three week history of looking "not quite right." This is her third visit in the past four days. The patient's mother is on disability due to cologne exposure at work, and the patient is uninsured. Her mother states that she has been having fevers as high as 37.2 (99) degrees and has been having early morning awakenings, e.g. 8am. Physical exam, family history, and past medical history are benign, but limited due to the patients use of her Nintendo DS during the exam. Her mother states that she had a cousin who was sick with HIV that felt better after receiving antibiotics. What tactic might keep the patient from returning to the office in the next 24 hours.
a. Give gentamicin, hope for an adverse effect that requires a ENT consult
b. Tell the patient the office will be closed for the next week
c. Give the mother a prescription for Valium
d. Put them in the waiting room for 4 hours before telling them their rapid strep was negative
2. A 46 year old male presents to the clinic with unbearable pain. He leapt unto the exam table like a Russian gymnast when no one was looking but now winces and moans in pain when the stethescope is placed on his chest, despite the fact that he complains of knee pain. All radiographic studies have been negative. He begins the interview by offering that he "isn't looking for pain meds or anything." In fact, he's never been better--in order to keep feeling better he just needs a few more vicodin to get him over the hump. When you ask how much he would need for a month he says "I don't know man!" When you write a prescription for sixty 5/500s he goes ballistic and accuses you of not "understanding" how much pain he is in. His unkempt wife sits in the corner shaking her head scoldingly. What is the next step.
a. Keep the patient from getting between you and the door
b. Refer to chiropractic care
c. Give daily cortisone shots for a week
d. Recommend physical therapy
to be continued...
