Primary Care

Question 1

Symptoms and treatment of acute bacterial sinusitis

Answer 1

Persistence of symptoms beyond 10 days, SEVERE symptoms (high fever 102, purulent nasal discharge, facial pain), worsening symptoms (headache, increased discharge). Treatment with amoxicillin-clavulanate

Question 2

Tdap administration for general adults, acute wound management, pregnant women

Answer 2

1. Every 10 years
2. Acute wound - every 5 years
3. Pregnancy weeks 27-36

Question 3

What is acute otitis media? What are symptoms? Causative organisms? How do you treat?

Answer 3

Eustachian tube dysfunction during an acute URI where fluid accumulates in narrow part of the tube and becomes infected. Causing by Strep pneumo and H influenzae. Diagnosed by bulging tymphanic erythematous tympanic membrane w/ poor mobility. Treat with amoxicillin - if symptoms persist past 72 hr treat with amoxicillin-clavulanate (resistant)

Question 4

What is the PHQ-9 and how do you use it to guide depression treatment?

Answer 4

Patient Health Questionnaire 9
Score > 10 indicated major depression and should start medication
After 6 weeks, check PHQ-9 again
If score decreases by 5 = continue with current therapy; if score decreases by 2-4 then increase the dose; if score decreases by <2 then consider changing the treatment