You are seeing 22-month-old, Luca—who is brought into the office with 2 concerns. His mum says that he has been scratching a small spot on his left arm for about 3-4 weeks. She thinks it is getting a little larger. He has not had any exposure to new food, medications, lotions or soaps. He has no allergies to food or medications that his mum is aware of. The mum says that she had the appointment about a week ago, and then wouldn’t you know, the last 4 days, he has been complaining of “ear hurt” and pulling at the right ear. The mum says that she is thankful that she already had the appointment for the “spot”, as it looks like he has two problems. Luca does go to Mum’s Day Out [at the church] 2-3 times a week from 10-3 pm—and enjoys it. The mum does not think any other child has been ill at the day care—with febrile illness or any skin rashes. Luca has had all immunizations that have been recommended. The mum has not treated the spot on his arm with anything except Neosporin [which did not help it at all], and she has not used anything else on it in the last 72 hours. As far as the ear pain—the mum says he has not been eating well for the last day or so. And he vomited once last night. She has not checked his temperature at home. Luca lives at home with his parents, a 10-year-old sister and a 4-year-old Maine coon cat. His mum does not work outside of the home; his father owns a technology company. No one at home is ill or has any skin problems. On exam today, you see a well-nourished Caucasian male. Vital signs: T- 39 degrees Pulse 105 Respirations 26 BP 90/50 Luca is 34 inches tall and weighs 27 pounds Luca’s skin is warm and dry—the only lesion on his skin is on his left forearm—it is the size of a quarter. It is a red, raised border with active scale at the borders and central clearing. Luca is active in the exam room but begins to cry as you start to check his ears. On exam you see that the left ear is normal, but the right ear has slight injection in the external canal, and the TM is slightly dull, but otherwise unremarkable. The nares are slightly red and swollen but no exudate. He really begins to cry when you look at his throat—both tonsils are swollen, and it appears that there are which patches on the back of the throat. There are palpable submental and anterior cervical lymph nodes. The lungs are clear and there is no increased work of breathing. There is no other abnormality on Luca’s exam. 1.What drug and drug class would be the best choice in this scenario? State name of drug and its mechanism of action. If there is information from the patient’s history or exam that was important in choosing the agent [patient specific factors], cite those. 2. Cite any lab/diagnostic testing needed for before prescribing that are required and any needed for monitoring. State patient education/counseling or side effect education that should be included. Note pertinent any drug-drug interactions, Black Box warnings and life span considerations?
You are seeing 22-month-old, Luca—who is brought into the office with 2 concerns. His mum says that he has been scratching a small spot on his left arm for about 3-4 weeks. She thinks it is getting a little larger. He has not had any exposure to new food, medications, lotions or soaps. He has no allergies to food or medications that his mum is aware of. The mum says that she had the appointment about a week ago, and then wouldn’t you know, the last 4 days, he has been complaining of “ear hurt” and pulling at the right ear. The mum says that she is thankful that she already had the appointment for the “spot”, as it looks like he has two problems.
Luca does go to Mum’s Day Out [at the church] 2-3 times a week from 10-3 pm—and enjoys it. The mum does not think any other child has been ill at the day care—with febrile illness or any skin rashes.
Luca has had all immunizations that have been recommended. The mum has not treated the spot on his arm with anything except Neosporin [which did not help it at all], and she has not used anything else on it in the last 72 hours.
As far as the ear pain—the mum says he has not been eating well for the last day or so. And he vomited once last night. She has not checked his temperature at home.
Luca lives at home with his parents, a 10-year-old sister and a 4-year-old Maine coon cat. His mum does not work outside of the home; his father owns a technology company. No one at home is ill or has any skin problems.
On exam today, you see a well-nourished Caucasian male.
Vital signs: T- 39 degrees Pulse 105 Respirations 26
BP 90/50 Luca is 34 inches tall and weighs 27 pounds
Luca’s skin is warm and dry—the only lesion on his skin is on his left forearm—it is the size of a quarter. It is a red, raised border with active scale at the borders and central clearing.
Luca is active in the exam room but begins to cry as you start to check his ears. On exam you see that the left ear is normal, but the right ear has slight injection in the external canal, and the TM is slightly dull, but otherwise unremarkable. The nares are slightly red and swollen but no exudate. He really begins to cry when you look at his throat—both tonsils are swollen, and it appears that there are which patches on the back of the throat. There are palpable submental and anterior cervical lymph nodes. The lungs are clear and there is no increased work of breathing. There is no other abnormality on Luca’s exam.
1.What drug and drug class would be the best choice in this scenario? State name of drug and its mechanism of action. If there is information from the patient’s history or exam that was important in choosing the agent [patient specific factors], cite those.
2. Cite any lab/diagnostic testing needed for before prescribing that are required and any needed for monitoring. State patient education/counseling or side effect education that should be included. Note pertinent any drug-drug interactions, Black Box warnings and life span considerations?
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