thinkertdm Posted January 31, 2018 Share Posted January 31, 2018 My first patient of the morning had a televisit a month prior to today. Quote History: The patient complains of coryza, congestion, sore throat, post nasal drip and productive cough for 12-14 days. The patient denies a history of chest pain, dizziness, nausea, shortness of breath, vomiting, weakness and weight loss and denies a history of asthma. Patient does not smoke cigarettes. OTC medication use for current symptoms advil He is seen with his mother on the video visit. (side note: isn't coryza congestion, sore throat, post nasal drip, and cough?) Here is the physical exam: Quote Video examination of the patient: looks tired Throat is red no visible exudate ASSESSMENT: viral upper respiratory illness and sinusitis "looks tired". Note that the history has nothing about the sinuses. Here's the treatment: Quote PLAN: Antibiotic therapy: amoxicillin 7 days . Symptomatic therapy suggested: push fluids, use ibuprofen prn and push fluids,rest,return office visit prn if symptoms persist or worsen. Call or return to clinic prn if these symptoms worsen or fail to improve as anticipated. It's not even the right antibiotic for sinusitis. (it was amox 500 mg tid x 7 days.) Why did this fellow take what, 7 years in med school for this? There aren't even vitals. I'm going to write that for my objective from now on. "looks tired". Next! I'm a little surprised, I kind of thought zpacks were indicated for "looks tired". Link to comment Share on other sites More sharing options...
BruceBanner Posted January 31, 2018 Share Posted January 31, 2018 Yeah I had a pt recently who was "seen" over the PHONE by a tele-doc with her insurance company. Diagnosed with STREP PHARYNGITIS......OVER THE PHONE....and given, guess what, a Z-Pack. I couldnt believe it. Also: co·ry·za noun MEDICINE catarrhal inflammation of the mucous membrane in the nose, caused especially by a cold or by hay fever. Link to comment Share on other sites More sharing options...
thinkertdm Posted January 31, 2018 Author Share Posted January 31, 2018 I put "pruritis and itching". Makes it sounds fancy. Erythema and redness. Link to comment Share on other sites More sharing options...
aimyhtixela Posted January 31, 2018 Share Posted January 31, 2018 I thought coryza was just 'runny nose'. As in the use here by CDC: "Measles typically begins with high fever, cough, runny nose (coryza)...." https://www.cdc.gov/measles/about/signs-symptoms.html One of the words that stuck with me in medical terminology was odynophagia, I hear that word and I think: I am ashamed. lol Link to comment Share on other sites More sharing options...
thinkertdm Posted January 31, 2018 Author Share Posted January 31, 2018 For dyspareunia: Link to comment Share on other sites More sharing options...
jmj11 Posted January 31, 2018 Share Posted January 31, 2018 I see this quite often. Established patient of mine, who has frequent migraines for decades. She has some that last 2-3 days. She lives 100 miles away from me, so it's not easy for her to get here for acute treatment. But, on her second day of her last migraine she went to see the NP at her PCP. She reported, "This is one of my typical migraines. It is in the second day. I have sensitivity to light and vomiting. No fever, no URI symptoms." The NP says, "Migraine cannot last more than 1 day. This is a sinus infection. I will prescribe a Z pack." Mike Link to comment Share on other sites More sharing options...
sk732 Posted January 31, 2018 Share Posted January 31, 2018 1 hour ago, jmj11 said: The NP says, "Migraine cannot last more than 1 day. This is a sinus infection. I will prescribe a Z pack." Mike Sigh...yet they can practice without oversight. I wonder what the strike three pitch would have been... SK Link to comment Share on other sites More sharing options...
Miaow Posted January 31, 2018 Share Posted January 31, 2018 2 hours ago, jmj11 said: The NP says, "Migraine cannot last more than 1 day. This is a sinus infection. I will prescribe a Z pack." The Z-pack's job in this scenario is to strengthen the presumed sinusitis bacteria and make them more resilient because as all us awesome PA's know: "Macrolides (clarithromycin or azithromycin), trimethoprim-sulfamethoxazole, and second- or third-generation cephalosporins are not recommended for empiric therapy because of high rates of resistance of S. pneumoniae (and of H. influenzae for trimethoprim-sulfamethoxazole) [4,5]." From: Uptodate.com Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 3, 2018 Moderator Share Posted February 3, 2018 On 1/31/2018 at 3:16 PM, jmj11 said: I see this quite often. Established patient of mine, who has frequent migraines for decades. She has some that last 2-3 days. She lives 100 miles away from me, so it's not easy for her to get here for acute treatment. But, on her second day of her last migraine she went to see the NP at her PCP. She reported, "This is one of my typical migraines. It is in the second day. I have sensitivity to light and vomiting. No fever, no URI symptoms." The NP says, "Migraine cannot last more than 1 day. This is a sinus infection. I will prescribe a Z pack." Mike WHAT??? I truly think there should be a way to report STUPID medical decisions to some board somewhere that then will go "talk" with the provider on one local phone call I had an ER provider tell me "can't be an abscess, no white count" "we can rule out abscess with and xray" and about 5 other things that left me speechless.... they we just flat wrong (for a guy with acute swelling of forearm, failed on Bactrim for infection, and 3/4" measurable girth difference of the forearm and him saying "there is fluid in my arm" Link to comment Share on other sites More sharing options...
sk732 Posted February 3, 2018 Share Posted February 3, 2018 I do POCUS on my soft tissue infections to look for a drainable abscess...never tried an XRay before. Nor will I. The rads would move to have my privileges revoked. PS...we really need to get some eye rolling emojis in here - one of my all time favorite calisthenics. SK Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 3, 2018 Share Posted February 3, 2018 3 hours ago, ventana said: WHAT??? I truly think there should be a way to report STUPID medical decisions to some board somewhere that then will go "talk" with the provider on one local phone call I had an ER provider tell me "can't be an abscess, no white count" "we can rule out abscess with and xray" and about 5 other things that left me speechless.... they we just flat wrong (for a guy with acute swelling of forearm, failed on Bactrim for infection, and 3/4" measurable girth difference of the forearm and him saying "there is fluid in my arm" The provider is probably one of those who would stick an 18 ga. needle into the swollen space and say that if the individual doesn't fly around like a balloon with air escaping out that there can't be a compartment syndrome concern either. Link to comment Share on other sites More sharing options...
thinkertdm Posted February 3, 2018 Author Share Posted February 3, 2018 This is pretty much the best therapy Link to comment Share on other sites More sharing options...
Joelseff Posted February 3, 2018 Share Posted February 3, 2018 This is pretty much the best therapy Unless you're allergic to dogs... LolSent from my SAMSUNG-SM-G891A using Tapatalk Link to comment Share on other sites More sharing options...
Guest Paula Posted February 3, 2018 Share Posted February 3, 2018 I've been off the forum for a while. Thanks for the humor. You all made my day!!!! Link to comment Share on other sites More sharing options...
thinkertdm Posted February 4, 2018 Author Share Posted February 4, 2018 My wife claims that little guy is hypoallergenic. Link to comment Share on other sites More sharing options...
Joelseff Posted February 4, 2018 Share Posted February 4, 2018 This was on my schedule once...Sent from my SAMSUNG-SM-G891A using Tapatalk Link to comment Share on other sites More sharing options...
sk732 Posted February 4, 2018 Share Posted February 4, 2018 A smelly heel? A scaly heel? Some sort of fishy parasite in the heel? An infected fish bite? MM Link to comment Share on other sites More sharing options...
Joelseff Posted February 4, 2018 Share Posted February 4, 2018 A smelly heel? A scaly heel? Some sort of fishy parasite in the heel? An infected fish bite? MMOne of my PSRs was trying to spell fasciitis... Another one said "bronchotits" lol I wish I had a screenshot of that. I was thinking "dinosaur breast issue?" hahahaSent from my SAMSUNG-SM-G891A using Tapatalk Link to comment Share on other sites More sharing options...
sk732 Posted February 4, 2018 Share Posted February 4, 2018 One of my PSRs was trying to spell fasciitis... Another one said "bronchotits" lol I wish I had a screenshot of that. I was thinking "dinosaur breast issue?" hahahaSent from my SAMSUNG-SM-G891A using TapatalkPendulous, dinosaur breast tissue...Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
Joelseff Posted February 4, 2018 Share Posted February 4, 2018 Pendulous, dinosaur breast tissue...Sent from my iPhone using TapatalkHahahaSent from my SAMSUNG-SM-G891A using Tapatalk Link to comment Share on other sites More sharing options...
Guest Paula Posted February 5, 2018 Share Posted February 5, 2018 Reading this thread is better than watching the Super Bowl. The last couple made me laugh til I cried. Link to comment Share on other sites More sharing options...
sk732 Posted February 5, 2018 Share Posted February 5, 2018 On 2018-02-03 at 3:53 PM, thinkertdm said: This is pretty much the best therapy My wife dropped by work with K9 Alpha and Bravo today - bit of therapy for me and some others (patients included). SK Link to comment Share on other sites More sharing options...
Guest JMPA Posted February 5, 2018 Share Posted February 5, 2018 On 2/3/2018 at 7:43 AM, ventana said: WHAT??? I truly think there should be a way to report STUPID medical decisions to some board somewhere that then will go "talk" with the provider on one local phone call I had an ER provider tell me "can't be an abscess, no white count" "we can rule out abscess with and xray" and about 5 other things that left me speechless.... they we just flat wrong (for a guy with acute swelling of forearm, failed on Bactrim for infection, and 3/4" measurable girth difference of the forearm and him saying "there is fluid in my arm" One can use an x-ray to evaluate for abscess although not an imaging of choice, it can also be very helpful to look for osteo Link to comment Share on other sites More sharing options...
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