Pt is an 11 yo M, 2 days of nasal congestion and sore throat. Coughing and sneezing productive of green mucus. There is postnasal drainage of copious yellow-green mucus, and enlarged tonsils.
This patient has a head cold, with postnasal drip that is causing his cough. Antiviral therapy (E) is not directed against the Rhinovirus. The patient does not show signs of bacterial infection which would require antibiotic therapy (F), namely tympanic membrane bulging and ear pain. There is no fever to indicate sever infection or sinus tenderness to indicate an X-ray of the sinuses is warranted (D), or that culture of discharge would change current treatment (C). Because this infection is self-limited and the child can blow their nose, sinus lavage in the clinic is not necessary. (B).
I believe that metformin is contraindicated due to Patients with renal disease having a higher chance of lactic acidosis. This patient has increased BUN and Cr indicating renal disease
rash seems to be that of shingles. Age range also matches up. Antiviral is the best option
My favorite default treatment option. (This comment needs to be over 50 characters and whatnot.)