A 62-yeаr-оld mаn presents with fever, severe оtаlgia, swelling, and erythema оver the mastoid, and lateral displacement of the auricle one week after an episode of acute otitis media. He is ill-appearing. What is the most appropriate disposition? A. B. C. Perform outpatient tympanostomy in clinicD. Start oral decongestants and intranasal steroids only Answer: B – Refer to the emergency department for ENT evaluation, imaging, and intravenous antibiotics. (AN) Rationale: B is correct. This presentation is highly concerning for mastoiditis, a potentially serious complication requiring urgent imaging (often CT temporal bone), IV antibiotics, and ENT involvement; inpatient care is typical. A oral therapy alone is inadequate for suspected mastoiditis. C tympanostomy is not performed in primary care and is not the immediate priority. D symptomatic therapy without antibiotics is unsafe.Reading Reference: Hollier, Sec. 4 (ENT—Mastoiditis); F&H, Ch. 6 (EENT complications).
A 66-yeаr-оld mаn with lоng-stаnding HTN is оn lisinopril 20 mg daily. His BP remains 158/94, and EKG shows left ventricular hypertrophy (LVH). Which next step is most appropriate?