Management of Acute and Episodic Conditions
Triage and Disposition
Acute care questions test whether you can separate self-limited illness from emergencies. Start with red flags: chest pain with diaphoresis, sudden severe headache, unilateral weakness, fever with neck stiffness, and abdominal pain with rigidity. For common episodic conditions, know first-line management. Acute otitis media in children may be observed in mild cases and treated with amoxicillin when antibiotics are indicated. Streptococcal pharyngitis is confirmed by rapid antigen or culture and treated with penicillin or amoxicillin. Uncomplicated cystitis is typically treated with nitrofurantoin or trimethoprim-sulfamethoxazole based on local resistance.
Traps to Watch
Overuse of antibiotics for viral illness is a frequent distractor. Another trap is failing to consider serious mimics: the "worst headache of life" is not a migraine until subarachnoid hemorrhage is excluded. Also watch for pediatric and pregnancy considerations that change drug choice, such as avoiding fluoroquinolones and tetracyclines in certain populations. Always ask whether the patient needs emergency transfer rather than outpatient management.
Worked Example
A 30-year-old presents with sore throat, cough, and rhinorrhea. Trap answer: "prescribe amoxicillin." Correct reasoning: cough and rhinorrhea suggest viral etiology; antibiotics are not indicated without confirmed strep. Rule of thumb: treat the diagnosis, not the symptom, and reserve antibiotics for bacterial infection.