Exam

A patient with no comorbidies has CAP, but is allergic to Macrolides, which antibiotic would you use

Azithromycin

Clarithromycin

Doxycycline

An 34 year old who works in a day care has CAP but is allergic to Penicillin, which antibiotic would you use?

Levofloxacin + Amoxicilin

Amoxicillin + Doxycycline

Levofloxacin

Levofloxacin + Azithromycin

43 year old nonsmoker with persistent cough, purulent sputum x 2 weeks, nasal congestion, and rhinorrea. T:98, HR:84, RR:16, BP: 124/60. Chest is clear, what is your diagnosis

CAP

URI

Acute Bronchitis

COPD

What is the cause of most cases of acute bronchitis

Viral

Bacterial

1 week ago, you diagnosed a 24 year old male with acute bronchitis. He calls to tell you that after 10 days total coughing he still has it. What do you do?

Order chest xray

Give him Azithromycin

Reassure him this is typical

Order sputum culture

What are symptoms of a 75 year old with acute bronchitis? Select all

Fever

Tachypnea

Decreased o2 sat

Decreased mental status

When acute bronchitis has a bacterial cause (7%), what are the common microbes? Select all

What are treatment options for acute bronchitis

Ressurance and symptomatic treatment

Antibiotic

Cough and sputum production for most days of the month for 3+ months for 2 consecutive years is most likely

Primary sign(s) of acute bronchitis? (Select all)

Bronchospasm

Hyperreactivity

Rales

Pleural rub

What is the utility of measuring a procalcitonin?

Low levels rule out viral pneumonia

Low levels rule out DVT

Marker of bacterial infection in acute bronchitis

Elevated levels indicated probability of PE

What is unique about the presentation of pneumonia in adults?

Significant fever is rare

Usually high fever

Usually tachypnea

Significant crackles are common

What is true about Pneumonia Severity Index?

Helps identify patients with CAP who can be treated in outpatient

Helps identify patients with CAP who should be treated inpatient

Helps identify patients with low risk of mortality from CAP

All of the above

60 year old man returns from a 2 week cruise with cough, fever, crackles, and tachypnea. What microbe is most likely responsible

DRSP

CAP

Legionella

Mycobacterium TB

Patient diagnosed with CAP has community acquired MRSA. What antibiotic should be added?

Vancomycin

Amoxicilin

Ceftin

Zosym

Patient with recent abx use < 3 weeks ago diagnosed with CAP and allergic to Levofloxacin and sulfa. Which abx will you use?

Low dose amoxicillin + azithromycin

Low dose amoxicillin + clarithromycin

Cefuroxime axetil + azithromycin

Sulfa + azithromycin

Which vaccine(s) are recommended to pt. with CAP

Tetanus

Influenza annually

Pneumococcal (if 65+ or asthma/smoker)

B & C

Most common sign of PE

Tachypnea

Dyspnea

Cyanosis

Pleuritic chest pain

Most common symptom of PE

Cough

Wheeze

Dyspnea

Tachypnea

What is the mortality rate of untreated PE?

50%

10%

25%

30%

Most patients with PE's have obvious signs/ symptoms

True

False

What is the utility of a d dimer

Low levels rule out viral pneumonia

Low levels rule out DVT

Marker of inflammation in acute bronchitis

Increased levels increase the probabilty of PE

Which statement about d dimer is false

A fibrin degradation product

Elevated level 100% sensitive to confirm PE

Abnormal results are common among pt. With recent surgeries

Used to exclude thromboembolitic disease

Which is the test to order for a PE (According to the american academy of radiology)

Chest radiograph

Echo

VQ Scan

Spiral CT or CT-PA

What does the Well's Criteria Predict

CAP severity

PE probability

Bacterial cause of bronchitis

Asthma severity

In which type of setting should a VQ scan and clinical probability be used to r/o a PE

Outpatient setting

CT experienced facility

CT inexperienced facility

Preferred treatment option for immediate use with a PE

Low molecular weight heparin

IV unfractionated heparin

Coumadin

Gold standard diagnosis of CAP? Select all

WBC

CXR

Clinical signs

Healthy pt. with CAP who have no risk factors for DRSP start with which abx

Florquinolone (Gemifloxacin)

Macrolide (Azithromycin) + Beta Lactam (Amoxicilin)

Macrolide (Azithromycin)

Beta Lactam (Amoxicilin) + Doxy

Patients with comorbidites use which abs for CAP? Select all

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