Exam
Most common pathogen for CAP
Bacteria
Viral
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 common symptoms of acute bronchitis? Select all
High fever (103F)
Cough
Wheezing
Purulent sputum
Chest wall tightness
Rales
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
Chlamydophilia pneumoniae
Mycoplasma pneumonia
Pertussis
Rhinovirus
Influenza A
When is a chest XRAY indicated for acute bronchitis? Select all
Never
P> 100
Rales
T> 100.4
Cough lasting longer than 1 week
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
Symptoms of CAP? Select all
Sputum
Cough
Fatigue
Dyspnea
Headache
Myalgias
Pleuritic chest pain
Fever
Nasopharngitis
Chest X-rays can always accurately diagnose CAP
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
Macrolide (Azithromycin)
Flourquinolone + Macrolide
Flourquinolone (Gemofloxacin)
Betalactam (Amoxicilin) + Macrolide (Azithromycin)/ Doxy
How long to treat CAP
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