A 57-year-old man is admitted to the intensive care unit after being involved in a motor vehicle collision. Three days later he develops a fever and productive cough of purulent sputum. His temperature is 38.1C, HR 110/min, RR 25/min, and BP 128/80 mmHg. Within hours the patient's respiratory status declines with cyanosis, necessitating intubation. A chest x-ray shows a new right upper lobe consolidation Which of the following drugs is the most appropriate for treatment of this patient?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة والشرح
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الإجابة: B. Piperacillin + Tazobactam
Pneumonia developing 3 days into an ICU stay, now intubated, is hospital/ventilator-associated pneumonia, where Pseudomonas must be covered with an anti-pseudomonal beta-lactam such as piperacillin-tazobactam. Gentamicin + vancomycin lacks that beta-lactam backbone, and aminoglycosides are nephrotoxic add-ons rather than the main agent. Ciprofloxacin alone is not the preferred backbone, and TMP-SMX is for PJP.
ليش كل خيار صح أو غلط
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A
ليش غلط
Vancomycin is the MRSA drug, and aminoglycosides such as gentamicin are agents to avoid when possible because they are harsh on the kidneys; the first-listed Pseudomonas drug is piperacillin-tazobactam.
✓ 10830170 - Respiratory Pathology - 017 ] Pneumonia [Notes].pdf · p. 18 -
B
ليش صح
Pneumonia after more than 2 days in hospital (here ICU, intubated) is HAP/VAP; for Pseudomonas the first-listed drug is piperacillin-tazobactam.
✓ 10830170 - Respiratory Pathology - 017 ] Pneumonia [Notes].pdf · p. 18 -
C
ليش غلط
Ciprofloxacin is not among the listed HAP drugs; a quinolone (levofloxacin or moxifloxacin) is only an occasional add-on if Legionella is suspected, while the first-listed Pseudomonas drug is piperacillin-tazobactam.
✓ 10830170 - Respiratory Pathology - 017 ] Pneumonia [Notes].pdf · p. 18 -
D
ليش غلط
Trimethoprim-sulfamethoxazole (Bactrim) is for Pneumocystis jirovecii pneumonia in HIV patients with CD4 below 200, not for HAP/VAP.
✓ 10830170 - Respiratory Pathology - 017 ] Pneumonia [Notes].pdf · p. 18
- المصدر
- Pulmonology 🫁.pdf · p. 15
10830170 - Respiratory Pathology - 017 ] Pneumonia [Notes].pdf · p. 18 - المحاضرة
- Pneumonia · Pulmonology · Module B
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- Respi bank