A 68-year-old woman has a 5-day history of fever, productive cough of yellowish sputum, and localized right- sided pleuritic chest pain. She has T2DM and hypertension. She does not smoke. On examination, Temp 38.8 C HR 102/min, BP 145/75mmHg, RR 32/min and oxygen saturation 89% on room air. She looks ill but alert and oriented. Chest examination reveals signs of consolidation at the right middle zone. Her WBC 16,000, random blood glucose 260mg/dl, BUN 30mg/dl, creatinine 0.5mg/dl and normal electrolytes, Chest X-ray shows right middle lobe infiltrate. Which of the following is the most appropriate management strategy for this patient based on the best evidence practice?
سؤال مجاني 3 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Ceftriaxone and azithromycin inpatient treatment
CURB-65 = 3 (age 68, RR 32, BUN 30 mg/dL >20; she is oriented and BP is normal), so she needs hospital admission and is managed as severe. Inpatient CAP is treated with a beta-lactam (ceftriaxone preferred) plus a macrolide (or a respiratory fluoroquinolone alone). Outpatient regimens (B, D) are inappropriate at this score, and metronidazole adds anaerobic cover that is not indicated.
ليش كل خيار صح أو غلط
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A
ليش صح
For inpatient (non-ICU) CAP the regimen is a macrolide (azithromycin) plus a beta-lactam, and the most preferred beta-lactam is ceftriaxone.
✓ 10830170 - Respiratory Pathology - 017 ] Pneumonia [Notes].pdf · p. 18 -
B
ليش غلط
Home treatment is for the low-risk group (CURB-65 0-1), and close outpatient management is at most an option at score 2; she scores 3 (age 68, RR 32, BUN 30), which means admission, managed as severe.
✓ Pulmonology 🫁.pdf · p. 17 -
C
ليش غلط
A respiratory fluoroquinolone is used alone as monotherapy for inpatient CAP; metronidazole is only listed with a beta-lactam for aspiration pneumonia (anaerobes), which she does not have.
✓ 10830170 - Respiratory Pathology - 017 ] Pneumonia [Notes].pdf · p. 18 -
D
ليش غلط
Home treatment is for the low-risk group (CURB-65 0-1), and close outpatient management is at most an option at score 2; she scores 3, which means admission, managed as severe.
✓ Pulmonology 🫁.pdf · p. 17
- المصدر
- Pulmonology 🫁.pdf · p. 17
10830170 - Respiratory Pathology - 017 ] Pneumonia [Notes].pdf · p. 18 - المحاضرة
- Pneumonia · Pulmonology · Module B
- ظهر في
- Respi bank