USMLE Forum Archives - USMLE Step 3 - community-acquired pneumonia
community-acquired pneumonia
meduploader - 05-02-09 13:26
A 64-year-old woman with congestive heart failure is evaluated because of cough, increasing sputum production, fever, and dyspnea. On physical examination, temperature is 38.6 °C (101.5 °F), respiration rate is 32/min, pulse rate is 128/min and regular, and blood pressure is 148/85 mm Hg. An area of consolidation is present over the right lower lung field. The remainder of the examination is normal. Arterial oxygen saturation is 91% by pulse oximetry with the patient breathing room air. Routine laboratory studies, two blood culture specimens, and sputum samples for Gram stain and culture are obtained, and the patient is hospitalized on a general medical floor.
Pending results of laboratory studies, which of the following is the most appropriate empiric antimicrobial regimen for this patient?
( A ) Imipenem plus oseltamavir
( B ) Ceftriaxone plus azithromycin
( C ) Moxifloxacin plus azithromycin
( D ) Moxifloxacin plus vancomycin
( E ) Moxifloxacin plus clindamycin
meduploader - 05-02-09 13:26
A 64-year-old woman with congestive heart failure is evaluated because of cough, increasing sputum production, fever, and dyspnea. On physical examination, temperature is 38.6 °C (101.5 °F), respiration rate is 32/min, pulse rate is 128/min and regular, and blood pressure is 148/85 mm Hg. An area of consolidation is present over the right lower lung field. The remainder of the examination is normal. Arterial oxygen saturation is 91% by pulse oximetry with the patient breathing room air. Routine laboratory studies, two blood culture specimens, and sputum samples for Gram stain and culture are obtained, and the patient is hospitalized on a general medical floor.
Pending results of laboratory studies, which of the following is the most appropriate empiric antimicrobial regimen for this patient?
( A ) Imipenem plus oseltamavir
( B ) Ceftriaxone plus azithromycin
( C ) Moxifloxacin plus azithromycin
( D ) Moxifloxacin plus vancomycin
( E ) Moxifloxacin plus clindamycin
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#3
Re: community-acquired pneumonia ammara - 05-04-09 02:36 wel my choice is B..
bt i hav a bit confusion here..according 2 american thoracic society guidelines for the management of adults with CAP which divided hospitalized CAP patients into 2 categories...
1)Hospitalized individuals not at risk for Pseudomonas..then treatment choice is either an intravenous fluoroquinolone active against Streptococcus pneumoniae OR beta-lactam antibiotic PLUS an intravenous macrolide for seven to ten days
2)Individuals requiring intensive care at risk for Pseudomonas..possible regimen is an intravenous antipseudomonal beta-lactam such as cefepime, imipenem, meropenem, or piperacillin/tazobactam plus an intravenous antipseudomonal fluoroquinolone
so how 2 decide patient is at risk of pseudomonas..???like if he is diabetic or.......????
#4
Re: community-acquired pneumonia babbu5508 - 02-22-11 09:43 ending results of laboratory studies, which of the following is the most appropriate empiric antimicrobial regimen for this patient?
( B ) Ceftriaxone plus azithromycin
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