USMLE Forum Archives - USMLE Step 3 - Peads: CF
Peads: CF
meduploader - 06-01-09 06:41
16-year-old WM is admitted to 4CMC with complaint of hemoptysis. His history is significant for cystic fibrosis, bronchitis and gastroesophageal reflux disease. He states that he has had a chronic cough since age 2 and has been hospitalized at least once a year for "pneumonia." He recalls coughing up 1 cup of blood approximately 2 weeks ago and continuing to do so at least once a day. He denies wheezing, shortness of breath, fever,rhinorrhea or sore throat. Current medications include Reglan 5 mg TID, Pulmozyme 2.5 mg BID, Septra DS 2 tabs BID, Rifampin 300 mg 1 tab BID, and TOBI . His physical examination is significant for bilateral inspiratory crackles heard best in the upper lobes,distant breath sounds in the lower lobes, and moderate digital clubbing. You are the subspecialty JMS on call. Upon some serious pimping by the resident you decide to prescribe IV tobramycin 220 mg q12h and ceftazidime 2.0 g q8h. Being the astute JMS on call you also remember to suggest ordering a tobramycin peak and trough level q3rd dose,CBC, and BMP. However, your resident is still angry. The most likely explanation for his fury (besides the occasional tantrum) is that
meduploader - 06-01-09 06:41
16-year-old WM is admitted to 4CMC with complaint of hemoptysis. His history is significant for cystic fibrosis, bronchitis and gastroesophageal reflux disease. He states that he has had a chronic cough since age 2 and has been hospitalized at least once a year for "pneumonia." He recalls coughing up 1 cup of blood approximately 2 weeks ago and continuing to do so at least once a day. He denies wheezing, shortness of breath, fever,rhinorrhea or sore throat. Current medications include Reglan 5 mg TID, Pulmozyme 2.5 mg BID, Septra DS 2 tabs BID, Rifampin 300 mg 1 tab BID, and TOBI . His physical examination is significant for bilateral inspiratory crackles heard best in the upper lobes,distant breath sounds in the lower lobes, and moderate digital clubbing. You are the subspecialty JMS on call. Upon some serious pimping by the resident you decide to prescribe IV tobramycin 220 mg q12h and ceftazidime 2.0 g q8h. Being the astute JMS on call you also remember to suggest ordering a tobramycin peak and trough level q3rd dose,CBC, and BMP. However, your resident is still angry. The most likely explanation for his fury (besides the occasional tantrum) is that
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#11
Re: Peads: CF conym5 - 04-09-10 08:29 Because albuterol is a B2-agonist with significant B1 crossreactions, it should not be used consecutively over an extended period of time. Sputum cultures are necessary to identify any new bacterial pathogen, but antibiotic regimen should be prescribed immediately to cover known "bugs."
#15
Re: Peads: CF babbu5508 - 08-31-10 00:35 My answer is: e.
you forget to consider a sputum culture prior to prescribing antibiotic treatment in CF patients.............
#20
Re: Peads: CF tesbenzon - 07-24-11 04:22 My answer is: e.
it is better to do culture to see which antimicrobial is best for the patient's infection
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