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  #1  
Old 10-30-2011
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Lungs Intubation Pneumonia Treatment

A 65-year-old man with a history of asthma presents to the emergency department in acute respiratory distress. He is wheezing. His family reports he ran out of bronchodilators 2 days ago and did not renew his prescriptions. The patient seems quite uncomfortable and is unable to complete a sentence. He is in respiratory extremis. He is given several doses of nebulizers and steroids. He does not respond. Arterial blood gas reveals respiratory acidosis. His pH is 7.25. As a result, the patient is intubated and admitted to the intensive care unit. In addition to administering nebulizers, steroids, and appropriate respirator care, which of the following should be given to the patient to minimize the risk for pneumonia in the setting of intubation?
A. Ceftazidime
B. Omeprazole
C. Ranitidine
D. Sucralfate
E. Tobramycin nebulizers
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  #2  
Old 10-30-2011
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I would go with E.
A is not the medication for pneumonia.
b and c are both anti-acid and will work in a couples of days?
I don't know D???
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  #3  
Old 10-31-2011
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id go with omeprazole!
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  #4  
Old 10-31-2011
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A. Ceftazidime
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  #5  
Old 10-31-2011
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The correct answer is D. Bacterial colonization of the stomach is increased in intubated patients in the presence of decreased acidity that can be caused by H2 blockers or antacids. Sucralfate heals ulcers without altering the gastric acidity. It is an ideal medicine to treat patients for ulcers while reducing the risk for hospital-acquired pneumonia.

A broad-spectrum antibiotic such as ceftazidime (choice A) is not indicated in this patient in the absence of neutropenia or fever.

Omeprazole (choice B) would reduce the acidity of the stomach and increase the risk for aspiration from bacterial overgrowth.

Ranitidine similarly would reduce the acidity of the stomach (choice C).

Tobramycin nebulizers (choice E) are used in the treatment of patients with cystic fibrosis presenting with Pseudomonas pneumonia. This patient does not require such treatment
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  #6  
Old 03-15-2012
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good one...
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Infectious-Diseases, Pulmonology-, Step-2-Questions

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