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Old 09-23-2012
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Arrow Gyrus Daily Questions; Internal Medicine #27

A 68-year-old woman comes to the emergency department with complaints of 3 days of fever, malaise, cough with green sputum, dyspnea, and right lower chest pain that is worse on inspiration. She is a 1 pack per day cigarette smoker and works in a retail store. Her only medication is hydrochlorothiazide for hypertension. She is alert but in mild respiratory distress. Her temperature is 39.2C, respiratory rate 32 breaths/min, blood pressure 110/70 mmHg, heart rate 105 beats/min, SaO2 on room air is 91%. Her chemistry studies show a serum glucose of 140 mg/dL and a BUN of 32 mg/dL. WBC is 12,500/μL with a left shift. There are bronchial breath sounds in the right lower lobe, and chest radiograph shows consolidation consolidation

in the right and left lower lobes. Which of the following
is the most appropriate antibiotic therapy?
A. Azithromycin
B. Ceftriaxone plus clarithromycin
C. Fluconazole
D. Piperacillin/tazobactam
E. Vancomycin
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Old 09-23-2012
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this is very similar to your q 26, except age of patient
i would go with B again
Ceftriaxone plus clarithromycin
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Old 09-23-2012
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Quote:
Originally Posted by theundead View Post
this is very similar to your q 26, except age of patient
i would go with B again
Ceftriaxone plus clarithromycin
but there is bilateral consolidation ,which seems to be a trap

I will go with B too
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Old 09-23-2012
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She has consolidation and a high as **** fever with left shift, I would pick B as well
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B. Ceftriaxone plus clarithromycin

In patient CAP (she is elderly with hypoxia-needs admission) is treated with Ceftriaxone plus macrolide OR respiratory fluoroquinolone (as a single agent).
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Infectious-Diseases, Internal-Medicine-, Pulmonology-, Step-2-Questions

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