ABFM KSA- CARE OF HOSPITALIZED PATIENTS EXAM | NEWEST ACTUAL ACCURATE EXAM COMPLETE QUESTIONS AND DETAILED VERIFIED ANSWERS GRADED A+ | 100% VERIFIED | LATEST UPDATE!!!

ABFM KSA- CARE OF HOSPITALIZED PATIENTS EXAM | NEWEST ACTUAL ACCURATE EXAM COMPLETE QUESTIONS AND DETAILED VERIFIED ANSWERS GRADED A+ | 100% VERIFIED |UPDATE!!!
A 42-year-old construction worker with a 3-day history of cough, fever,
chills, dyspnea, and right posterolateral chest pain with inspiration is
brought to the emergency department by his wife. He has been in good
health until this illness and has never been hospitalized. He does not
take any routine medications, does not smoke, and drinks alcohol only
occasionally.On examination he appears ill and in mild respiratory
distress. His temperature is 40.3°C (104.5°F), pulse rate 126 beats/min,
respiratory rate 32/min, blood pressure 136/70 mm Hg, and oxygen
saturation 88% on room air. He has diminished breath sounds in the
right posterolateral chest. His Pneumonia Severity Index is 97. Based on
the severity of his illness you recommend hospital admission.Antibiotic
choices recommended for empiric treatment in this patient include
which of the following?
Ceftriaxone plus azithromycin (Zithromax)
Cefuroxime
Ciprofloxacin (Cipro) intravenously
Piperacillin/tazobactam (Zosyn) plus vancomycin (Vancocin)
A
Relative risk stratification should be performed for patients with
community-acquired pneumonia (CAP), using a clinical prediction tool
such as the Pneumonia Severity Index (PSI) or the CURB-65 (SOR A).
These tools can be used along with the judgment of the physician to
decide whether or not a patient can be treated as an outpatient or
should be admitted to the hospital. This patient is moderately ill and
has a PSI score of 97 based on his age, heart rate, respiratory rate,
temperature, and oxygenation. This score indicates that he should
initially be treated in the hospital.A macrolide plus a β-lactam is
recommended for combination therapy in patients hospitalized with
CAP who are at low risk (PSI score of 71–130) (SOR A). A respiratory
fluoroquinolone (levofloxacin or moxifloxacin) can also be used as
monotherapy (SOR A). Because of concerns about increasing levels of
resistance, macrolides are not recommended as monotherapy for a
moderately ill patient (SOR C). Ciprofloxacin, a first-generation
quinolone, has poor potency against Streptococcus pneumoniae and
is therefore not appropriate treatment for CAP (SOR C). Treatment
with piperacillin/tazobactam is not indicated since there are no risk
factors for Pseudomonas. Vancomycin is likewise not indicated since
there are no MRSA risk factors.Adults hospitalized with non-severe
CAP who do not have risk factors for MRSA can be treated by either of
the following regimens:(1) combination therapy with a β-lactam
(ampicillin plus sulbactam, 1.5–3 g every 6 hours; cefotaxime, 1–2 g
every 8 hours; ceftriaxone, 1–2 g daily; or ceftaroline, 600 mg every 12
hours) AND a macrolide (azithromycin, 500 mg daily, or
clarithromycin, 500 mg twice daily)(2) monotherapy with a respiratory
fluoroquinolone (levofloxacin, 750 mg daily, or moxifloxacin, 400 mg
daily)A combination of ceftriaxone and levofloxacin is not
recommended.It should be noted that β-lactam/macrolide therapy
reduced mortality in patients with CAP compared with patients
treated with β-lactam monotherapy, so monotherapy with a β-lactam
for hospital-treated pneumonia is not recommended.