CAP Quiz Answers
1. A 34 y/o female presents to your office c/o cough, fever, and sob. PMH is significant for DM I which she is on insulin for. Her vitals are all in the normal range. Her cxr shows a RLL infiltrate. Which of the following is true?
Patient meets criteria for admission based upon her CURB-65 score.
She should be treated with azithromycin for 5 days (z-pack).
She should be treated with Augmentin 875mg PO BID with azithromycin.
Answer: She should be treated with amoxicillin 1000mg PO TID with azithromycin.
She should be treated for 10 days.
Discussion:
2. A previously healthy 28 y/o male presents to the ED with worsening sob, cough, and fever. He states he recently had H1N1 approx 3 weeks ago. He did not require any treatment. Vitals: HR 110 T: 102 RR: 33 O2 Sat: 93% RA. He has crackles at his right base. CXR shows a large infiltrate in RML. Labs show a BUN of 39 with a cr of 1.2. Which of the following is true?
This patient can safely be treated at home.
Answer: This patient should be admitted and placed on Vancomycin with azithromycin.
This patient is at high risk for drug resistant strep pneumonia.
This patient should be admitted and placed on ceftriaxone with azithromycin.
3. A 67 y/o male with PMH CAD, DM presents to your office with cough, fever, and sob. His wife reports he has not been himself, acting slighly confused over the past 24 hours. His vitals are wnl, including O2 sat of 94%, with exam positive for left basilar bronchiolar breathsounds. CXR confirms LLL infiltrate. No labs are ordered. Which of the following is true.
This patient can safely be treated at home.
He should be started on azithromycin.
Answer: This patient is at high risk for drug resistant strep pneumonia.
Vancomycin is the drug of choice for drug resistant strep pneumonia.
4. The above patient is treated appropriately. You are contacted that despite 24 hours of antibiotics, he continues to spike fevers. Which of the following is true?
Patient should have his antibiotics changed to Vancomycin, piperacillin/tazobactam, and cipro.
Answer: If patient does not have any further fevers, antibiotics can be stopped after 5 days of treatment.
Pulmonology should be consulted for a possible bronchoscopy due to treatment failure.
The patient should take a cool bath for any fevers over 102.
5. A 71 y/o female with h/o bronchiectasis presents to the ED with c/o sob, fever, and cough. She is hypoxic with a HR of 102. Her cxr shows a RLL infiltrate. Which of the following is true?
She should be admitted and placed on ceftriaxone with azithromycin.
Answer: She should be admitted and placed on piperacillin/tazobactam with cipro.
The patient should be treated for 8 days.
The patient is at low risk for drug resistant strep pneumonia.
6. A 28 y/o healthy male presents with cough, sob, and fever. He has normal vital signs with an exam concerning for right upper lung field bronchiolar bs. A cxr shows a RUL infiltrate. Which of the following is true?
Answer: He should be placed on azithromycin.
He should be placed on augmentin 2 grams PO BID with azithromycin.
He should be placed on levofloxacin (Levaquin) for 10 days.
He should be instructed to avoid NSAIDs for the next 72 hours.
7. A 68 y/o homeless male presents to the ED with sob, cough, and fever. He does not know his PMH, but thinks he may have had a heart attack in the past. His vitals are wnl, with a pulse ox of 93% on RA. His cxr shows a very large RLL infiltrate. The ED wishes to admit the patient. Which of the following is true?
CURB-65 is a validated scoring system for this situation.
Answer: The patient should be admitted and placed on levofloxacin (Levaquin).
The patient should be treated with azithromycin alone.
This patient is at low risk for drug resistant strep pneumonia.