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Thread: 68-year active smoker with worsening respiratory symptoms and cough for one week

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    Arrow 68-year active smoker with worsening respiratory symptoms and cough for one week

    A 68-year active smoker with long-standing chronic obstructive pulmonary
    disease and five admissions to the hospital in the past two years is admitted to the
    intensive care unit because of respiratory failure. He had complained of worsening
    respiratory symptoms and cough for one week but claimed to experience no fevers.
    Admission chest radiograph shows new infiltrates in left upper and right lower lobes.
    Purulent sputum is obtained immediately following intubation that shows greater
    than 25 PMN's/hpf and small gram-negative bacilli. Which of the following
    statements regarding treatment is true?

    A. Antibiotic selection should include coverage for Pseudomonas aeruginosa
    B. The lack of fevers suggests that aspiration pneumonia is highly likely
    C. Legionella rarely affects patients with COPD, and therapy with a cephalosporins
    drug such as cefotaxime or ceftazidime should be sufficient
    D. Bronchoscopy should be ordered to rule out an obstruction because of this
    patient’s smoking history
    E. Streptococcus pneumoniae is the most likely cause of pneumonia in this patient
    [hide]
    Answer: A. Patients admitted to the intensive care unit should have antibiotic
    coverage covering resistant pathogens such as P. aeruginosa, especially if they have
    structural lung disease (COPD) and have had recent prior courses of antibiotics.
    Though bilobar pneumonia increases the likelihood of the pneumococcus, the gram
    stain suggests otherwise. Bronchoscopy is normally not required for initial diagnosis
    in the nonimmunocompromised patient. Persisting infiltrates beyond six weeks or
    recurrence of pneumonia in the same lobe in a smoker should prompt consideration
    of an obstruction.[/hide]

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    I'll go with A...

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    It's the Correct Answer. Good Job man !! You r ready for your PG exams i see !!! Keep it up !! i'll post more MCQ, hope they are helping you a lot to build up your confidence.

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    Thanks bro..ya they are helping me to build my confidence..but i have long way to go..keep posting..nice job..

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