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BCPS With Complete Questions and Answers
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BCPS With Complete Questions and AnswersBCPS With Complete Questions and AnswersBCPS With Complete Questions and AnswersBCPS With Complete Questions and Answers Patient Case RL is a 68 year old man Chief complaint: cough and shortness of breath HPI: Symptoms began 4 days ago and have wors...

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  • September 27, 2024
  • 29
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • bcps stuvia
  • bcps with complete questions and answers
  • patient case rl is a 68 year old man chief compla

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  • BCPS

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BCPS 2024-2025 With Complete
Questions and Answers
Patient Case
RL is a 68 year old man
Chief complaint: cough and shortness of breath
HPI: Symptoms began 4 days ago and have worsened over the last 24 hours. He is
coughing up yellowish-green sputum and complains of chills with a fever to 102.4°F
PMH: CAD with an MI 5 years ago, CHF, hypertension and osteoarthritis.
SH: rarely drinks alcohol; quit smoking; lives at home with wife
Meds on admission: lisinopril 10mg daily, hydrochlorothiazide 25mg daily and
acetaminophen 650mg QID.
PE: alert and oriented - VS: Temp 101.8°F, HR 100, RR 32, BP 142/94.
Labs: nl except BUN=32 mg/dl (Scr=1.23mg/dl).
Chest x-ray: infiltrates in the right lower lobe.
Sputum specimen is not available.


Which is the best empiric therapy for RL?
Ampicillin/sulbactam 1.5g IV q6h
Piperacillin/tazobactam 4.5g IV q6h plus gentamicin 180mg IV q12h
Ceftriaxone 1g IV q24h plus azithromycin 500mg IV daily
Doxycycline 100mg IV q12h - ANSWER - Ceftriaxone 1g IV q24h plus azithromycin
500mg IV daily


(CAP pt case)


Patient factors NOT seen in CAP - ANSWER - -Hospitalization 2 or more days in past
90 days
-Residence in long-term care facility
-Received IV abx, chemotherapy, or wound care in last 30 days

,-Attendance at hospital or HD clinic


CAP most common organisms - ANSWER - S. pneumoniae
M. pneumoniae
H. influenzae


Community-acquired PNA - Outpatient Therapy
Previously healthy / No antibiotics in 3 months - ANSWER - Macrolide
(clarithromycin or azithromycin, especially if H. influenzae suspected)
Doxycycline


Community-acquired PNA - Outpatient Therapy
Comorbidities / Antibiotics in 3 months - ANSWER - "Respiratory" Fluoroquinolone
(levo- 750mg, moxi-, gemi-)
Macrolide (or doxycycline) with high-dose amoxicillin (1g TID) or
amoxicillin/clavulanate (2g BID) or cephalosporin (ceftriaxone, cefotaxime,
cefpodoxime)


Community-acquired PNA (Moderately severe) - Inpatient Therapy - ANSWER -
Fluoroquinolone (levo- 750mg, moxi-, gemi-)
Macrolide (or doxycycline) plus 3rd generation
cephalosporin, ampicillin or [ertapenem]
Corticosteroids (typically prednisone 20-50mg for
7 days)


Benefit of corticosteroids in CAP inpatient therapy - ANSWER - Decreases need for
mechanical ventilation, ARDS and
hospital stay (by 1 day)
Greater incidence of hyperglycemia requiring treatment


Community-acquired PNA (Severe) - Requiring ICU Therapy - ANSWER -
Ampicillin/sulbactam plus a respiratory fluoroquinolone or azithromycin

, 3rd generation cephalosporin plus a respiratory fluoroquinolone or azithromycin
May also need broader antibacterial activity


When to add on MRSA coverage for severe CAP - ANSWER - ICU admission
Necrotizing or cavitary infiltrates
Empyema


Predictors of more complicated CAP infection - ANSWER - -Age >65
-Co-morbidities (COPD, DM, CHF, ESRD)
-Temp >101F
-Bacteremia
-AMS
-Immunosuppression/CA
-High-risk etiology (Legionella, S. aureus, GNB, anaerobic aspiration)
-Multi-lobe involvement or pleural effusions


CAP duration - ANSWER - 5-7 days


(Need to be afeb 48-72 hours with no more than 1 sign of clinical instability before
therapy d/c)


Patient Case
BP is a 66 year old woman
HPI: CABG x2 8 days ago; now on ventilator in ICU. She has a new infiltrate and is
spiking temperatures.
PMH: CAD with an MI 2 years ago, COPD, and hypertension.
All anti-pseudomonal antibiotics are active against at least 90% of strains


Which is the best empiric therapy for BP?
Ceftriaxone 1 g daily plus gentamicin 7mg/kg daily plus linezolid 600mg q12h

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