ABFM HOSPITAL MEDICINE COMPLETE SOLUTIONS EXAM 2023,2024 VERIFIED

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 130 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? (Mark all that are true.) Ceftriaxone (Rocephin) plus azithromycin (Zithromax) Ceftriaxone plus doxycycline Ciprofloxacin (Cipro) Clarithromycin (Biaxin) Levofloxacin (Levaquin) A, B, E Relative risk stratification should be performed for patients with community-acquired pneumonia, 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, based on his presentation, has a PSI score of 97 (based on his age, respiratory rate, temperature, and pulse oximetry). 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 community-acquired pneumonia who are at low risk (PSI score of 71- 130) (SOR A). In addition to a β-lactam, doxycycline can be used as an alternative to a macrolide (SOR B). A respiratory fluoroquinolone (levofloxacin, gemifloxacin, moxifloxacin) can 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 no antimicrobial activity against Streptococcus pneumoniae and is therefore not appropriate treatment for community-acquired pneumonia (SOR C).