Lower Respiratory tract disease

Question 1

Minimum diagnostic evaluation for pneumonia? (3)

Answer 1

CBC with WBC differential, BUN/Cr, chest x-ray

Question 2

Pneumonia treatment for those without significant comorbidities? AABCDE (5)

Answer 2

Azithromycin, Amoxicillin (+), Biacin/clarithromycin, doxycycline (+), or erythromycin

Question 3

Treatment for pneumonia for those with significant comorbidities? (3)

Answer 3

Fluroquinolone (Moxci, levofloxacin)
OR
Doxy or select macrolide (azitho- or clarithomycin) PLUS beta-lactam ( ex. amoxicillin-clavulanate)

Question 4

What does CURB-65 stand for? (5)

Answer 4

Confusion
BUN elevated (>19)
Respirations elevated (30 and above)
Low BP (SBP < 90, DBP <60)
Over 65

Question 5

Treatment for acute bronchitis? (3)

Answer 5

Symptom management, may use SAMA/SABA or short course of oral corticosteroid. Antibiotics use discouraged.

Question 6

Asthma controller medications (5)

Answer 6

Inhaled corticosteroids (ex. Fluticasone (flovent), Budesonide (Pulmicort)
Inhaled Corticosteroid/Long-acting-beta2-agnosts (ICS/LABA)
Leukotriene modifiers (not preferred)
Long-acting muscarinic antagonist (LAMA) (add on if not controlled with ICS/LABA
Theophylline (not commonly used)

Question 7

Asthma quick relief/rescue meds (2)

Answer 7

SABA (albuterol)

Systemic corticosteroids for aggressive treatment of inflammation during asthma flare

Question 8

Treatment for COPD (6)

Answer 8

SABA/SAMA (used PRN for bronchospasm)
LABA
LAMA
ICS
Oral theophylline
Oral PDE-4 inhibitor

Question 9

Which antibiotic should you avoid use w/ ACEI or ARB, especially with CKD and/or dehydration, due to hyperkalemia risk? (1)

Answer 9

TMP/SMX

Question 10

Which antibiotic is vulnerable to destruction by beta-lactamase? (1)

Answer 10

Amoxicllin

Question 11

Which antibiotic can cause QT-prolongation risk, particularly in individuals w/ higher CVD risk? (1)

Answer 11

Azithromycin

Question 12

Which ABX use is associated with tendon rupture risk, especially when used w/ systemic corticosteroid? (1)

Answer 12

Moxifloxacin

Question 13

Which ABD has a less than 1% cross-risk with penicillin allergy? (1)

Answer 13

Cefpodoxime

Question 14

If ABX therapy is needed for mild-to-moderate COPD exacerbation, which is the best choice? (2)

Answer 14

Doxycycline and cephalosporin (cefdinir, cefpodoxime)

Question 15

If ABX therapy is needed for severe COPD exacerbation, which is the best choice? (2)

Answer 15

Doxycycline
Cephalosporin (cefdinir, cefpodoxime)