sprint123
Forum Guru
Topics: 129
Posts: 870
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Hi all-I found this question in a different site of this forum...It would be better to discuss on this one..
A 72-year-old woman with a history of bronchiectasis is evaluated because of worsening cough, purulent sputum production, and occasional scant hemoptysis. She reports no fever, but says that she has difficulty gaining weight. She has never smoked cigarettes.
She is hospitalized because of tachypnea and hypoxia. Spirometry shows moderately severe obstructive impairment. Chest radiograph shows tramlines without infiltrate. Gram stain of the sputum shows numerous leukocytes, but no bacteria; culture results are pending. Previous IgE levels were normal. There is no eosinophilia. An immediate skin test for Aspergillus is negative. A tuberculin skin test performed last month was nonreactive.
Which of the following is appropriate therapy for this patient?
( A ) A β-lactam/β-lactamase combination
( B ) A macrolide
( C ) A fluoroquinolone and an aminoglycoside
( D ) Itraconazole
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| snake0613
Forum Elite
Topics: 97
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c?
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| snowdrops
Forum Senior
Topics: 6
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C, I guess.
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| nadiabarati
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C
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| Justice
Just signed contract
Topics: 118
Posts: 2,369
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I do not think this is pneumonia... This is bronchitis: no fever but cough + obstructive pattern...
And before the culture is known, I start with (A)
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| radonc
Forum Senior
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Isn't this exacerbation of his bronchiectasis? Clinically he is getting short of breath with more purulent sputum, even though no inflitrates on CXR.
My answer is C, you need to cover for unusual bacteria, esp gram negatives.
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| doc_clotaire
Forum Guru
Topics: 159
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This is exacerbation of bronchiectasias whitch can be secondary to viral or bacteria infection . In this case it 's could be secondary to viral infection but we still have to give broad spectrum antibiotics and especially anti-peudomonal antibiotics
I definitly would go with C .........................
Fluoquinolone and Aminoglycosides both cover PSEUDOMONA AEROGINOSA
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| sprint123
Forum Guru
Topics: 129
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Though there is no infiltrates,We still go with the MCC of pneumonia in bronchiectasis---PSEUDOMONAS and I think the ansr is C..
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