Delusional
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A 65 year old patient presents to the ER with cough and a CXR that shows a right lower posterior infiltrate. What is the importance of the followingpoints in history in determining the antibiotic coverage?
1....Drinks a gallon of Vodka a day
2....H/O influenza a week ago
3....Living near a construction area
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| prep4usmle
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1....Drinks a gallon of Vodka a day
Probably aspiration pneumonia, should cover the gram negatives & anaerobes too with cephalosporin + aminoglycoside
2....H/O influenza a week ago
Probably staph pneumonia, should cover it with ox/clox/diclox...
3....Living near a construction area
Don't know: asbest? silicosis? lead?
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| Delusional
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Thanx Prep ...sorry for the delay in the reply,,,,
Perfect answer
Yes ...correct... the first one is most likely an anerobe....Actinmocyes...
and the last one is most probably a fungal cause.. like Histoplasma
Always suspect Aspiration pneumonia (an abcess chronically) in any patient with a unilateral lesion involving a dependant region.....
The Lower lobe sperior or prosterior segment (usually Right lung) in a patinet who is not bedridden
The Upper lobe in a bed-ridden patient (usually right lung)
Thanx 
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| prep4usmle
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Thanks Delusional !
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