Answer and explanation 10

10.  B is the correct answer.  Pneumocystis Carini Pneumonia is best treated with bactrim.  Cipro is best used in patients with a pseudomonas risk such as people who have structural lung disease or are on steroids.  Amoxicillins work best against streptococcal pneumonia infections.  Macrolides such as zithormax are used for atypical organisms such as mycoplasma, haemophillus, and legionella.

Question 10

10.  Your patient is a 63 year old HIV patient presents with a fever of 103, cough and chills.  Physical exam reveals crackles in the left lower lobe.  Which of the following  agents would be most appropriate to treat his infiltrate seen on Chest X Ray?

A. Cipro
B.  Bactrim
C. Amoxicillin
D.  Zithromax

Answer and Explanation 9

9.  D is the correct answer.  The patient has a restrictive lung disease pulmonary pattern with moderately impaired diffusion capacity.  He need referred to pulmonary rehab and to be referred to pulmonary for bronchoscopy.  He likely has pulmonary fibrosis.  This patient is not going to have any significant response to prednisone, albuterol, glucocorticoids, or singular as documented by his PFT's.

Question 9

9.  Your patient present to your office after notice a 18 month history of progressively worsening shortness of breath. You have sent him for outpatient pulmonary function tests.  Based on the data below, what is the best management option?

Pre Bronchodilator
FVC     49% Prediceted
FEV1   47% Predicted
TLC     45% Predicted
RV       42% Predicted


Post Bronchodilator
FVC     47% Predicted
FEV1   45% Predicted
DLCO 38% Predicted


A. Start the patient a burst of Prednisone and re-evaluate the patient in a month to see if they responded.

B. Start the patient on albuterol 4 times a day with an inhaled glucocorticoid

C.  Start the patient on singulair 10 mg daily

D.  Start the patient in Pulmonary Rehabilitation and refer to patient to pulmonary.

Answer and Explanation 8

8.  Answer C is the correct answer.  The patient has a classic "thumb signs" seen on the soft tissue x ray characteristic of epiglottitis.  The patient should be intubated ideally in surgery by anesthesia.  The patient should not be agitated unncessarily.  Croup presents differently with a barky croup cough and stridor.  They usually are not drooling.  Decadron and Racemic Epinephrine are beneficial in croup.  The main issue in epiglottitis is to make sure the airway is safe.  It is also comon in unimmunized children.  Haemophilus is usually the causitive organism for which marcolides like azithromycin work well against.

Question 8

8.  Your patient is a 9 month old female brought in by her mother because of drooling and trouble breathing.  Look at the X Ray  and determine the best management.

A. Give the patient a shot of Decadon IM

B.  Give the patient a Racemic Epinephrine Treatment

C.  Call Anesthesia to Intubate the patient and try not to disturb or agitate the patient.

D.  Start the patient on azithromycin IV