A 26 year-old seasonal worker from South America came to the ER ...

[cmoore54]

A 26 year-old seasonal worker from South America came to the ER with a history of a dry, hacking blood-tinged cough, fever, chills, and loss of appetite. The chest x-ray showed cavitary lesion in the right upper lobe.
 
  After a week in the hospital, the sputum culture shows the present of acid-fast stained organisms. Which of the following medications would you recommend for this patient at this time?
  1. Ceftizoxime
  2. Isoniazid
  3. Rifampin
  4. Ethambutol
  a. 1 only
  b. 2 and 4 only
  c. 1, 2, and 3 only
  d. 2, 3, and 4 only

Question 2

The chest radiograph is often of little help in the diagnosis of nosocomial pneumonia in mechani-cally ventilated patients in the ICU because these individuals often have other reasons for radio-graphic abnormalities.
 
  Indicate whether the statement is true or false.

[Viet Thy]

Answer to Question 1

ANS: D
Isoniazid, rifampin, pyrazinamide, and ethambutol are first-line antituberculous medications. Pending antimicrobial susceptibility results; treatment with four drugs at the outset is recom-mended. In those with drug-susceptible pulmonary tuberculosis, a number of 6- to 9-month treatment regimens have been shown to be effective as outlined in the ATS/CDC/IDSA guide-lines.

Answer to Question 2

ANS: T
The chest radiograph is often less helpful in the diagnosis of VAP because mechanically venti-lated patients often have other reasons for radiographic abnormalities, such as ARDS, CHF, pulmonary thromboembolism, alveolar hemorrhage, or atelectasis.