16 ans a decision rule curb 65 provides framework for

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16. ANS: A Decision Rule: CURB-65 provides framework for determining whether the patient diagnosed with community- acquired pneumonia can be safely monitored and treated at home. One point is awarded for each of the following factors present: Confusion of new onset BUN is greater than 20mg/dl Respiratory rate of ³ 30 breaths/minute Blood pressure is less than 90 mmHg systolic or diastolic ² 60 mm Hg Age 65 or older Patients scoring 3 to 5 typically require hospitalization for observation and therapy. Scores of 0 to 1 indicate likelihood that outpatient management is appropriate. A score of 2 is inconclusive. 17. ANS: C In pneumonia, chest film typically reveals an area of infiltrate. It is a red flag if a pleural effusion is also visualized, in which case adequate follow-up to exclude development of an empyema is mandatory. This often involves prompt referral to a pulmonologist for possible thoracentesis. Cultures and Gram stains of sputum are usually not ordered for outpatients. 18. ANS: D Cough is the most common symptom of bronchitis and may persist for several weeks after the initial infection is resolved. During the acute phase, the cough may be productive. There may be associated symptoms, including fever, malaise, chest discomfort, chills, and headache. The chills and chest discomfort are mild in comparison to the symptoms of pneumonia. There may be wheezes and/or rhonchi on auscultation, which disappear or alter with cough effort. 19. ANS: C With pneumonia, the chest film typically reveals an area of infiltrate. It is a red flag if a pleural effusion is also visualized, in which case adequate follow-up to exclude development of an empyema is mandatory. This often involves prompt referral to a pulmonologist for possible thoracentesis. Cultures and Gram stains of sputum are usually not ordered for outpatients. The white blood cell count is often elevated. 20. ANS: B
In bronchiectasis, there is usually a history of chronic, productive cough. Sputum is typically mucopurulent and produced in increased amounts. Other common findings include shortness of breath, wheezing, fatigue, and possibly hemoptysis. Physical examination reveals rhonchi and/or wheezing. In advanced disease, clubbing and cyanosis may be present. 21. ANS: C Many times, patients with active tuberculosis are essentially symptom free. Some complain of malaise and/or fevers but have no significantly disruptive complaints. When respiratory symptoms occur with tuberculosis, cough is common; the cough is nonproductive at first and is later associated with sputum production. Additionally, patients with tuberculosis may experience progressive dyspnea, night sweats, weight loss, and hemoptysis. It is important to suspect tuberculosis when the patient has travelled to a country where TB is endemic, such as Asia.

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