CURB-65 Score for CAP Severity

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Questions and Answers

How is a CURB-65 score of 2 interpreted in terms of patient care?

The patient should be admitted to ICU for severe care.

The patient requires inpatient care on a general ward. (correct)

The patient is not eligible for any treatment.

The patient can be treated as an outpatient.

In the case of the 67-year-old woman with a CURB-65 score assessment, what is the most appropriate setting for her treatment?

She should be sent home with no treatment.

Outpatient care is sufficient.

General ward hospitalization is required. (correct)

ICU admission is necessary.

What is the significance of a sodium level of 130 mmol/L in a CURB-65 score assessment?

It suggests the patient should receive outpatient treatment.

It disqualifies the patient from CURB-65 assessment.

It indicates a normal status and poses no concern.

It qualifies as a minor criterion for severe cases. (correct)

What is the minimum duration for empiric treatment of Community-Acquired Pneumonia (CAP) under normal circumstances?

5 days Signup and view all the answers

How should a patient with Positive respiratory rate and confusion in the CURB-65 assessment be evaluated?

They need to be immediately admitted to ICU due to severity. Signup and view all the answers

What is the primary characteristic of Mycobacterium tuberculosis?

Rod-shaped thin aerobic bacterium Signup and view all the answers

Which of the following conditions is associated with active tuberculosis?

Presence of lesions in the lungs Signup and view all the answers

What distinguishes multidrug-resistant tuberculosis (MDR-TB) from other forms of TB?

Resistance to at least Isoniazid and Rifampin Signup and view all the answers

What type of tuberculosis primarily affects the lungs?

Pulmonary TB Signup and view all the answers

Which treatment is commonly prescribed for MRSA infections?

Vancomycin Signup and view all the answers

What action is recommended if vision does not improve after stopping EMB?

Stop INH treatment as well. Signup and view all the answers

Which group should be prioritized for LTBI treatment if they have a positive TST reaction that is more than 5 mm?

Recent contacts of infectious TB cases. Signup and view all the answers

Which condition increases the risk of TB and prioritizes individuals for LTBI treatment?

Prolonged use of steroids. Signup and view all the answers

In which of the following situations should infants be prioritized for LTBI treatment?

If they are exposed to adults in high-risk groups. Signup and view all the answers

Which of the following groups is NOT considered high priority for LTBI treatment?

Healthy adults with no underlying conditions. Signup and view all the answers

What constitutes extensive drug resistance TB (XDR-TB)?

MDR-TB with additional resistance to fluoroquinolone and second-line injectable Signup and view all the answers

Which of the following sites is NOT typically associated with extrapulmonary TB?

Lungs Signup and view all the answers

What is the consequence of a false-positive reaction in a Tuberculin Skin Test?

It suggests previous vaccination with BCG may have occurred Signup and view all the answers

Which of the following is a risk factor for developing extensive drug resistance TB (XDR-TB)?

HIV infection Signup and view all the answers

What symptom is associated with extrapulmonary TB affecting the kidneys?

Cloudy urine Signup and view all the answers

Which test can be used to diagnose latent TB in individuals who have received the BCG vaccine?

Interferon-gamma release assay (IGRA) Signup and view all the answers

What is a common mode of TB transmission?

Airborne droplets Signup and view all the answers

Which clinical presentation is NOT typical for latent TB?

No symptoms Signup and view all the answers

Which of the following medications is recommended during pregnancy?

None of the above Signup and view all the answers

What is the initial recommended dosage of dexamethasone for adults with TB meningitis?

12 mg/day Signup and view all the answers

Under what conditions should anti-TB drugs be stopped immediately?

If ALT levels are ≥ 5 X ULN with or without symptoms Signup and view all the answers

What indicates severe hepatotoxicity due to anti-TB drugs?

ALT level is > 10 X ULN Signup and view all the answers

What should be done when a patient exhibits an itchy rash without systemic signs?

Continue medications and treat symptomatically with antihistamines Signup and view all the answers

What is the purpose of corticosteroids in treating TB meningitis?

To decrease mortality Signup and view all the answers

Which of the following is categorized as moderate toxicity in hepatotoxicity management?

ALT level 5-10 X ULN Signup and view all the answers

In cases of smear positive TB where discontinuation of therapy is unsafe, what should be considered?

Using a non-hepatotoxic second-line anti-TB treatment Signup and view all the answers

Study Notes

CURB-65 Score for Community-Acquired Pneumonia (CAP) Severity

Confusion: Present or absent.
Uremia: Blood urea nitrogen (BUN) > 20 mg/dL.
Respiratory rate: >30 breaths/minute.
Blood pressure: Systolic < 90 mmHg or diastolic < 60 mmHg.
Age: ≥ 65 years.
Scoring: 1 point per criterion. 1 point = outpatient treatment; 2 points = inpatient treatment; ≥3 points = ICU admission.

Case Study 1: 67-Year-Old Woman with CAP

67-year-old female with mild Alzheimer's disease.
Two-day history of productive cough, fever, and increased confusion.
Vital signs: Temperature 38.4°C, Blood pressure 145/85 mmHg, Respiratory rate 30, Heart rate 120, Oxygen saturation 91% (room air).
Lung exam: Crackles in both lower lung fields.
Mental status: Oriented to person only.
Lab results: White blood cell count (WBC) 4000, Sodium 130 mmol/L, BUN 25 mg/dL.
Chest X-ray: Infiltrates in both lower lobes.
Recommended Care: Inpatient-ICU admission (based on CURB-65 score and clinical presentation).

Case Study 2: 84-Year-Old Woman with CAP

84-year-old female with new onset confusion.
Vital signs and Labs: Temperature 101.4°F, WBC 13.2, Hematocrit 34%, Sodium 137, Potassium 3.9, BUN 17, Creatinine 1, CO2 20, Glucose 91, Blood pressure 108/76 mmHg, Heart rate 78, Respiratory rate 24, Oxygen saturation 92% on room air.
CURB-65 Score: 3 (Confusion, Respiratory rate, Age).

Empiric Treatment of CAP

Outpatient: Macrolide (azithromycin or clarithromycin). Clarithromycin is used in areas with high pneumococcal macrolide resistance.
Inpatient (Non-ICU): Treatment guidelines not specified in provided text.
Inpatient (ICU): Treatment guidelines not specified in the provided text.
Treatment Duration: Minimum 5 days, longer for P. aeruginosa (7 days) and MRSA (7 days).

Treatment of Specific CAP Pathogens

Streptococcus pneumoniae (non-β-lactamase producing): Amoxicillin, azithromycin, clarithromycin, fluoroquinolone, doxycycline.
S. pneumoniae (β-lactamase producing): 2nd or 3rd generation cephalosporin, azithromycin, clarithromycin, fluoroquinolone, doxycycline.
Legionella spp.: Fluoroquinolone, macrolide, doxycycline.
Methicillin-resistant Staphylococcus aureus (MRSA): Vancomycin, linezolid, TMP-SMX, clindamycin.
Methicillin-susceptible Staphylococcus aureus (MSSA): Antistaphylococcal penicillin, cefazolin, clindamycin.

Tuberculosis (TB) Overview

Caused by Mycobacterium tuberculosis.
Primarily affects lungs but can disseminate to other organs.
Two phases: latent and active.
M. tuberculosis characteristics: Rod-shaped, thin, aerobic bacterium.

Types of TB

Pulmonary TB: Lungs are affected.
Open TB: Pulmonary TB with lesions, cough, and sputum.
Extrapulmonary TB: TB affecting organs other than lungs.
Disseminated TB: TB spread from lungs to multiple organs.
Miliary TB: Acute form with nodules in multiple organs.
Drug-resistant TB: Resistance to at least isoniazid and rifampin (MDR-TB), or additional resistance to fluoroquinolones and second-line injectables (XDR-TB).

TB Sites of Involvement

Pulmonary TB
Extrapulmonary sites (lymph nodes, genitourinary tract, bones and joints, meninges, intestine, skin).

TB Risk Factors

Weakened immune system (HIV, immunosuppressants).
Healthcare workers.
Travel to high-incidence areas.
Alcoholism.
Organ transplantation.
Low body weight.
Injection drug use.
Diabetes mellitus, severe kidney disease, leukemia, lymphoma, head and neck cancer.

TB Clinical Presentations

Pulmonary TB: Cough, sputum production, hemoptysis, chest pain, fever, weight loss, fatigue.
Extrapulmonary TB: Variable depending on the affected organ (bone pain, joint pain, painful urination, cloudy urine, headaches, stiff neck).
Latent TB: Usually asymptomatic.

TB Transmission and Isolation

Primarily airborne transmission.
Not all forms of TB are contagious; pulmonary TB is the most contagious form.
Extrapulmonary TB (lymph nodes, pleura, osteoarticular system) usually not considered infectious.

TB Diagnosis

Latent TB: Tuberculin skin test (TST)/Purified protein derivative (PPD) test, interferon-gamma release assay (IGRA). Note that BCG vaccination can cause false-positive TST results.
Active TB: Chest x-ray, sputum culture, other diagnostic tests depending on the site of involvement.

Latent TB Treatment Candidates

High priority: Recent contacts of infectious TB cases, HIV-positive people, individuals from high-TB-incidence countries, drug users, people with suggestive chest X-rays, organ transplant recipients, those with immunocompromising conditions, those working in microbiology labs, children <5 years old, infants exposed to high-risk adults. Moderate priority: People with TST ≥5 mm or IGRA positive.

TB Treatment: Second-Line Drugs

Cycloserine, fluoroquinolones, aminoglycosides, and ethionamide are not recommended during pregnancy.

Corticosteroids in TB Meningitis

Adjunctive corticosteroids (dexamethasone or prednisolone) are recommended to decrease mortality.
Dexamethasone: 12 mg/day or 0.4 mg/kg/day for the first 3 weeks in adults, tapered over 3-5 weeks.

Management of Common TB Adverse Effects

Hepatotoxicity: (INH, RIF, PZA) Monitor ALT levels. Stop treatment if ALT ≥ 5 x ULN (with or without symptoms) or if ALT ≥ 3 x ULN with symptoms. Consider alternative treatment for smear-positive TB.
Rash: Usually managed symptomatically with antihistamines; continue anti-TB medications unless severe or involving mucous membranes.

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Description

Test your understanding of the CURB-65 scoring system for assessing the severity of community-acquired pneumonia (CAP). Through a case study of a 67-year-old woman, evaluate the criteria and determine the appropriate treatment based on the CURB-65 points. This quiz is essential for those in the medical field dealing with pneumonia cases.