CURB-65 Score for CAP Severity Quiz

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary causative agent of tuberculosis?

Escherichia coli

Mycobacterium tuberculosis (correct)

Streptococcus pneumoniae

Legionella pneumophila

Which type of tuberculosis occurs only in the lungs?

Extra-pulmonary TB

Open TB

Pulmonary TB (correct)

Disseminated TB

What defines Multi-drug resistance TB (MDR-TB)?

Resistance to at least Isoniazid and Rifampin (correct)

Resistance to only Rifampin

Resistance to all first-line drugs

Resistance to all antibiotics

Which of the following best describes the feature of miliary TB?

It affects multiple organs through the bloodstream Signup and view all the answers

Which treatment option is recommended for MRSA infections?

Vancomycin Signup and view all the answers

What is the CURB-65 score classification for a patient that presents with confusion, uremia (BUN = 25 mg/dL), respiratory rate of 30 breaths per minute, blood pressure of 145/85 mm Hg, and is over 65 years old?

2 = inpatient treatment Signup and view all the answers

For the 84-year-old patient with a temperature of 101.4°F, WBC count of 13.2, and confusion, what is the correct CURB-65 score based on the presented data?

2 Signup and view all the answers

What is the initial empiric treatment recommended for outpatient community-acquired pneumonia (CAP) in areas with low pneumococcal resistance?

Azithromycin 500 mg on the first day followed by 250 mg daily Signup and view all the answers

According to the IDSA–ATS guidelines, how is severe community-acquired pneumonia (CAP) defined?

Presence of one major or three or more minor criteria Signup and view all the answers

What is the minimum duration of therapy for community-acquired pneumonia (CAP), excluding specific exceptions?

5 days Signup and view all the answers

What is the primary mechanism of action for Isoniazid in the treatment of TB?

Inhibits the synthesis of mycolic acids Signup and view all the answers

Which of the following is NOT a method used for the diagnosis of active TB?

Blood tests for antibodies Signup and view all the answers

What is a common adverse effect associated with Isoniazid treatment?

Peripheral neuropathy Signup and view all the answers

How long does culture testing for TB typically take?

2-4 weeks or 8 weeks Signup and view all the answers

Which statement is true regarding Rifampicin?

It is a potent CYP3A4 inducer. Signup and view all the answers

What is the recommended treatment duration for latent TB in patients co-infected with HIV using Isoniazid?

9 months Signup and view all the answers

Which treatment regimen is preferred for children and pregnant women with latent TB?

Isoniazid 300 mg/day for 9 months Signup and view all the answers

What is a common treatment duration for extrapulmonary TB with bone or joint involvement?

6–9 months Signup and view all the answers

Which medication is NOT included in the conventional regimens for treating extrapulmonary TB?

Ciprofloxacin Signup and view all the answers

What additional supplement should breastfeeding women taking Isoniazid be prescribed?

Pyridoxine Signup and view all the answers

Which of the following is a primary treatment option for latent TB in non-HIV infected patients?

Isoniazid 300 mg/day for 6–9 months Signup and view all the answers

Which treatment for pregnant women with active TB involves isoniazid, rifampin, and ethambutol?

2-month intensive regimen Signup and view all the answers

For patients with extrapulmonary TB with CNS infection, what is the recommended treatment duration?

9–12 months Signup and view all the answers

What is the recommended dosage regimen for corticosteroids in TB meningitis for adults?

12 mg/day or 0.4 mg/kg/day for the first 3 weeks Signup and view all the answers

Which of the following drugs are not recommended during pregnancy?

Cycloserine Signup and view all the answers

What indicates severe hepatotoxicity in a patient undergoing TB treatment?

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

What should be done if ALT levels are ≥ 5 X ULN in a patient with suspected hepatotoxicity?

Stop anti-TB drugs immediately Signup and view all the answers

What is the appropriate management for a rash caused by antituberculosis drugs that is primarily itchy without systemic signs?

Use antihistamines and continue medications Signup and view all the answers

In TB meningitis, what is the purpose of adjunctive corticosteroids?

To reduce inflammation and decrease mortality Signup and view all the answers

What monitoring is required when using corticosteroids in TB treatment?

Observing for improvement and tapering dosage Signup and view all the answers

Which of the following best describes the management when a patient has smear positive TB and hepatotoxicity is suspected?

Consider a non-hepatotoxic anti-TB treatment if discontinuation is unsafe 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/min
Blood pressure: Systolic < 90 mmHg or diastolic < 60 mmHg
Age: ≥ 65 years
Scoring: 0-1 points: outpatient treatment; 2 points: inpatient treatment; ≥3 points: ICU admission

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

67-year-old woman with mild Alzheimer's disease
Two-day history of productive cough, fever, and increased confusion
Vital signs: T 38.4°C, BP 145/85 mmHg, RR 30, HR 120, O2 saturation 91% (room air)
Lung findings: Crackles in both lower lung fields
Mental status: Oriented to person only
Lab values: WBC 4000, Na 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 woman with new-onset confusion
Vital signs: T 101.4°F, WBC 13.2, Hct 34%, Na 137, K 3.9, BUN 17, Cr 1, CO2 20, Glu 91, BP 108/76 mmHg, HR 78, RR 24, O2 saturation 92% on room air
CURB-65 Score: 3 (Confusion, Respiratory rate, Age) - Inpatient-ICU admission

Empiric Treatment of CAP

Outpatient: Macrolide (azithromycin or clarithromycin - clarithromycin only in areas with high pneumococcal macrolide resistance)
Hospitalized, Non-ICU: (Specific regimen not detailed)
Hospitalized, ICU: (Specific regimen not detailed)

Duration of CAP Treatment

Minimum 5 days
Exceptions: Pseudomonas aeruginosa (7 days), MRSA (7 days)

Treatment Options for Various Pathogens in CAP

Typical Pneumonia: Amoxicillin, fluoroquinolones, doxycycline, macrolides (azithromycin, clarithromycin) depending on β-Lactamase production
Legionella spp.: Fluoroquinolones, macrolides, doxycycline
MRSA: Vancomycin, linezolid, TMP-SMX, clindamycin
MSSA: Antistaphylococcal penicillin, cefazolin, clindamycin

Tuberculosis (TB) Overview

Caused by Mycobacterium tuberculosis, a rod-shaped, aerobic bacterium
Primarily affects the lungs but can disseminate to other organs
Two phases: latent and active
Can be fatal if untreated

TB Definitions

Pulmonary TB: TB in the lungs; Open TB: Pulmonary TB with cough and sputum production
Extrapulmonary TB: TB affecting organs other than the lungs
Disseminated TB: TB spread from lungs to multiple organs
Miliary TB: Acute TB with small nodules in multiple organs
Multi-drug-resistant TB (MDR-TB): Resistance to isoniazid and rifampin

TB Diagnosis

Active TB: Three consecutive early morning sputum samples for acid-fast bacilli smear and culture; chest X-ray; nucleic acid amplification tests.

TB Treatment Pharmacology

Isoniazid (INH): Inhibits mycolic acid synthesis; adverse effects: peripheral neuropathy, hepatotoxicity. Pyridoxine (vitamin B6) may be given to prevent neuropathy.
Rifampin (RIF): Inhibits bacterial RNA synthesis; adverse effects: reddish-orange discoloration of body fluids. Potent CYP3A4 inducer.

Latent TB Treatment

HIV-positive: Isoniazid 300 mg/day or 900 mg twice weekly for 9 months; alternative regimens available.
HIV-negative: Isoniazid 300 mg/day or 900 mg twice weekly for 6-9 months; Rifampin 600 mg/day for 4 months; Rifapentine 900 mg + isoniazid 900 mg/week for 12 weeks.

Directly Observed Therapy (DOT)

(Information not detailed)

Management of Treatment Interruptions

(Information not detailed)

Extrapulmonary TB Treatment

Conventional regimens using first-line medications (isoniazid, rifampin, pyrazinamide, ethambutol)
Duration varies depending on the affected organ (6-12 months)

TB Treatment During Pregnancy

Latent TB: 4-month rifampin regimen (4R), 3-month isoniazid/rifampin regimen (3HR), or 6-9 month isoniazid regimen (6H, 9H).
Active TB: Isoniazid, rifampin, ethambutol for 2 months, then isoniazid and rifampin for 7 months (longer regimens possible).
Pyridoxine (vitamin B6) recommended with isoniazid.
Second-line drugs generally avoided.

Corticosteroids in TB Meningitis

Dexamethasone or prednisolone recommended to reduce mortality
Dosage: Dexamethasone 12 mg/day or 0.4 mg/kg/day for 3 weeks, then tapered

Management of Common Adverse Effects

Hepatotoxicity: Stop anti-TB drugs if ALT levels ≥ 5 x ULN or ≥ 3 x ULN with symptoms; consider non-hepatotoxic alternatives.
Rash: If itchy without systemic manifestations, continue treatment with antihistamines.

Hepatotoxicity Re-challenge

(Information not detailed)

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on the CURB-65 scoring system for assessing the severity of community-acquired pneumonia (CAP). This quiz will evaluate your understanding of the criteria used to determine treatment options and the implications of clinical case studies. Answers are based on recognizing the signs and interpreting the scores appropriately.