Examen Integrado - Medicina Practice Questions - Argentina Medical Residencies Integrated Examination (Examen Integrado De Residencias De La Salud - Medicina) Exam

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A 68-year-old male is brought to the emergency department in Rosario with a 3-day history of high fever, chills, pleuritic right-sided chest pain, and rust-colored sputum. On examination, he is disoriented to time and place. Vital signs: BP 94/58 mmHg, HR 108 bpm, RR 32 breaths/min, temperature 38.9 C, and SpO2 90% on room air. Chest examination reveals right lower lobe bronchial breath sounds and dullness to percussion. Serum urea is 56 mg/dL (BUN 26 mg/dL). Chest radiograph confirms right lower lobe consolidation. Based on the CURB-65 score and Argentine consensus guidelines for Community-Acquired Pneumonia (CAP), what is the appropriate management setting and initial empiric antibiotic regimen?

Hospital admission with intensive-care assessment given the high severity score; intravenous Ampicillin/Sulbactam plus Clarithromycin (or Ceftriaxone plus Azithromycin) Outpatient management; oral Amoxicillin 500 mg every 8 hours for 5 days Outpatient management; oral Ciprofloxacin 500 mg every 12 hours for 7 days Immediate endotracheal intubation, ICU admission, and monotherapy with intravenous Vancomycin

Correct Answer:

Hospital admission with intensive-care assessment given the high severity score; intravenous Ampicillin/Sulbactam plus Clarithromycin (or Ceftriaxone plus Azithromycin)

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