APEA Pulmonology-Questions with Correct Answers/ Verified
• Amoxicillin 1 gram three times daily (strong recommendation, moderate quality of evidence), OR
• Doxycycline 100 mg twice daily (conditional recommendation, low quality of evidence), OR
• Macrolide (azithromycin 500 mg on first day, then 250 mg daily or clarithromycin 500 mg twice
daily or clarithromycin ER 1,000 mg daily) only in areas with macrolide resistance <25% (conditional
recommendation, moderate quality of evidence). - ✔✔Community acquired pneumonia For healthy
adult outpatients without comorbidities?
• "No particular order of preference"
Monotherapy:
▪ Respiratory fluoroquinolone (levofloxacin 750 mg daily, moxifloxacin 400 mg daily, or gemifloxacin
320 mg daily) ▪ Strong recommendation, moderate quality of evidence
Combination therapy:
▪ Amoxicillin/clavulanate or a cephalosporin (cefpodoxime 200 mg twice daily or cefuroxime 500 mg
twice daily); PLUS ▪ Macrolide or doxycycline
-Strong recommendation, moderate quality of evidence for combination with macrolide
-Conditional recommendation, low quality of evidence for combination therapy with doxycycline -
✔✔Treatment of CAP for outpatient adults WHO HAVE comorbidities: (chronic heart, lung, liver, or
renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia)
• 5-10 days .... usually • Consider age, comorbidities
• Not necessary if responding appropriately and symptom resolution in 5-7 days - ✔✔How long for
an antibiotic?
Follow-Up Chest X-ray?
Adults ≥65 generally healthy: PPSV23 (recommended) OR "shared decision making:" PCV13 plus
PPSV23
, • Adults ≥65 with immunocompromising condition: PCV13, PPSV23
• Adults 19-64 years at increased risk of pneumococcal disease (asthma, COPD, smokers, CV
diagnosis [not HTN], DM, liver disease, etc.): PPSV23 only
• Adults 19-64 with asplenia, immunocompromising conditions, cerebrospinal fluid (CSF) leaks,
cochlear implants: PCV13 now, then PPSV23 in 8 weeks, then PPSV23 in 5 years - ✔✔Pneumococcal
Vaccines?
-COPD Midlife onset, symptoms slowly progressive, exposure to lung irritant
-Asthma Onset early in life, symptoms vary widely from day to day, symptoms worse at
nighttime/early AM, allergic rhinitis, eczema, family history, obesity
-Heart failure Chest X-ray with dilated heart, pulmonary edema
-Tuberculosis Onset all ages, chest X-ray with lung infiltrate, microbiologic confirmation
-Bronchiectasis Large volumes of purulent sputum, chest X-ray: bronchial wall thickening, bronchial
dilation - ✔✔differential dx for COPD?
Ipratropium (Atrovent) (short-acting antimuscarinic: SAMA) 6 hours Suffix is "-tropium" Many
potential side effects, interactions
Tiotropium (Spiriva) (long-acting antimuscarinic: LAMA) 24 hours Once daily; suffix is "-tropium"
Many potential side effects, interactions - ✔✔Inhaled Anticholinergics (Inhaled Antimuscarinics):
prevent bronchoconstriction (by blocking action of acetylcholine at muscarinic receptors)? they
prevent bronchoconstriction?
what are the brand names?
Aclidinium (Tudorza Pressair)
