Board Questions

1. Which is the most sensitive index of disease severity in patients with pneumonia?

a) Hypoxemia
b) Hypercarbia
c) Tachypnea
d) Retractions

2. Of the following regarding empyema management, which is NOT true? 

a) VATS performed within 48 hours of empyema diagnosis is associated with reduced hospital stay
b) VATS is superior to tPA administration in the first 48 hours after diagnosis in terms of overall clinical outcomes
c) VATS is more expensive than tPA administration
d) Either VATS or tPA can be used to treat a loculated pleural effusion

3. Which of the following is NOT a common causative organism for ventilator associated infection?

a) MRSA
b) Pseudomonas
c) Enterobacter
d) Mycoplasma



ANSWERS & EXPLANATIONS

1. C. Tachypnea is the most sensitive index of disease severity in pneumonia

2. B. Two randomized controlled trials have shown equivalent outcomes between early VATs vs. fibrionlysis (Sonnappa S, AJRCC 2006, St Peter SD et al, J Ped Surg 2009)

3. D. Pseudomonas and MRSA are the two most common organisms for ventilator associated infections (VAI). Hence, in mechanically ventilated patients at risk for VAI, empiric antibiotic coverage should generally cover these organisms (i.e vancomycin and pipercillin-tazobactam) until culture results are available. Other gram negative organisms such as Acinetobacter and Enterobacter are also common. Mycoplasma is not a common VAI organism.


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