MKPSAP--comments - docfinish2008

[ArchivalUser]

How useful is MKSAP -14th/ed for ck prep?

[ArchivalUser]

it is more than u should know for step 2, i have a book and just read in it in my extra time but i think it is over for that level, but for sure if u do it , exam will be just like playing but take time factor in consideration.

[ArchivalUser]

i m using it and enjoying. iliked it more than UW and kaplan Qbank. note i m not reading text but only doing the self assemsent. text i like from mayo clinic and putting notes in kaplan notes. the software for MKSAP 14 is great.
and in addition to giving the explaination to answer choices it gives u some HY hints too.
31-year-old man is evaluated in the emergency department in September for progressive dyspnea, fever, chills, and a persistent nonproductive cough. Two days earlier, he had been evaluated in the emergency department for fever, chills, right-sided pleuritic chest pain, and a nonproductive cough; chest radiograph at that time was clear. He was prescribed amoxicillin and was discharged. The patient smokes cigarettes, weighs 100 kg (220 lb); his ideal body weight is 70 kg (154 lb).

On physical examination, the patient is in moderate respiratory distress, breathing at a rate of 37/min and using accessory muscles. His blood pressure is 140/70 mm Hg, and heart rate is 123/min. He has moist crackles bilaterally on lung examination. Arterial blood gases with the patient using a 100% nonrebreather mask revealed a PO2 of 62 mm Hg, PCO2 of 28 mm Hg, and a pH of 7.48. Chest radiograph shows a lobar infiltrate at the right base. Sputum and blood cultures are obtained.

Which of the following is the most appropriate initial management for this patient?

[1% of pretesters selected this option [INCORRECT]] [1% of pretesters selected this option [INCORRECT]] A Withholding antibiotics awaiting culture results
[3% of pretesters selected this option [INCORRECT]] [3% of pretesters selected this option [INCORRECT]] B Ceftriaxone
[85% of pretesters selected this option [CORRECT]] [85% of pretesters selected this option [CORRECT]] C Azithromycin and ceftriaxone
[11% of pretesters selected this option [INCORRECT]] [11% of pretesters selected this option [INCORRECT]] D Vancomycin, piperacillin/tazobactam, and ciprofloxacin

[ArchivalUser]

Late summer and early fall are the times when Legionella pneumonia is most likely to occur. Urine should be analyzed for Legionella antigen in this patient, and adequate antibiotic coverage for Legionella pneumophila begun. Although the infiltrate is localized, this makes Legionella pneumonia no more or less likely than pneumococcal pneumonia, although Legionella pneumonias are more likely to spread bilaterally after presentation. Amoxicillin alone is not sufficient therapy for L pneumophila. Azithromycin plus ceftriaxone begun as soon as possible (within 8 hours of presentation and ideally sooner) is considered adequate initial coverage for a severe community-acquired pneumonia, the azithromycin providing Legionella coverage. Waiting for the results of cultures would be inappropriate; the patient most likely has a bacterial process not covered by amoxicillin, not a nonbacterial one. Vancomycin, piperacillin/tazobactam, and ciprofloxacin would be appropriate if the patient had a healthcare“acquired pneumonia (HCAP).

[ArchivalUser]

Key Points

* Urinary Legionella pneumophila antigen test should be done in patients with suspected Legionella pneumonia.
* Early therapy with azithromycin plus ceftriaxone is considered adequate initial coverage for a severe community-acquired pneumonia.

its an example of one MCQ and i hope that it will help u in decesion.