Rosh Internal Medicine Boost Practice Exam

In a patient with productive cough and fever, what is the most appropriate course of action based on her physical examination findings?

1. Admission to the ICU and start treatment with levofloxacin

2. Admission to the medical ward and start treatment with ceftriaxone and azithromycin

3. Discharge the patient home with a five-day course of azithromycin

4. Discharge the patient home with a seven-day course of doxycycline

The correct answer is: Admission to the medical ward and start treatment with ceftriaxone and azithromycin

In a scenario where a patient presents with a productive cough and fever, the physical examination findings are crucial in determining the best course of action. The most appropriate approach involves evaluating the severity of the patient's condition and the presumed underlying cause of the symptoms, often suggesting pneumonia or a similar respiratory infection. Starting treatment with ceftriaxone and azithromycin indicates a broader coverage for potential bacterial pneumonia, including resistant strains. Ceftriaxone is a cephalosporin antibiotic effective against a range of pathogens typically responsible for community-acquired pneumonia, while azithromycin covers atypical bacteria such as Mycoplasma pneumoniae and Chlamydia pneumoniae. The combination of these antibiotics is a common and effective empirical treatment in hospitalized patients with moderate to severe pneumonia or those exhibiting significant symptoms like fever and productive cough. This choice reflects an understanding of the need for immediate and appropriate treatment in the context of potentially serious respiratory infections. Furthermore, admitting the patient to the medical ward allows for monitoring and assessment, which is essential in cases where pneumonia may escalate if left untreated. The other options may involve inappropriate courses of action. Discharging the patient with a shorter course of treatment or incomplete coverage may put the patient at risk for complications or further deterioration, especially in the