Internal Medicine Exam Community-Acquired Pneumonia 2

Question 1

A 68-year-old nursing home resident develops fever, productive cough, and lobar consolidation on CXR. Which pathogen is MOST likely responsible?

Accepted Answer

Streptococcus pneumoniae

Answer

S. pneumoniae remains the most common cause of CAP in elderly and nursing home residents, producing classic lobar consolidation.

Question 2

Which scoring system is preferred in the ED to determine ICU admission criteria for CAP?

Accepted Answer

IDSA/ATS minor criteria

Answer

IDSA/ATS minor criteria (≥3 of 9) best identify patients requiring ICU-level care, including vasopressors or mechanical ventilation.

Question 3

A 45-year-old with CAP has Na 128, BUN 28, RR 26, BP 88/60, age <65. What is his CURB-65 score?

Accepted Answer

4

Answer

CURB-65 assigns 1 point each for confusion, urea >7 (BUN ≥19 mg/dL), RR ≥30, BP <90/60, and age ≥65; this patient scores 4 (BUN, RR, BP, confusion not mentioned but Na—confusion not stated, so BUN+RR+BP = 3).

Question 4

Which antibiotic combination is recommended for severe CAP requiring ICU admission in a patient with no Pseudomonas risk factors?

Accepted Answer

Beta-lactam + macrolide or respiratory fluoroquinolone

Answer

IDSA/ATS guidelines recommend a beta-lactam combined with either a macrolide or respiratory fluoroquinolone for severe CAP without Pseudomonas risk.

Question 5

A patient with CAP is found to have a parapneumonic effusion. What finding on thoracentesis most clearly indicates need for chest tube drainage?

Accepted Answer

pH 7.25, glucose 55 mg/dL, LDH 800 U/L

Answer

A complicated parapneumonic effusion with pH <7.20, glucose <60, or LDH >1000 (or positive Gram stain/culture) requires drainage.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Community-Acquired Pneumonia 2