Internal Medicine Exam Community-Acquired Pneumonia 4

Question 1

A 72-year-old with COPD develops CAP. Which outpatient antibiotic regimen is recommended by IDSA guidelines?

Accepted Answer

Respiratory fluoroquinolone OR beta-lactam + macrolide

Answer

Patients with comorbidities (COPD, DM, heart failure, etc.) should receive a respiratory fluoroquinolone or beta-lactam/macrolide combination to cover resistant organisms.

Question 2

Which criterion defines 'severe CAP' requiring ICU admission per IDSA/ATS major criteria?

Accepted Answer

Need for mechanical ventilation OR septic shock requiring vasopressors

Answer

IDSA/ATS major criteria for severe CAP are: need for invasive mechanical ventilation OR septic shock requiring vasopressors.

Question 3

Procalcitonin (PCT) is most useful in CAP management for which purpose?

Accepted Answer

Guiding antibiotic duration and de-escalation

Answer

Serial PCT measurements guide antibiotic duration — declining PCT levels support stopping antibiotics, reducing unnecessary therapy.

Question 4

A healthy 30-year-old college student develops low-grade fever, dry cough, and diffuse bilateral interstitial infiltrates over 2 weeks. Which pathogen is most likely?

Accepted Answer

Mycoplasma pneumoniae

Answer

M. pneumoniae causes 'walking pneumonia' in young adults — insidious onset, dry cough, mild symptoms, and interstitial infiltrates out of proportion to clinical severity.

Question 5

Which vaccine has the greatest impact on reducing CAP incidence in adults over 65?

Accepted Answer

PCV15 or PCV20 (pneumococcal conjugate vaccine)

Answer

Higher-valency pneumococcal conjugate vaccines (PCV15, PCV20) are now preferred over PPSV23 alone for adults ≥65, providing superior immunogenicity and protection.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Community-Acquired Pneumonia 4