Internal Medicine Exam Community-Acquired Pneumonia 5

Question 1

A 66-year-old on chronic corticosteroids develops CAP with bilateral ground-glass opacities and a CD4 count of 180. LDH is markedly elevated. What is the most likely diagnosis?

Accepted Answer

Pneumocystis jirovecii pneumonia (PCP)

Answer

PCP should be suspected in immunocompromised patients (corticosteroids, low CD4) with bilateral ground-glass infiltrates and elevated LDH.

Question 2

Which finding on urinalysis would suggest Legionella as the etiology of CAP?

Accepted Answer

Positive Legionella urinary antigen

Answer

The Legionella urinary antigen test is performed on urine and is the rapid diagnostic of choice, detecting serogroup 1 antigen.

Question 3

A 55-year-old presents with CAP and a PSI score placing him in Risk Class IV. What is the recommended site of care?

Accepted Answer

Inpatient hospitalization

Answer

PSI Risk Class IV (score 91–130) carries significant mortality risk (8.2%) and warrants inpatient hospitalization.

Question 4

Which empiric antibiotic is recommended for CAP in a hospitalized non-ICU patient with a penicillin allergy (non-anaphylactic)?

Accepted Answer

Respiratory fluoroquinolone (levofloxacin or moxifloxacin)

Answer

A respiratory fluoroquinolone alone provides adequate monotherapy for non-ICU hospitalized CAP and avoids beta-lactam use in penicillin-allergic patients.

Question 5

What is the most common cause of CAP-associated empyema requiring surgical drainage?

Accepted Answer

Streptococcus pneumoniae

Answer

S. pneumoniae is the leading cause of empyema complicating CAP; empyemas that fail chest tube drainage may require VATS or open decortication.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Community-Acquired Pneumonia 5