Urgent Care For Pneumonia 2 — Questions and Answers
Question 1: A 70-year-old nursing home resident presents with confusion, low-grade fever, and productive cough. Which organism is the most likely cause of his pneumonia?
- Streptococcus pneumoniae (Correct answer)
- Pseudomonas aeruginosa
- Mycoplasma pneumoniae
- Legionella pneumophila
Correct answer: Streptococcus pneumoniae
Streptococcus pneumoniae remains the most common cause of community-acquired pneumonia even in nursing home residents.
Question 2: Which of the following chest X-ray findings is most consistent with Pneumocystis jirovecii pneumonia (PCP)?
- Lobar consolidation
- Bilateral interstitial or perihilar infiltrates (Correct answer)
- Pleural effusion with empyema
- Unilateral cavitary lesion
Correct answer: Bilateral interstitial or perihilar infiltrates
PCP typically presents with bilateral interstitial or ground-glass perihilar infiltrates on chest X-ray in immunocompromised patients.
Question 3: A 45-year-old with HIV and a CD4 count of 80 presents with dyspnea and dry cough. His SpO2 is 88% on room air. Which finding would MOST support PCP pneumonia over bacterial pneumonia?
- High fever with rigors
- Productive purulent sputum
- Hypoxia disproportionate to the chest X-ray findings (Correct answer)
- Pleuritic chest pain
Correct answer: Hypoxia disproportionate to the chest X-ray findings
PCP classically causes hypoxia that appears worse than expected from relatively subtle chest X-ray abnormalities.
Question 4: Which of the following criteria is part of the PSI/PORT score used to risk-stratify pneumonia patients?
- Vaccination history
- Blood urea nitrogen level (Correct answer)
- Stool culture results
- Number of pack-years smoked
Correct answer: Blood urea nitrogen level
Blood urea nitrogen (BUN) is one of the laboratory values included in the PSI/PORT scoring system to determine pneumonia severity.
Question 5: A patient with pneumonia has a pH of 7.30, PaO2 of 55 mmHg, and bilateral infiltrates. Which additional criterion would indicate ARDS complicating pneumonia?
- SpO2 > 95% on 2L nasal cannula
- PaO2/FiO2 ratio < 200 (Correct answer)
- Unilateral pleural effusion
- Heart rate < 60 bpm
Correct answer: PaO2/FiO2 ratio < 200
ARDS is defined by a PaO2/FiO2 ratio < 200 (severe) along with bilateral infiltrates and non-cardiac pulmonary edema.
Question 6: Which antibiotic regimen is recommended for outpatient treatment of CAP in a healthy adult with no recent antibiotic use?
- Vancomycin IV
- Amoxicillin or doxycycline (Correct answer)
- Meropenem IV
- Clindamycin plus rifampin
Correct answer: Amoxicillin or doxycycline
IDSA/ATS guidelines recommend amoxicillin or doxycycline as first-line outpatient therapy for CAP in otherwise healthy adults.
Question 7: A chest X-ray shows a right lower lobe opacity with blunting of the costophrenic angle. What complication should be suspected?
- Pneumothorax
- Parapneumonic pleural effusion (Correct answer)
- Pulmonary embolism
- Lobar atelectasis
Correct answer: Parapneumonic pleural effusion
Blunting of the costophrenic angle indicates fluid accumulation, which in the setting of pneumonia is a parapneumonic effusion.
Urgent Care For Pneumonia 2
A 70-year-old nursing home resident presents with confusion, low-grade fever, and productive cough.
Which organism is the most likely cause of his pneumonia?