Urgent Care For Pneumonia 3 — Questions and Answers
Question 1: A 60-year-old diabetic returns from a Caribbean cruise with fever, diarrhea, and a chest X-ray showing a patchy right lower lobe infiltrate. Which organism should be highest on the differential?
- Streptococcus pneumoniae
- Legionella pneumophila (Correct answer)
- Haemophilus influenzae
- Moraxella catarrhalis
Correct answer: Legionella pneumophila
Legionella pneumophila is associated with water-cooling systems on cruise ships and presents with GI symptoms alongside pneumonia.
Question 2: Which diagnostic test has the highest sensitivity for diagnosing Legionella pneumonia in the urgent care or ED setting?
- Sputum Gram stain
- Urinary antigen test (Correct answer)
- Blood culture
- Cold agglutinins
Correct answer: Urinary antigen test
The Legionella urinary antigen test is rapid, highly sensitive for serogroup 1 (the most common), and the preferred initial test.
Question 3: In a pediatric patient with 'walking pneumonia,' which organism is most commonly responsible?
- Staphylococcus aureus
- Mycoplasma pneumoniae (Correct answer)
- Klebsiella pneumoniae
- Group A Streptococcus
Correct answer: Mycoplasma pneumoniae
Mycoplasma pneumoniae is the classic cause of atypical or 'walking' pneumonia, particularly in school-age children and young adults.
Question 4: Which of the following is the most appropriate empiric antibiotic regimen for a hospitalized non-ICU patient with CAP?
- Vancomycin + piperacillin-tazobactam
- Beta-lactam + macrolide, or respiratory fluoroquinolone alone (Correct answer)
- Trimethoprim-sulfamethoxazole alone
- Doxycycline + metronidazole
Correct answer: Beta-lactam + macrolide, or respiratory fluoroquinolone alone
IDSA/ATS guidelines recommend a beta-lactam plus macrolide combination or a respiratory fluoroquinolone alone for non-ICU hospitalized CAP.
Question 5: Which CURB-65 score indicates the patient should be considered for hospitalization?
- Score of 0
- Score of 1
- Score of 2 or more (Correct answer)
- Score of 5 only
Correct answer: Score of 2 or more
A CURB-65 score of 2 or higher indicates increased mortality risk and should prompt consideration for hospitalization.
Question 6: A patient with pneumonia develops sudden worsening dyspnea, tracheal deviation to the left, and absent breath sounds on the right. What is the most likely diagnosis?
- Pulmonary embolism
- Tension pneumothorax (Correct answer)
- Massive pleural effusion
- Right main-stem intubation
Correct answer: Tension pneumothorax
Tracheal deviation away from the affected side with absent breath sounds and hemodynamic instability indicates tension pneumothorax.
Question 7: Which of the following best describes aspiration pneumonia compared to aspiration pneumonitis?
- Aspiration pneumonia is a chemical injury; pneumonitis is bacterial infection
- Aspiration pneumonia involves bacterial infection; pneumonitis is a chemical injury from gastric acid (Correct answer)
- Both require immediate antibiotic treatment
- Pneumonitis has a higher mortality rate than pneumonia
Correct answer: Aspiration pneumonia involves bacterial infection; pneumonitis is a chemical injury from gastric acid
Aspiration pneumonia is an infectious process caused by bacteria, while aspiration pneumonitis is a sterile chemical injury from gastric acid requiring supportive care.
Urgent Care For Pneumonia 3
A 60-year-old diabetic returns from a Caribbean cruise with fever, diarrhea, and a chest X-ray showing a patchy right lower lobe infiltrate.
Which organism should be highest on the differential?