Urgent Care For Pneumonia 5 — Questions and Answers
Question 1: A 40-year-old with cystic fibrosis presents with an acute pneumonia exacerbation. Which organism is the most common culprit in this population?
- Streptococcus pneumoniae
- Pseudomonas aeruginosa (Correct answer)
- Haemophilus influenzae
- Moraxella catarrhalis
Correct answer: Pseudomonas aeruginosa
Pseudomonas aeruginosa chronically colonizes and infects the airways of most adults with cystic fibrosis, making it the dominant pathogen in exacerbations.
Question 2: Which of the following is a risk factor specifically for healthcare-associated pneumonia (HCAP) rather than community-acquired pneumonia?
- Age > 65 with no recent hospitalizations
- Recent hospitalization within the past 90 days (Correct answer)
- No chronic medical conditions
- Immunization up to date
Correct answer: Recent hospitalization within the past 90 days
Hospitalization within the previous 90 days is a defining risk factor for HCAP, which requires broader antibiotic coverage including resistant organisms.
Question 3: A patient presents with pneumonia and is found to have hyponatremia (Na 127 mEq/L) and elevated LFTs. Which atypical organism classically causes this combination?
- Mycoplasma pneumoniae
- Chlamydophila psittaci
- Legionella pneumophila (Correct answer)
- Coxiella burnetii
Correct answer: Legionella pneumophila
Legionella pneumophila characteristically causes hyponatremia, elevated liver enzymes, and GI symptoms alongside pneumonia.
Question 4: Which of the following patients with pneumonia should receive empirical MRSA coverage in the urgent care or ED setting?
- A healthy 25-year-old with no comorbidities and CAP
- A post-influenza patient with necrotizing cavitary pneumonia (Correct answer)
- A 70-year-old with lobar pneumonia and normal vitals
- A 55-year-old with mild CAP and no recent hospitalizations
Correct answer: A post-influenza patient with necrotizing cavitary pneumonia
Post-influenza necrotizing pneumonia with cavitation strongly suggests CA-MRSA and requires empirical coverage with vancomycin or linezolid.
Question 5: Which of the following is the correct duration of antibiotic therapy for uncomplicated CAP in an outpatient with good clinical response?
- 3 days
- 5 days (Correct answer)
- 14 days
- 21 days
Correct answer: 5 days
Current IDSA guidelines recommend 5 days of antibiotic therapy for uncomplicated CAP in patients who achieve clinical stability.
Question 6: A 65-year-old woman presents with pneumonia. Her nurse asks when she can be safely discharged. Which set of criteria best guides clinical stability for discharge?
- Normal WBC and CRP only
- Temperature ≤ 37.8°C, HR ≤ 100, RR ≤ 24, SpO2 ≥ 90%, tolerating oral intake (Correct answer)
- Resolution of all infiltrates on chest X-ray
- Sputum culture clearance
Correct answer: Temperature ≤ 37.8°C, HR ≤ 100, RR ≤ 24, SpO2 ≥ 90%, tolerating oral intake
Clinical stability criteria include normalization of vital signs, adequate oxygen saturation, and ability to tolerate oral medications and intake.
Question 7: Which of the following statements about pneumonia in pregnant patients is correct?
- Pregnant women have lower risk of severe pneumonia due to immune enhancement
- Influenza and varicella pneumonia carry significantly higher morbidity in pregnancy (Correct answer)
- Fluoroquinolones are the preferred antibiotic for CAP in pregnancy
- Chest X-ray is absolutely contraindicated in pregnancy
Correct answer: Influenza and varicella pneumonia carry significantly higher morbidity in pregnancy
Pregnancy alters immune function and respiratory mechanics, making influenza and varicella pneumonias significantly more severe with higher rates of ICU admission.
Urgent Care For Pneumonia 5
A 40-year-old with cystic fibrosis presents with an acute pneumonia exacerbation.
Which organism is the most common culprit in this population?