Internal Medicine Community-Acquired Pneumonia Questions and Answers

Question 1

A 67-year-old male with a history of COPD and type 2 diabetes presents to an outpatient clinic with a 3-day history of productive cough, fever, and dyspnea.
He has not taken antibiotics in the past year.
According to the 2019 IDSA/ATS guidelines, which of the following is the most appropriate empiric antibiotic regimen for this patient?

Accepted Answer

Amoxicillin-clavulanate plus doxycycline

Answer

Azithromycin monotherapy

Answer

Amoxicillin monotherapy

Answer

Ciprofloxacin

Question 2

Which of the following clinical parameters is a component of the CURB-65 score for assessing the severity of community-acquired pneumonia?

Accepted Answer

A respiratory rate ≥ 30 breaths per minute

Answer

Oxygen saturation <92%

Answer

Multilobar infiltrates on chest x-ray

Answer

Serum sodium < 130 mEq/L

Question 3

A 58-year-old female with no significant past medical history is admitted to a general medical ward for community-acquired pneumonia. She is hemodynamically stable, with an oxygen saturation of 94% on room air. Which of the following antibiotic regimens is the most appropriate initial empiric therapy?

Accepted Answer

Ceftriaxone plus azithromycin

Answer

Vancomycin plus piperacillin-tazobactam

Answer

Levofloxacin monotherapy

Answer

Doxycycline monotherapy

Question 4

A 62-year-old patient is admitted to the ICU with severe community-acquired pneumonia requiring mechanical ventilation. According to the 2019 IDSA/ATS guidelines, which of the following is the strongest indication to add empiric coverage for *Pseudomonas aeruginosa*?

Accepted Answer

Recent hospitalization with receipt of parenteral antibiotics

Answer

Living in a nursing home

Answer

History of alcoholism

Answer

Admission to the ICU

Question 5

A 70-year-old man presents with a 4-day history of high fever, a non-productive cough, watery diarrhea, and confusion. He is a retired plumber who recently worked on his home's hot water tank. Laboratory studies are notable for a serum sodium of 127 mEq/L. Which pathogen is the most likely cause of his pneumonia?

Accepted Answer

Legionella pneumophila

Answer

Streptococcus pneumoniae

Answer

Haemophilus influenzae

Answer

Mycoplasma pneumoniae

Question 6

A 65-year-old patient is hospitalized for community-acquired pneumonia and has been receiving intravenous ceftriaxone and azithromycin for 72 hours. The patient's fever has resolved, heart rate is 85 bpm, blood pressure is 120/75 mmHg, and respiratory rate is 18 breaths/min. The patient is alert and has begun eating meals. Which of the following is the most appropriate next step in management?

Accepted Answer

Switch to an equivalent oral antibiotic regimen.

Answer

Continue IV antibiotics until the chest x-ray shows complete resolution of the infiltrate.

Answer

Obtain a procalcitonin level to guide the duration of therapy.

Answer

Discharge the patient with a prescription for a 3-day course of IV antibiotics from a home infusion service.