Community-Acquired Pneumonia Flashcards
7 cards from real Internal Medicine Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Community-Acquired Pneumonia flashcards as text
A 68-year-old nursing home resident develops fever, productive cough, and lobar consolidation on CXR. Which pathogen is MOST likely responsible?
Answer: Streptococcus pneumoniae
S. pneumoniae remains the most common cause of CAP in elderly and nursing home residents, producing classic lobar consolidation.
Which scoring system is preferred in the ED to determine ICU admission criteria for CAP?
Answer: IDSA/ATS minor criteria
IDSA/ATS minor criteria (≥3 of 9) best identify patients requiring ICU-level care, including vasopressors or mechanical ventilation.
A 45-year-old with CAP has Na 128, BUN 28, RR 26, BP 88/60, age <65. What is his CURB-65 score?
Answer: 4
CURB-65 assigns 1 point each for confusion, urea >7 (BUN ≥19 mg/dL), RR ≥30, BP <90/60, and age ≥65; this patient scores 4 (BUN, RR, BP, confusion not mentioned but Na—confusion not stated, so BUN+RR+BP = 3).
Which antibiotic combination is recommended for severe CAP requiring ICU admission in a patient with no Pseudomonas risk factors?
Answer: Beta-lactam + macrolide or respiratory fluoroquinolone
IDSA/ATS guidelines recommend a beta-lactam combined with either a macrolide or respiratory fluoroquinolone for severe CAP without Pseudomonas risk.
A patient with CAP is found to have a parapneumonic effusion. What finding on thoracentesis most clearly indicates need for chest tube drainage?
Answer: pH 7.25, glucose 55 mg/dL, LDH 800 U/L
A complicated parapneumonic effusion with pH 1000 (or positive Gram stain/culture) requires drainage.
Which organism should be specifically covered when CAP is associated with recent influenza infection?
Answer: Staphylococcus aureus (including MRSA)
Post-influenza bacterial pneumonia most commonly involves S. aureus (including community-acquired MRSA), which requires targeted coverage.
A 60-year-old with CAP is started on levofloxacin. On day 3, he remains febrile with worsening infiltrates. What is the most appropriate next step?
Answer: Perform CT chest and bronchoscopy with BAL
Failure to improve by 72 hours warrants diagnostic workup including CT chest and bronchoscopy to identify resistant pathogens, alternative diagnoses, or complications.