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 66-year-old on chronic corticosteroids develops CAP with bilateral ground-glass opacities and a CD4 count of 180. LDH is markedly elevated. What is the most likely diagnosis?
Answer: Pneumocystis jirovecii pneumonia (PCP)
PCP should be suspected in immunocompromised patients (corticosteroids, low CD4) with bilateral ground-glass infiltrates and elevated LDH.
Which finding on urinalysis would suggest Legionella as the etiology of CAP?
Answer: Positive Legionella urinary antigen
The Legionella urinary antigen test is performed on urine and is the rapid diagnostic of choice, detecting serogroup 1 antigen.
A 55-year-old presents with CAP and a PSI score placing him in Risk Class IV. What is the recommended site of care?
Answer: Inpatient hospitalization
PSI Risk Class IV (score 91–130) carries significant mortality risk (8.2%) and warrants inpatient hospitalization.
Which empiric antibiotic is recommended for CAP in a hospitalized non-ICU patient with a penicillin allergy (non-anaphylactic)?
Answer: Respiratory fluoroquinolone (levofloxacin or moxifloxacin)
A respiratory fluoroquinolone alone provides adequate monotherapy for non-ICU hospitalized CAP and avoids beta-lactam use in penicillin-allergic patients.
What is the most common cause of CAP-associated empyema requiring surgical drainage?
Answer: Streptococcus pneumoniae
S. pneumoniae is the leading cause of empyema complicating CAP; empyemas that fail chest tube drainage may require VATS or open decortication.
A 40-year-old bird handler develops CAP with headache, dry cough, and splenomegaly. Which pathogen is most likely?
Answer: Chlamydophila psittaci
Psittacosis (C. psittaci) is a zoonotic atypical pneumonia associated with bird exposure, characterized by headache, dry cough, and splenomegaly.
What is the recommended follow-up chest X-ray interval after hospitalization for CAP in a patient over 50 who smokes?
Answer: 4–6 weeks post-discharge
Follow-up CXR at 4–6 weeks is recommended in older smokers to confirm radiographic resolution and exclude underlying malignancy masquerading as CAP.