Question 1

A patient was initially treated as an outpatient for pneumonia and then after 2 weeks was hospitalized after no improvement was evident. The patient continues to show no improvement after several antibiotic regimens have been attempted. What is the next step in managing this patient?

A) Administration of the pneumonia vaccine
B) Increasing the dose of the antibiotics
C) Open lung biopsy
D) Performing diagnostic bronchoscopy

D

Accepted Answer

Performing diagnostic bronchoscopy is the next step in managing a patient who shows no improvement after several antibiotic regimens for pneumonia. This procedure allows for direct visualization of the airways, collection of samples for culture or biopsy, and can help identify the cause of the persistent pneumonia, which is crucial for guiding further treatment.

Question 2

A young, previously healthy adult clinic patient reports symptoms of pneumonia including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is unable to expectorate sputum. Which treatment is recommended for this patient?

A) A B-lactam antibiotic plus a fluoroquinolone
B) A respiratory fluoroquinolone antibiotic
C) Empirical treatment with a macrolide antibiotic
D) Hospitalization for intravenous antibiotics

C

Accepted Answer

The combination of high fever, cough, and rales on physical exam suggest a bacterial pneumonia, likely of atypical or viral etiology. The normal chest radiograph also supports an atypical or viral process. As the patient is unable to expectorate sputum, obtaining a specimen for culture and sensitivity is not possible. Empirical treatment with a macrolide antibiotic such as azithromycin or clarithromycin provides coverage for common atypical pathogens such as Legionella, Mycoplasma, and Chlamydophila. Hospitalization is not necessary at this time, as the patient is young and previously healthy with stable vital signs.

Question 3

A patient presents with a cough and fever. The provider auscultates rales in both lungs that do not clear with cough. The patient reports having a headache and sore throat prior to the onset of coughing. A chest radiograph shows patchy, nonhomogeneous infiltrates. Based on these findings, which organism is the most likely cause of this patient's pneumonia?

A) A virus
B) Mycoplasma
C) S. pneumoniae
D) Tuberculosis

B

Accepted Answer

Mycoplasma pneumonia often presents with symptoms like headache and sore throat followed by cough, and is characterized by patchy, nonhomogeneous infiltrates on chest radiograph, distinguishing it from the other options listed.

Deck 93: Pneumonia