The Diagnosis and Management of Community-Acquired Pneumonia in the Adult

Chapter 30 The Diagnosis and Management of Community-Acquired Pneumonia in the Adult




Clinical Case Problem 1: A 24-Year-Old University Student with a Dry, Hacking Cough


A 24-year-old university student presents to the student health service with a 3-day history of a dry, hacking cough that was initially nonproductive but has become productive of scant, white sputum. The patient also complains of malaise, headache, and fever as well as muscle aches and pains. The patient had no other upper respiratory tract symptoms before this illness began (no rhinorrhea, sore throat, or conjunctivitis).


The patient has had no episodes like this in the past; however, her roommate developed the same symptoms 2   days ago.


On examination, the patient has a temperature of 39°C (102.2°F). You hear a few scattered rales in the left lung base but find no other abnormalities.



Select the best answer to the following questions




1. Which of the following is the most cost-effective strategy at the present time?


a. order no laboratory tests or imaging investigations; assume that it is viral and will clear up on its own

b. order no laboratory tests or imaging investigations; treat with ampicillin just to be on the safe side

c. order the complete workup: every possible test; no matter what the patient has, you will not be the one to get sued

d. on the basis of your clinical findings, order a chest radiograph

e. forget the tests; just treat her with “big-gun” therapy

2. What is the most likely diagnosis in this patient?


a. viral pneumonia

b. Mycoplasma pneumoniae pneumonia

c. Streptococcus pneumoniae pneumonia

d. Klebsiella pneumoniae pneumonia

e. no pneumonia of any kind, a case of simple acute bronchitis

3. If you ordered a chest radiograph, what would be the most likely finding?


a. nothing: clear and normal

b. left lower lobe pneumonia

c. patchy bilateral lower lobe infiltrates

d. right middle lobe infiltrates

e. bilateral upper lobe infiltrates

4. What is the treatment of choice for this patient?


a. symptomatic treatment only

b. ribavirin for respiratory syncytial virus

c. clarithromycin

d. ampicillin

e. penicillin G


Clinical Case Problem 2: A Very Sick 55-Year-Old Woman


A 55-year-old woman, previously healthy and recovering from an episode of bronchitis, suddenly develops a “shaking chill,” followed by the onset of a high fever (temperature of 40°C [104°F]), pleuritic chest pain, and cough productive of purulent, rust-colored sputum.


On examination, the patient appears ill. Her respiratory rate is 40 breaths/minute, and bronchial breath sounds are heard in the left lower lobe. Chest radiograph reveals consolidation present in the left lower lobe.



5. On the basis of the history, the physical examination, and the radiographic findings, what is the most likely laboratory finding if sputum is obtained?


a. gram-negative bacilli

b. gram-negative cocci

c. gram-positive bacilli

d. gram-positive cocci (lancet shaped)

e. mixed flora

6. What is the most likely organism responsible for this patient’s illness?


a. S. pneumoniae

b. K. pneumoniae

c. M. pneumoniae

d. influenza A

e. Haemophilus influenzae

7. What is the initial treatment of this patient?


a. ceftriaxone

b. ciprofloxacin

c. gentamicin

d. macrolide

e. a and d


Clinical Case Problem 3: A 35-Year-Old Renal Transplant Patient with Fever, Dyspnea, and 2 Days of Diarrhea


A 35-year-old man with chronic renal failure presented 4   days ago with fever, dyspnea, and 2   days of diarrhea. He had a renal transplant 6   months ago and is being treated with corticosteroids and cyclosporine. The chest radiograph showed an area of consolidation in the right middle lobe and a diffuse interstitial infiltrate. He has failed to respond to ceftriaxone and has a continued fever and cough. Today he is lethargic and confused.



8. What is the most likely organism causing his pneumonia?


a. Pneumocystis carinii

b. Legionella pneumoniae

c. Mycobacterium tuberculosis

d. Mycobacterium avium-intracellulare

e. cytomegalovirus

9. What is (are) the drug(s) of first choice for this patient?


a. macrolide

b. cephalosporin

c. quinolone

d. tetracycline

e. a and c


Clinical Case Problem 4: A 75-Year-Old Alcoholic Patient with Fever, Shortness of Breath, Chest Pain, and Cough Productive of Purulent Sputum and Blood


A 75-year-old alcoholic patient, with a history of congestive heart failure and suffering from fever, shortness of breath, chest pain, and cough productive of purulent sputum and blood, is admitted to the hospital. On physical examination, the patient has a temperature of 39°C (102.2°F), a respiratory rate of 28 breaths/minute, and bronchial breath sounds in the right upper lobe.


A chest radiograph confirms the diagnosis of right upper lobe pneumonia, with a small cavitary lesion.



10. What is the most likely organism responsible for this patient’s illness?


a. S. pneumoniae

b. K. pneumoniae

c. M. pneumoniae

d. influenza A

e. H. influenzae

11. What is the treatment of choice for this patient?


a. erythromycin

b. cefotaxime plus azithromycin

c. penicillin G

d. ampicillin

e. ampicillin plus gentamicin

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  3. Sexual Dysfunction
  4. Illustrated Review

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on The Diagnosis and Management of Community-Acquired Pneumonia in the Adult

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