Chapter 93: Pneumonia
Buttaro: Primary Care: A Collaborative Practice, 6th Edition
MULTIPLE CHOICE
1. 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
ANS: B
Atypical pneumonias, such as those caused by mycoplasma, often present with headache and
sore throat and will have larger areas of infiltrate on chest radiograph. Viral pneumonias show
more diffuse radiographic findings. S. pneumonia will have high fever and cough and distinct
areas of infiltration.
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
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c. Empirical treatment with a macrolide antibiotic
d. Hospitalization for intravenous antibiotics
ANS: C
This patient likely has community-acquired pneumonia. The patient has typical symptoms
and, even though the chest radiograph is normal, will require outpatient treatment. For
community-acquired pneumonia in a previously healthy individual, treatment with a
macrolide antibiotic is the recommended first-line therapy. B-lactam plus fluoroquinolone
therapy is used for patients in the ICU. Respiratory fluoroquinolones are used for patients with
underlying disorders who develop pneumonia. Hospitalization is not necessary.
3. 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
ANS: D
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