acute lung conditions LOs

What is the classic presentation of community-acquired pneumonia (CAP)?

Fever, productive cough, dyspnea, pleuritic chest pain, and focal lung findings.

What is the most likely diagnosis in a patient with 3 days of fever, yellow sputum, pleuritic chest pain, and focal crackles?

Community-acquired pneumonia (CAP).

What physical examination findings suggest pulmonary consolidation from pneumonia?

Focal crackles, decreased breath sounds, dullness to percussion, increased tactile fremitus, and positive egophony.

What does increased tactile fremitus suggest in a patient with pneumonia?

Pulmonary consolidation.

What does positive egophony suggest?

Pulmonary consolidation.

What does dullness to percussion suggest in a patient with suspected pneumonia?

Consolidation or pleural fluid.

What is the classic presentation of aspiration pneumonia?

Fever, cough, dyspnea, and pulmonary infiltrates following aspiration in a patient with swallowing dysfunction.

What risk factors increase the likelihood of aspiration pneumonia?

Stroke, dysphagia, impaired swallowing, choking episodes, altered consciousness, and impaired airway protection.

What is the most likely diagnosis in an elderly patient with prior CVA, dysphagia, choking during meals, fever, and cough?

Aspiration pneumonia.

What is the distinguishing feature of aspiration pneumonia compared with typical CAP?

History of aspiration or dysphagia with dependent lung infiltrates.

What chest X-ray findings support bacterial CAP?

Focal pulmonary infiltrate or consolidation.

What chest X-ray findings support aspiration pneumonia?

Infiltrates in dependent lung regions, commonly the right lower lobe.

How does atypical pneumonia typically differ from bacterial CAP?

Often less focal lung findings and variable interstitial infiltrates.

What findings suggest viral pneumonia?

Fever, cough, myalgias, and possible positive viral testing.

What distinguishes acute bronchitis from pneumonia?

Acute bronchitis typically follows a URI and lacks focal pulmonary consolidation.

What findings suggest heart failure rather than pneumonia?

Orthopnea, peripheral edema, JVD, bilateral crackles, and pulmonary vascular congestion.

What findings suggest pulmonary embolism rather than pneumonia?

Sudden dyspnea, pleuritic chest pain, tachycardia, hypoxemia, and VTE risk factors.

What findings suggest asthma or COPD exacerbation rather than pneumonia?

Wheezing, airflow obstruction, cough, and dyspnea.

What findings suggest pneumothorax rather than pneumonia?

Sudden unilateral pleuritic chest pain, decreased unilateral breath sounds, and pleural air on CXR.

What distinguishes aspiration pneumonitis from aspiration pneumonia?

Aspiration pneumonitis is chemical lung injury; aspiration pneumonia is an infectious process.

What history framework should be used when evaluating acute respiratory symptoms?

OLD CARTS or PQRST.

What additional history is important in suspected pneumonia?

Recent illness, sick contacts, travel, exposures, vaccinations, medications, comorbidities, smoking, and prior hospitalizations.

What additional history is especially important when aspiration pneumonia is suspected?

Stroke history, dysphagia, choking during meals, difficulty swallowing liquids, and previous swallow evaluations.

What is the first-line imaging study for suspected pneumonia?

Chest X-ray (CXR).

What laboratory studies may be obtained when evaluating pneumonia?

CBC with differential, BMP/CMP, CRP, ESR, and lactate when clinically indicated.

What microbiologic tests may be obtained when evaluating pneumonia?

Sputum culture, blood cultures, influenza testing, and SARS-CoV-2 testing when indicated.

What does leukocytosis with neutrophilia suggest in suspected pneumonia?

Supports a bacterial infectious process.

What do elevated CRP and ESR suggest in pneumonia?

Inflammation; findings are nonspecific.

What is the purpose of measuring lactate in a patient with severe infection?

Evaluate possible tissue hypoperfusion and sepsis severity.

What is the purpose of procalcitonin testing?

May help assess bacterial infection, but should not independently determine whether antibiotics are initiated.

What additional diagnostic evaluation is important in suspected aspiration pneumonia with dysphagia?

Speech-language pathology (SLP) swallow evaluation.

What are the five components of CURB-65?

Confusion, Urea/BUN elevation, Respiratory rate ≥30, low Blood pressure, Age ≥65.

What CURB-65 score generally supports outpatient management?

0-1, if otherwise clinically stable.

What CURB-65 score suggests considering hospitalization?

2.

What CURB-65 score suggests severe pneumonia requiring hospital evaluation and possible ICU care?

3-5.

What is the major limitation of CURB-65 when determining disposition?

It does not directly account for oxygenation, swallowing safety, or all clinical stability factors.

What is the Pneumonia Severity Index (PSI) used for?

Estimating pneumonia mortality risk and helping guide disposition.

What is the first-line antibiotic regimen for outpatient CAP with diabetes in the lecture?

Amoxicillin-clavulanate (Augmentin) PLUS doxycycline.

What is the prescribed Augmentin dose for outpatient CAP in the lecture?

875/125 mg PO twice daily.

What is the prescribed doxycycline dose for outpatient CAP in the lecture?

100 mg PO twice daily.

What is an alternative first-line outpatient CAP regimen in the lecture?

Augmentin PLUS azithromycin.

What is the second-line outpatient CAP medication listed in the lecture?

Levofloxacin (Levaquin).

What levofloxacin dose does the lecture specifically list to memorize?

500 mg PO daily.

What amoxicillin dose does the lecture specifically list to memorize?

500 mg PO three times daily.

What azithromycin dosing regimen does the lecture list to memorize?

500 mg PO on day 1, then 250 mg PO daily for the remainder of the course.

What is the usual antibiotic duration for outpatient CAP in the lecture?

5-7 days, guided by clinical response.

What clinical findings should be present before stopping CAP antibiotics according to the lecture?

Clinical improvement and afebrile for 48 hours.

What nonpharmacologic treatments are recommended for outpatient CAP?

Rest, adequate oral hydration, temporary work restriction, and follow-up.

What medication precautions are important with NSAIDs and acetaminophen?

NSAIDs require caution with renal dysfunction; acetaminophen requires caution with liver disease.

What medications may be used for nausea?

Ondansetron (Zofran) or metoclopramide (Reglan).

What is the first-line IV antibiotic regimen for inpatient aspiration pneumonia in the lecture?

Ampicillin-sulbactam (Unasyn) 3 g IV every 6 hours.

What alternative IV antibiotic regimen for aspiration pneumonia is listed in the lecture?

Metronidazole 500 mg IV PLUS penicillin G 1 million units IV every 6 hours.

Why should a patient with aspiration pneumonia and unsafe swallowing initially avoid oral medications?

Risk of recurrent aspiration; keep NPO until swallowing safety is established.

What does NPO mean?

Nothing by mouth, including oral medications when specified.

What consultation is essential for aspiration pneumonia associated with dysphagia?

Speech-language pathology (SLP).

What aspiration precautions should be implemented for hospitalized patients?

Elevate head of bed 30-45°, oral care, and upright positioning during oral intake when cleared.

What oxygen saturation target is specified in the aspiration pneumonia admission orders?

SpO₂ 94-98%.

What medication is ordered for inpatient VTE prophylaxis in the lecture?

Enoxaparin (Lovenox) 40 mg SQ daily.

What monitoring is ordered for hospitalized aspiration pneumonia?

Vital signs and SpO₂ every 4 hours, continuous pulse oximetry while requiring oxygen, intake/output, and daily weights when receiving IV fluids.

What laboratory monitoring is ordered for inpatient aspiration pneumonia?

Repeat CBC with differential and BMP.

What should the provider do if a pneumonia patient has SpO₂ 88% on room air?

Initiate supplemental oxygen and admit for monitoring and treatment.

What is the management error in discharging a hypoxemic pneumonia patient solely because CURB-65 is low?

CURB-65 does not account for hypoxemia; oxygenation and clinical stability must guide disposition.

What is the management error in prescribing oral antibiotics to a patient with unsafe swallowing?

Risk of aspiration; keep NPO, obtain swallow evaluation, and use an appropriate alternative route.

What is the management error in treating aspiration pneumonia without addressing dysphagia?

Failure to prevent recurrent aspiration; order SLP evaluation and aspiration precautions.

What is the management error in failing to administer oxygen to a hypoxemic pneumonia patient?

Uncorrected hypoxemia; initiate supplemental oxygen.

What is the management error in failing to monitor respiratory status during hospitalization?

Delayed recognition of deterioration; monitor RR, SpO₂, work of breathing, and oxygen requirements.

What is the management error in ignoring worsening dyspnea or increasing oxygen requirements?

Failure to recognize respiratory deterioration; reassess and escalate care.

What is the management error in failing to provide return precautions for outpatient CAP?

Patient may delay seeking care; explain symptoms requiring urgent evaluation.

What is the appropriate approach when a patient has limited English proficiency?

Use a qualified medical interpreter, translated instructions, and teach-back.

What additional barriers should be addressed when planning outpatient pneumonia treatment?

Medication affordability, transportation, work restrictions, access to follow-up, and available home support.

What should be monitored during outpatient CAP treatment?

Fever, cough, dyspnea, oral intake, medication adherence, and overall clinical improvement.

When should an outpatient CAP patient contact the office if symptoms are not improving?

Within 48-72 hours.

When does the lecture recommend routine follow-up after outpatient CAP?

Approximately 1 week.

What outpatient symptoms warrant urgent reassessment?

Worsening dyspnea, confusion, inability to tolerate fluids, or clinical deterioration.

What respiratory findings warrant escalation of care?

Increasing work of breathing, persistent hypoxemia, rising oxygen requirements, RR >30, inability to speak full sentences, or respiratory fatigue.

What hemodynamic findings warrant urgent escalation?

Hypotension, shock, or signs of poor perfusion.

What infection-related findings warrant escalation of care?

Persistent or worsening fever, new confusion, suspected sepsis, or inability to tolerate oral intake.

What aspiration-related findings warrant escalation of care?

Recurrent choking, inability to protect the airway, or worsening oxygenation.

What findings should trigger provider notification in the lecture's inpatient admission orders?

SBP

What is the appropriate escalation for outpatient pneumonia with worsening hypoxemia?

Emergency department evaluation and possible hospital admission.

What is the appropriate escalation for hospitalized pneumonia with impending respiratory failure or shock?

Urgent reassessment and ICU-level evaluation.