Post-Quiz: Community-Acquired Pneumonia EM 201

JJ is a 65-year-old, 75 kg, female with no significant past medical history who presented to the emergency department with shortness of breath. She was intubated and transferred to the medical intensive care unit (ICU). After being on mechanical ventilation for 6 days, the patient developed a fever with a maximum temperature of 100.1°F, became hypotensive, and required initiation of vasopressors. Additionally, a chest X-ray showed new infiltrates. The patient’s basic metabolic panel revealed a sodium level of 132 mEq/L (reference range 135-145 mEq/L), potassium level of 3.8 mEq/L (reference range 3.5-5.0 mEq/L), chloride level of 98 mEq/L (reference range 98-106 mEq/L), bicarbonate level of 22 mEq/L (reference range 22-28 mEq/L), blood urea nitrogen (BUN) level of 18 mg/dL (reference range 7-20 mg/dL), and a creatinine level of 0.9 mg/dL (reference range 0.5-1.1 mg/dL). Which of the following is the most appropriate empiric antibiotic regimen to start for JJ?

A previously healthy 25-year-old female presents with 5 days of productive cough, fevers, chills, and pleuritic chest pain. Vital signs show temperature 102°F, pulse 110 bpm, blood pressure 118/76 mm Hg, and respiratory rate 22/min. Physical exam is notable for crackles at the right lung base. Chest x-ray confirms right lower lobe infiltrate concerning for pneumonia. Sputum gram stain shows gram positive diplococci. Which of the following is the most appropriate treatment?

A 72-year-old male is hospitalized for community-acquired pneumonia. He was started on ceftriaxone and azithromycin. After 2 days he is clinically improving. Blood cultures are negative. Sputum culture grows pan-sensitive Streptococcus pneumoniae. Which of the following is the best next step in management?

A 22-year-old college student presents with 2 days of fevers, body aches, dry cough, and nasal congestion. He recently traveled with friends to Cancun for spring break. Vital signs show temperature 101.2°F, pulse 92 bpm, blood pressure 124/78 mm Hg, respiratory rate 14/min, and oxygen saturation 98% on room air. Physical exam is unremarkable. Rapid influenza test is positive. Chest x-ray is clear. His symptoms are most consistent with:

A 65-year-old female with a history of rheumatoid arthritis treated with weekly methotrexate and prednisone 10mg daily presents with productive cough, fevers, and dyspnea. She was diagnosed with community-acquired pneumonia and hospitalized for treatment with vancomycin, piperacillin-tazobactam, and azithromycin. She is clinically improving on day 3 of antibiotic therapy. Blood culutres, MRSA nasal, sputum cultures show no growth. The next best step is to: