A 58-year-old male is brought to your office by his wife for follow-up after an urgent care clinic visit 3 days ago where he was diagnosed with pneumonia based on a chest radiograph. He has been taking his antibiotics as prescribed. He had shaking chills last night, and this morning at home he had a fever and has been very fatigued and slightly confused. He has a blood pressure of 110/70 mm Hg, a respiratory rate of 27/min, and a temperature of 38.7°C (101.7°F). Laboratory studies reveal elevated WBCs and elevated creatinine and lactate levels.

Which one of the following would be the most appropriate next step?

An otherwise healthy 21-year-old male sees you for follow-up after a hospitalization for pneumonia. This was his second pneumonia infection of the year. He reports a history of multiple sinus infections and upper respiratory infections over the years that were treated with antibiotics on an outpatient basis. Laboratory studies reveal a normal CBC and a decreased IgA level. A trial of pneumococcal polysaccharide vaccine (PPSV23, Pneumovax 23) reveals no measurable response.

This presentation is most consistent with

You receive a call from the home health nurse who is caring for a bedridden 57-year-old male with progressive multiple sclerosis. She is concerned that he has a weak cough reflex and may not be swallowing safely. She has not witnessed an aspiration event. He was hospitalized for pneumonia 4 months ago. While awaiting the results of a full swallow evaluation, which one of the following is the most appropriate intervention to prevent recurrent pneumonia in this patient?

A 42-year-old male sees you for follow-up after his third episode of pneumonia. He has no other significant medical history. He has never smoked, drinks alcohol occasionally, and has no other drug use or known exposures. A physical examination is normal. Pulmonary function tests demonstrate an FEV1 of 72% of predicted and an FEV1/FVC ratio of 0.68, which does not normalize with bronchodilator administration. A chest radiograph shows hyperinflation but no other significant findings.

Laboratory Findings

Platelets 102,000/mm3 (N150,000–450,000)

Creatinine 0.7mg/dL (N0.6–1.2)

AST 56U/L (N8–48)

ALT 43U/L (N7–55)

Albumin  3.3g/dL (N3.5–5.0)

Which one of the following conditions best explains this patient’s abnormal findings?

A previously healthy 62-year-old female presents to your office with a 3-day history of fever and a cough productive of purulent sputum. On examination she has a temperature of 39.2°C (102.6°F), a blood pressure of 110/70 mm Hg, a pulse rate of 92 beats/min, a respiratory rate of 25/min, and an oxygen saturation of 94% on room air. She shows no signs of confusion. An examination is significant for crackles at the right lower lung base and a chest radiograph confirms an infiltrate in the same location.

Which one of the following treatment settings would be most appropriate at this time for this patient’s community-acquired pneumonia?

A 67-year-old male is admitted to the hospital for community-acquired pneumonia. An examination reveals a temperature of 40.0°C (104.0°F), a respiratory rate of 50/min, a pulse rate of 110 beats/min, a blood pressure of 90/50 mm Hg, and an oxygen saturation of 88% on room air. The patient is confused and requires aggressive fluid resuscitation for hypotension and he is transferred to the intensive-care unit. He has no known additional risk factors or exposures.

In addition to treatment with ceftriaxone and azithromycin (Zithromax), which one of the following medications is most likely to result in improved outcomes?

A 71-year-old male is hospitalized for community-acquired pneumonia. He has a past medical history of hypertension and a small, stable abdominal aortic aneurysm.

Which one of the following antibiotics is likely to increase the risk of rupture of this patient’s aneurysm?

A 75-year-old male nursing home resident is brought to the emergency department with a cough and fever. His past medical history is significant for coronary artery disease, COPD, hypertension, and osteoarthritis. On examination he has a blood pressure of 145/90 mm Hg, a pulse rate of 84 beats/min, and an oxygen saturation of 89% on room air. A physical examination is remarkable for mildly labored breathing and crackles in his left lower lung field. A chest radiograph confirms left lower lobe pneumonia. He is admitted to the hospital for intravenous antibiotics.

Which one of the following would be the most appropriate antibiotic treatment?

A 35-year-old female is admitted to the hospital with fever, tachycardia, and hypotension. Her medical history is significant for current injection drug use.

Which one of the following is the most common infection in patients such as this?