Questions for Discussion:

1. Does this patient have pneumonia?
   
2. What are the generally accepted criteria for a diagnosis of pneumonia?
   
3. Should this patient be admitted to the hospital?   Is she at increased risk for a complicated course?
   
4. What further history regarding exposure should be asked of this patient and her family before bed assignment?
   
5. Explain the physical findings present in consolidation versus pleural effusion.
   
6. What further lab studies should be ordered to ascertain the etiology of her pneumonia?   What is the percentage of patients who have a febrile bacteremia associated with pneumonia?   What is the most common early sign of pneumonia in the elderly?
   
7. Discuss the sensitivity and specify of the gram stain and the sputum culture.
   
8. What four ways do micro-organisms get to the lung and which of these four is most common?
   
9. What is the most common pathogen in community acquired pneumonia?   What antibiotic coverage might you suggest initially?
   
10. What pathogens are involved in nosocomial pneumonia and what antibiotic coverage might you suggest?
    
11. When should the patient have a repeat CXR?   How long might it take before her CXR is normal?
    
12. What care can be given this patient in your OPC to prevent another pneumonia next year?

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