LEARNING OBJECTIVES :
KNOWLEDGE - Students should be able to describe:
- The pathogenesis of pneumonia, clinical manifestations, diagnosis and treatment.
- The epidemiology and prevention of community acquired pneumonia.
SKILLS - Students should be able to:
- History: ascertain the pertinent history, including exposure, occupation, TB, travel and pets; determine if the patient is immunocompromised or at risk for TB or PCP - in order to initiate respiratory isolation in the ER; and rule out non-infectious mimics of pneumonia .
- Physical examination: perform the lung examination; differentiate consolidation from pleural effusion.
- Differential diagnosis : distinguish the various etiologies of community acquired and nosocomial pneumonia; and distinguish pneumonia from its non-infectious mimics.
- Laboratory : know the sensitivity and specificity of sputum culture and the proper way of obtaining sputum for gram stain and culture. Students should be aware of the correlation of positive blood and pleural fluid cultures with lung pathogens.
- Communication : communicate optimism and encourage risk reduction, including smoking cessation.
- Procedures : obtain sputum for gram stain and observe the gram stain performed in the microbiology lab; perform the gram stain, blood cultures and thoracentesis with assistance.
- Management : choose the appropriate antibiotics and make changes based on culture results. Students should be aware that the patient will improve before the x-ray does; and know when to order a follow-up x-ray; and encourage patients to have a pneumovax (if not given previously).
- Be familiar with LUMC protocols regarding stratification and treatment of community-acquired pneumonia .
ATTITUDES AND PROFESSIONAL BEHAVIORS:
- Students should understand the patient's fear and uncertainty, and be able to deal with the occasional difficult patient.
RECOMMENDED READINGS :
- Bartlett JG et al., Practice Guidelines for the Management of Community Acquired Pneumonia in Adults. Clinical Infectious Diseases, 2000; 31: 347-82.
- Halm, EA Management of Community-Acquired Pneumonia . NEJM Dec 19, 2002. Vol 347;2039-45. Number 25