Respiratory Infections/Pneumonia

RESPIRATORY INFECTIONS/PNEUMONIA

Knowledge

Students should be able to define and describe:

the difference between bronchitis and pneumonia

differentiate acute from chronic pneumonia.

the spectrum of organisms responsible for the clinical presentation of lower respiratory tract infection in community-acquired, nosocomial, or aspiration pneumonia and respiratory infections in the immunocompromised host.

patients who are at risk for impaired immunity.

the complications of acute bacterial pneumonia including:

bacteremia

sepsis

empyema

meningitis

metastatic microabscesses

the antimicrobial susceptibility patterns of s. pneumoniae

the rationale for antibiotic selection in different patient populations and the appropriate duration of therapy

the role of intravenous versus oral antibiotics in the management of community acquired pneumonia

the pharmacokinetics of commonly prescribed antibiotics

the role of pneumococcal vaccine and influenza vaccine

Skills

Students should demonstrate specific skills, including:

History-Taking Skills: Students should be able to obtain, document, and present an a medical history that differentiates among the etiologies of lower respiratory infection.

Physical Exam Skills: Students should be able to perform an appropriate physical exam to establish the diagnosis and severity of disease, including:

determining respiratory rate and level of distress.

recognizing rales, rhonchi and wheezes.

recognizing signs of pulmonary consolidation, parenchymal collapse and pleural effusion.

recognizing signs of pneumonia complications listed above.

Laboratory Interpretation: Students should be able to interpret:

a chest x-ray

gram stain and acid-fast stain of sputum

pleural fluid cell count, gram stain and chemistries

arterial blood gases

Students should be able to define the indications for and interpret (with consultation) the significance of the results of:

sputum culture and sensitivities and sputum cytology

Communication Skills: Students should be able to:

explain the results of the evaluation, treatment plan and prognosis of the disease to patients and their families.

educate about pneumococcal and influenza immunizations

Management Skills: Students should be able to:

select an appropriate empiric antibiotic regimen for community-acquired, nosocomial, immunosuppressed-host, and aspiration-pattern pneumonia.

Resources

Aspiration Pneumonitis and Aspiration Pneumonia, Marik, Paul E., M.B., B.Ch., The New England Journal of Medicine, March 1, 2001, Vol. 344, Number 9, pp 665-671.

The Diagnosis and Treatment of Cough, Irwin, Richard S., M.D., Madison, J Mark, M.D., The New England Journal of Medicine, Dec. 7, 2000, Vol. 343, Number 23, pp 1715-1721.

Acute Bronchitis, Richard P. Wenzel, M.D., and Alpha A. Fowler III, M.D., The New England Journal of Medicine, 2006;355:2125-30.

Clerkship Seminar, “Respiratory Infections,” N. Khardori, MD

Clerkship Seminar, “Use of Antibiotics,” N. Khardori, MD

Internal Medicine Clerkship Guide, Paauw et al, Mosby 2003, 45-50, 82-86, 364-372

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