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:
- 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
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.
- Resident Seminars, TBD
- Internal Medicine Clerkship Guide, Paauw et al, Mosby 2003, 45-50, 82-86, 364-372
- Antibiotics for Acute Bronchitis; Smith, SM, Fahey, T, Smucny, J, Becker, LA; Cochrane Database of Systematic Reviews; 2014; 10.1002/14651858.CD000245.pub3
- Community-Acquired Pneumonia; Musher, DM, Thorner, AR; New England Journal of Medicine; October 23, 2014; DOI: 10.1056/NEJMra1312885
- Health Care-associated Pneumonia: An Evidence-based review; Attridge, RT; American Journal of Medicine; Aug;124(8):689-97. doi: 10.1016/j.amjmed.2011.01.023.