Respiratory Infections/Pneumonia
Presentations
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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