SIU School of Medicine

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Department of Internal Medicine

Respiratory Infections/Pneumonia


How to Read A Chest X-Ray

Chest X-Rays Part 2


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


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.


  • 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