PANCE Blueprint Pulmonary (12%)

Viral pneumonia

Patient will present as → a 45-year-old male with a one week history of hacking non-productive cough, low grade fever, malaise and myalgias. The chest x-ray reveals bilateral interstitial infiltrates and a cold agglutinin titer that is negative. Examination reveals scattered rhonchi and rales upon auscultation of the chest.

Adults → Flu is the most common viral cause

Kids → RSV - 1st episode of wheezing

Adenovirus tends to cause symptoms fast, will present with GI symptoms and lasts about 1 week. May differentiate from bacterial mycoplasma pneumonia as mycoplasma is slow and insidious.

Chest X-ray will show bilateral interstitial infiltrates

  • Rapid antigen testing for influenza
  • RSV nasal swab
  • cold agglutinin titer that is negative

Influenza can be treated with oseltamivir (Tamiflu)

  • Zanamivir and Oseltamivir (Tamiflu) both treat influenza A and B must be given within 48 hours
  • Amantadine and Rimantadine treat only influenza A

Treatment is usually symptomatic, may use beta 2 agonists, fluids, rest

CXR showing typical findings of bilateral interstitial infiltrates

CXR showing typical findings of bilateral interstitial infiltrates

Question 1
A 15 year-old male presents with a 1 week history of hacking non-productive cough, low grade fever, malaise and myalgias. Examination is unremarkable except for a few scattered rhonchi and rales upon auscultation of the chest. The chest x-ray reveals interstitial infiltrates and a cold agglutinin titer was negative. Which of the following is the most likely diagnosis?
A
acute bronchitis
Hint:
While the patient's clinical symptoms of dry cough and rhonchi support this diagnosis, the chest x-ray would be normal or only show a mild increase in bronchovascular markings, not infiltrates.
B
viral pneumonia
C
mycoplasma pneumonia
Hint:
While the gradual onset of symptoms suggest mycoplasma, the negative cold agglutinin titer makes this less likely.
D
pneumococcal pneumonia
Hint:
In older children the signs and symptoms of pneumococcal pneumonia are similar to an adult and consist of an abrupt onset of cough, fever and chills. The chest x-ray would reveal a lobar consolidation, not interstitial, picture.
Question 1 Explanation: 
The patient's clinical symptoms as well as chest x-ray findings and negative cold agglutinin titer are most consistent with viral pneumonia.
There is 1 question to complete.
Return
Shaded items are complete.
1
Return
Bacterial pneumonia (ReelDx) (Prev Lesson)
(Next Lesson) Fungal pneumonia
Back to PANCE Blueprint Pulmonary (12%)

NCCPA™ Content Blueprint

The Daily PANCE and PANRE

Get 60 days of PANCE and PANRE Multiple Choice Board Review Questions delivered daily to your inbox. It's 100% FREE and 100% Awesome!

You have Successfully Subscribed!