A 74 year old woman presents with 1 week of lethargy, productive cough, and fevers. Prior to this illness she was relatively well. She has no recent hospitalizations and lives at home with her husband of 43 years. She does not smoke, drink, or use illicit drugs. PMH: HTN, hyperlipidemia, hypothyroidism PSH: Non-contributory, C-section x2, appendectomy Meds: HCTZ, Atorvastatin, Synthroid All: Denies ROS: Positive for loss of appetite, productive cough, fevers/chills. PE: Vitals: Temp 101.4, HR 108, RR 24, BP 138/78, O2 sat: 94% on room air, No pain General: She is awake and alert, uncomfortable but in NAD Skin: Warm HEENT: Unremarkable Neurologic: Unremarkable CV: Slightly tachycardic, Normal S1/2, RRR, no murmurs/rubs/gallops Pulmonary: Her chest is symmetric, she has normal respiratory effort, her chest expansion is normal, she has dullness to percussion in the left lower lobe, she has coarse crackles over her left lower lobe as well. Abdomen: S/NT/ND, no guarding/rebound MSK: Unremarkable You order a chest x-ray and some basic labs because you are good clinicians. Her labs have a leukocytosis of 16 and a left lower lobe pneumonia. What do you do now? Admit? Outpatient therapy? When would you see them back? What is the difference between community acquired pneumonia and hospital acquired? How differently are they treated? What is the most common cause of community acquired pneumonia, which organism and what are the other less common organisms? What is the pneumovax? Who gets it? Why? What is egophony and brochophony? Would you expect this patient to demonstrate these findings and why? .

1. A 74 year old woman presents with 1 week of lethargy, productive cough, and fevers. Prior to
this illness she was relatively well. She has no recent hospitalizations and lives at home with her
husband of 43 years. She does not smoke, drink, or use illicit drugs.
PMH: HTN, hyperlipidemia, hypothyroidism
PSH: Non-contributory, C-section x2, appendectomy
Meds: HCTZ, Atorvastatin, Synthroid
All: Denies
ROS: Positive for loss of appetite, productive cough, fevers/chills.
PE:
Vitals: Temp 101.4, HR 108, RR 24, BP 138/78, O2 sat: 94% on room air, No pain
General: She is awake and alert, uncomfortable but in NAD
Skin: Warm
HEENT: Unremarkable
Neurologic: Unremarkable
CV: Slightly tachycardic, Normal S1/2, RRR, no murmurs/rubs/gallops
Pulmonary: Her chest is symmetric, she has normal respiratory effort, her chest expansion is
normal, she has dullness to percussion in the left lower lobe, she has coarse crackles over her left
lower lobe as well.
Abdomen: S/NT/ND, no guarding/rebound
MSK: Unremarkable
You order a chest x-ray and some basic labs because you are good clinicians. Her labs have a
leukocytosis of 16 and a left lower lobe pneumonia.
What do you do now? Admit? Outpatient therapy? When would you see them back?
What is the difference between community acquired pneumonia and hospital acquired? How
differently are they treated?
What is the most common cause of community acquired pneumonia, which organism and what
are the other less common organisms?

2. What is the pneumovax? Who gets it? Why?
What is egophony and brochophony? Would you expect this patient to demonstrate these
findings and why?