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Pulmonary

In a child with bacterial pneumonia, when would clinical improvement be expected after initiation of an antibiotic with activity against the pathogen?

A. 2 to 4 hours

B. 6 to 8 hours

C. 12 to 24 hours

D. 48 to 72 hours

Answer: D

For a child with a bacterial pneumonia on adequate antibiotic therapy, clinical improvement is expected to occur within 48 to 72 hours. If a child is on adequate antibiotic coverage and worsens or does not improve within 48 to 72 hours, she should be reevaluated for alternative diagnoses, antibiotic resistance, or abscess.

Reference: Gereige RS, Laufer PM. Pneumonia. Pediatr Rev. 2013;34(10):438-456. Pubmed ID: 24085792.

For a child treated for uncomplicated bacterial pneumonia as an outpatient, when should a repeat chest x-ray (CXR) be obtained to document clearance of pneumonia?

A. After the child has been afebrile for 48 to 72 hours

B. 1 to 3 weeks after completion of antibiotics

C. 4 to 6 weeks after resolution of all symptoms

D. A CXR is not needed to document clearance of pneumonia

Answer: D

For children treated for uncomplicated bacterial pneumonia as an outpatient, x-rays are not needed to document clearance of pneumonia. If CXRs are obtained for other reasons, note that it can take 4 to 6 weeks for resolution of radiographic signs of pneumonia.

Reference: Gereige RS, Laufer PM. Pneumonia. Pediatr Rev. 2013;34(10):438-456. Pubmed ID: 24085792.

What is the most common cause of bacterial pneumonia in school-aged children and young adults?

A. Streptococcus pneumoniae

B. Bordetella pertussis

C. Mycoplasma pneumoniae

D. Chlamydophila pneumoniae

Answer: C

The most common cause of bacterial pneumonia in school-aged children and young adults is Mycoplasma pneumoniae. Chlamydophila pneumoniae is also a cause of bacterial pneumonia in this age group, although not as common as Mycoplasma. Streptococcus pneumoniae is the most common cause of bacterial pneumonia in children between the ages of 1 week old and 5 years old. Bordetella pertussis is a less common cause of bacterial pneumonia in this age group.

Reference: Gereige RS, Laufer PM. Pneumonia. Pediatr Rev. 2013;34(10):438-456. Pubmed ID: 24085792.

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