skip to main content

Community-Acquired Pneumonia — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

HardInfectious DiseasesCommunity-Acquired PneumoniaABIM Board

An 84-year-old nursing-home resident with dementia develops fluctuating attention after receiving diphenhydramine. She is afebrile and hemodynamically stable, with no dysuria, frequency, suprapubic pain, flank pain, or costovertebral tenderness. Urinalysis shows pyuria and culture grows Escherichia coli. What is the most appropriate response?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Address delirium precipitants and observe clinically rather than give antibiotics

The best answer is “Address delirium precipitants and observe clinically rather than give antibiotics”. In an older adult with bacteriuria and delirium but no local urinary symptom, fever, or hemodynamic instability, a causal UTI has not been established. Pyuria commonly accompanies asymptomatic bacteriuria and does not resolve the distinction. Treating ASB does not improve delirium and increases adverse drug events, C difficile infection, and resistance. The anticholinergic exposure is a more actionable precipitant.

Reference: IDSA Guideline for Asymptomatic Bacteriuria: https://www.idsociety.org/practice-guideline/asymptomatic-bacteriuria/