High-risk community-required pneumonia (CAP) mimics include all of the following conditions EXCEPT:
a. Congestive heart failure
b. Pulmonary embolus
c. Asthmatic bronchitis
d. Carcinoma of the lung
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Answer: C. Patients with CAP can present with a wide range of symptoms, many of which can also be caused by other medical conditions. Lower-risk CAP mimics include minor asthma exacerbations, uncomplicated bronchitis, and viral upper respiratory infections. These conditions are generally not as severe as CAP, but an accurate diagnosis is important to prevent overtreatment with antibiotic therapy. High-risk CAP mimics include congestive heart failure, acute coronary syndromes, pulmonary embolism, neoplastic lesions, and pulmonary abscess/empyema. Pulmonary embolism can be particularly easy to miss if there is pulmonary infarct resulting in a CAP-like radiographic infiltrate. Neoplasia should be suspected in a patient with CAP who does not improve with antimicrobials over weeks or has other ominous constitutional signs. While a detailed history and physical examination may be sufficient to rule out high-risk CAP mimics in many cases, a more thorough workup may be required.
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