Which of the following is considered a "red flag" when diagnosing a patient with pneumonia?
A. Fever of 102
B. Infiltrates on chest x-ray
C. Pleural effusion on chest x-ray
D. Elevated white blood cell count
ANS: C
With pneumonia, the chest film typically reveals an area of infiltrate. It is a red flag if a pleural effusion is also visualized, in which case adequate follow-up to exclude development of an empyema is mandatory. This often involves prompt referral to a pulmonologist for possible thoracentesis. Cultures and Gram stains of sputum are usually not ordered for outpatients. The white blood cell count is often elevated.
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