How to Diagnose Pneumonia Flashcards
Classic hx of pneumonia
Retrocardiac airspace with air bronchograms
Pneumonia dx
Sx of LRT infection
Means of 6 days
Radiographic infiltrate
Criteria are not 100% specifc
X-rays can be negative but CT scans should not
Sx
COugh and fatigue are common
Fever not in all
Consolidation (egophony) in less than 1/3
A lot have sputum production
Pneumo vs. bronchitis
Both have cough, sputum production, hemoptysis, dyspnea, and rhonchi
Penumo only - true fever, pleuritic pain, consolidation, hypoxemia
Influenza
Infects resp epithelium and is explosive in onset
Fever, chills, myalgia, etc.
Retrosternal pain (vs. lateral in bacterial pneumonia)
S pneumo
Lobar classic
Gram-positive bullet cshaped diplococci
Most common pathogen in almost every scenario
Urine antigen is a rule in test
Croup
vs. bronchiolitis and epiglottitis
Croup - barking cough, low grade fever and stridor (parainfluenza)
bonrchiolitis - upper airway findings but not aggressive coguh…will have weheezes and crackles
Epiglottitis - high fever, drooling, muffled voice and leaned forward
Bact vs. virsues, vs. pneumocystis
Bact - high fever, true rigor, purulent phlegm, and streaky hemoptysis
Viruses - dry cough, except influenza
Pneumo - rarely pleghm or prominant airway sx due to lack of inflammation
S aureus
Cocci in clusters
Tendency to cavitate
Anti staph - vanc, linezolid, ceftrarolin
Hib
vs. legionella
Gram neg short bacilli
More in patients with chronic bronchitis
Copious sputum
Cannot ID by gram stain (legionella)
How to determine empyema
How to cover legionella
Is costophrenic angle there?
Add azirthromycin
Legionnaires
Longer prodrome and dry cough
Elderly, smokers, immunocomp
Clinical findings may point away from lung
Dx with urinary antigen or culture
COP vs. bac penumonia
Bacterial - think 6 days
COP - think 4-6 weeks
Empyema
Begins as pneumonia but spreads through the visceral pleura and into the pleural space producing a closed- space infection
Drainage AND antibiotics are rquired for resolution of the process
Provisional
Confirmed
PAth dx
Risk-benefit favors AB tx
Pt’s condition improves ofr resolves with ABs +/- mico testing
Lung biopsy/autopsy confirms clinical impresion
