pneumonia Flashcards
sudden onset differential diagnoses of sob (seconds to mins)
Pneumothorax trauma Aspiration Pulmonary oedema Pulmonary embolism
Acute onset differential diagnoses of sob (hours to days)
Asthma COPD RTI Pleural effusion Lung tumours Metabolic acidosis
chronic sob differential diagnoses
COpD Lung tumours Anaemia Valvular heart disease Cardiac failure Cystic fibrosis Interstitial lung disease Chest wall deformities Neuromuscular disorders
Differential diagnoses of productivite cough
COPD
TB
Bronchiectasis
Pulmonary oedema
Differential diagnosis of non-productive cough
Asthma Post nasal drip GORD Drugs (ACEi) Sarcoidosis
resp causes of fever
LRTI.URTI pneumonia COPD lung tumour Empyema Bronchiectasis TB Lung abscess
Differences between LRTI and pneumonia
LRTI-
Acute illness
Cough main symptom and +1 other LRTI symptom:
-fever, sputum, sob, wheeze, chest discomfort or pain
Pneumonia
Viral or bacterial infection of LRTI. Acute inflammation with an infiltration of neutrophils in and around the alveoli and terminal bronchioles
–>Consolidation shows on CXR. This is how you confirm diagnosis
common pathogens of HAP
- Gram negative enterobacteria
- Methicillin-resistant staphylococcus aureus (MRSA)
- Pseudomonas
- Klebsiella
Common pathogens of CAP
1 Strep pneumonia
2 Atypical pathogens- legionella, mycoplasma pneumonia
3 Viral causes including influenza, RSC and COVID
4 haemophilus influenza
What is pneumonia
Acute inflammation secondary to infection
Two types of how pneumonia can affect lung
Lobar
Bronchopneumonia (1 or more lobes, bronchioles and adjacent alveoli)
What are the 4 stages of inflammation
1) Congestion- Inflammation leads to leaky pulmonary capillaries causing alveolar exudate
2) Red hepatisation – haemorrhagic inflammatory alveolar exudate with no gas exchange in alveoli
3) Grey hepatisation – Fibrinopurulent inflammatory exudate (alveoli full of neutrophils and dense fibrous strands. Purulent sputum)
4) Resolution (without abx) – final stage of processing exudate left (monocytes clear the inflammatory debris and normal air filled lung architecture is restored
Risk factors
Old Child Hospitlaisation MAle Autumn/winter Smoking alcohol IV drugs Viral illness Underlying lung pathology Immunocompromised Aspiration risk
symptoms of pneumonia
Fever PRoductive cough sOB Pleuritic chest pain Malaise Haemoptysis Loss of appetite
Signs of pneumonia
Low GCS Delirium Increased RR, HR Low BP Cyanosis Low o2 sat decreased chest expansion Increased vocal remits / vocal resonance Crepitations/bronchial breathing Pleural rub
