Internal Diseases – Part 1 (Rheumatology, Pulmonology, Phthisiatrics, Cardiology, Haematology) · MU Plovdiv

2. Empirical therapy of community acquired pneumonias

Inside: 22 sections · 7 tables · 29 flashcards · 13 min

Topic 7 of 68 in the MU Plovdiv syllabus for Internal Diseases – Part 1 (Rheumatology, Pulmonology, Phthisiatrics, Cardiology, Haematology) (Medicine, Year 4). The free AceMed note covers it in 22 sections, about 1,341 words (13 min of reading), with 29 flashcards.

In this note

  1. Essay 2- Empirical therapy of community acquired pneumonias
  2. Definition of pneumonia
  3. Definition of CAP
  4. Etiology
  5. Pathophysiology
  6. Symptoms
  7. Physical examination
  8. Diagnosis
  9. DD
  10. Empirical treatment
  11. Principles
  12. Where to treat: severity scores
  13. Empirical treatment of community-acquired pneumonia
  14. Pathogen-directed treatment
  15. Empirical treatment of hospital-acquired and ventilator-associated pneumonia
  16. Duration and switch to oral
  17. Supportive treatment
  18. Non-resolving pneumonia
  19. Prevention
  20. Introduction
  21. Community-acquired pneumonia (CAP)
  22. Hospital-acquired and ventilator-associated pneumonia

Definition of pneumonia

  • Pneumonia is an infection of the lungs caused by bacteria, viruses, fungi and other microorganisms

Definition of CAP

  • Pneumonia that develops in the outpatient setting or within 48 hours of admission to a hospital

Etiology

  • Typical agents- S.pneumoniae, H.influenzae, M.catarrhalis, S.aureus
  • Atypical- Legionella, Mycoplasma, Chlamudia pneumoniae, C.psottaci
  • Most common bacterial pathogens are:
  • S.pneumoniae
  • H.influenzae
  • M.catarrhalis

Pathophysiology

  • Colonization of the pharynx with pathogens, followed by micro-aspiration, is the mechanism of entry into the lower respiratory tract.
  • In the interaction between the pathogen and host pulmonary defense, pneumonia results if there is a defect in host defense or it is overcome by high inoculum or virulence of the pathogen.
  • Hematogenous spread and macro-aspiration are other mechanisms.

Symptoms

  • Fever
  • Chills
  • Cough productive of purulent sputum
  • Dyspnea
  • Pleuritic chest pain
  • Weight loss
  • Weakness
  • Altered mental status
  • Dyspepsia

Physical examination

Inspection

  • Hyperthermia
  • Tachypnea (more than 18 respirations per min)
  • Use of accessory muscles to breath
  • Tachycardia
  • Central cyanosis (lips, tongue, hands, feet, and mucous membranes of the oral cavity)
  • Altered mental status

Palpation

  • Tactile fremitus may be increased

Percussion

  • Dullness when percussion occurs over lung fields

Auscultation

  • Crackles
  • Ronchi
  • Wheezes
  • Bronchial breathing
  • Bronchophony- when assessing fremitus, “99ˮ is muffled. Abnormal if it is louder and clearer
  • Whispering pectoriloquy- when patient whispers “99ˮ, it is faint. Abnormal if it is louder and clearer

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