Conjunctivitis conunctival redness, itching, painless, no visual change, uni- or bilateral other infectious, allergic. Infection - e. Dental infection , poor chronic care, lack of access to dentists. GERD heartburn, bad taste in mouth when lie down Cancer hx smoking, etoh, slowly progressive sx Psychogenic. COPD, asthma, other.
UCSD's Practical Guide to Clinical Medicine
Hypertenion, hyperlipidemia, congestive heart failure, valvular heart disease, coronary artery disease, peripheral vascular disease, stroke, etc. Cerebral hypo-perfusion from sudden drop in blood pressure, noting that BP is a function of: Cardiac output x systemic vascular resistance; and CO is a function of heart rate x stroke volume; and stroke volume is a function of inotropy and pre-load. BPH, cancer, stones, intrinsic renal disease, etc. Erectile Dysfunction ED? Cancer progressive, painless hydrocele painless. Risks as per STIs.
Infection Acute - bacterial Localize site by Sx - e.
Infertility, endometriosis, infection, cancer, etc. Stroke, seizure, neurodegenerative - Multiple sclerosis, ALS, etc. Suggests sensory abnormality - e. Poorly controlled dm see under Genito-Urinary - Frequency. See under General - Weight loss. See under General - Weight gain. It is the most common hospital-acquired infection in the intensive care unit ICU. It affects an estimated 5 to 10 of every 1, hospitalized patients every year.
More than half of these cases may be due to strains of bacteria that have developed resistance to antibiotics. In fact, methicillin-resistant Staphylococcus aureus MRSA and multidrug-resistant P aeruginosa are leading causes of death from hospital-acquired pneumonia. Those at highest risk are:. Hospitalized patients are particularly vulnerable to Gram-negative bacteria and staphylococci, which can be particularly dangerous in people who are already ill. CAP is the most common type of pneumonia. It develops outside of the hospital. Older people, infants, and young children are at greatest risk for the disease.
Chronic obstructive lung disease COPD , which includes long-term chronic bronchitis and emphysema, affects 15 million people in the US. This condition is a major risk factor for pneumonia. Long-term use of corticosteroid inhalers may increase the risk of pneumonia in people with COPD. People with other types of chronic lung diseases, such as bronchiectasis and interstitial lung diseases, are also at increased risk for getting pneumonia and more likely to have complications. Bronchitis is the inflammation of the bronchi, the main air passages to the lungs.
It generally follows a viral respiratory infection. Symptoms include coughing, shortness of breath, wheezing, and fatigue. People with impaired immune systems are extremely susceptible to pneumonia. A wide variety of organisms, including P jiroveci , myobacterium species, Histoplasma capsulatum , Coccidioides immitis , aspergillus species, cytomegalovirus, and Toxoplasma gondii , can cause pneumonia. In addition to AIDS, other conditions that compromise the immune system include:. People who are on corticosteroids or other medications that suppress the immune system such as chemotherapy drugs are also prone to infection.
People at high risk for pneumonia should take gastric acid-suppressing drugs only when necessary and at the lowest possible dose. Reducing levels of bacteria-killing stomach acid may allow germs to spread in the upper gastrointestinal tract and move into the respiratory tract. The risk posed by these medications is highest in:. The risk is strongest when people have recently begun treatment with PPIs, and lessens over time. Recruits on military bases and college students living in dormitories are at higher-than-average risk for Mycoplasma pneumonia.
These groups are at lower risk, however, for more serious types of pneumonia. The risk for pneumonia in people who smoke more than a pack a day is 3 times that of nonsmokers. Those who are chronically exposed to secondhand cigarette smoke, which can injure airways and damage the cilia, are also at risk.
Risk factors: Who gets it?
Quitting smoking reduces the risk of dying from pneumonia to normal, but the full benefit takes up to 10 years to be realized. Toxic fumes, industrial smoke, and other air pollutants may also damage cilia function, which is a defense against bacteria in the lungs. Alcohol or drug abuse is strongly associated with pneumonia. These substances act as sedatives and can diminish the reflexes that trigger coughing and sneezing.
Alcohol also interferes with the actions of macrophages, the white blood cells that destroy bacteria and other microbes. Intravenous drug abusers are at risk for pneumonia from infections that start at the injection site and spread through the bloodstream to the lungs. Men with CAP tend to fare worse than women.
Certain children have a higher-than-normal risk for pneumonia and pneumonia that returns. Conditions that predispose infants and small children to pneumonia include:. It is important to determine whether the cause of CAP is a bacterium, atypical bacterium, or virus, because they require different treatments. In children, for example, S pneumoniae is the most common cause of pneumonia, but RSV may also cause the disease. Although symptoms may differ, they often overlap, which can make it difficult to identify the organism by symptoms alone.
The cause of CAP is found in only about half of cases. Nevertheless, in many cases of mild-to-moderate CAP, the physician is able to diagnose and treat pneumonia based solely on a medical history and physical examination. Diagnosing pneumonia is particularly difficult in hospitalized patients for a number of reasons:.
The person's history is an important part of making a pneumonia diagnosis. People should report any of the following:.
- SUBTROPOLIS THREE.
- Pneumonia: Symptoms, causes, and treatments?
- Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia.
The stethoscope is the tool that the physician uses to listen to the body sounds, including chest sounds produced while breathing. Sounds that may indicate pneumonia include:.
A pulse oximetry test can help determine if a person needs hospital care. A simple test using a device on the fingertip or earlobe, this determines the amount of oxygen in the blood. Although current antibiotics can attack a wide spectrum of organisms, it is best to use an antibiotic that targets the specific one making a person sick. Unfortunately, people carry many bacteria, and sputum and blood tests are not always effective in distinguishing between harmless and harmful kinds.
Many of these laboratory tests take 4 to 5 days or longer to complete, however, and therapy should be started before results are available. Although viral pneumonia accounts for more than a third of CAP cases, it can sometimes be difficult to determine if the pneumonia is viral or bacterial in origin.
In severe cases, a doctor needs to use invasive diagnostic measures to identify the cause of the infection. These tests are not commonly performed in outpatients. Standard lab tests are used to help diagnose pneumonia. The person coughs as deeply as possible to bring up mucus from the lungs, since a shallow cough produces a sample that usually only contains normal mouth bacteria.stylacnecmeiso.ga
Some people may need to inhale a saline spray to produce an adequate sample. In some cases, a tube will be inserted through the nose into the lower respiratory tract to trigger a deeper cough. The sputum sample is sent to the laboratory, where it is analyzed for the presence of bacteria and to determine whether the bacteria are Gram-negative or Gram-positive. Urine antigen tests for Legionella pneumophila Legionnaires disease and S pneumoniae may be helpful in some people with severe CAP. In critically-ill people with VAP, doctors have tried sampling fluid taken from the lungs or trachea.
These techniques enabled the physicians to identify the pneumonia-causing bacteria and start the appropriate antibiotics.