Pneumonia: Clinical (To be retired)
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Pneumonia: Clinical (To be retired)
Medical and surgical emergencies
Cardiology, cardiac surgery and vascular surgery
Advanced cardiac life support (ACLS): Clinical (To be retired)
Supraventricular arrhythmias: Pathology review
Ventricular arrhythmias: Pathology review
Heart blocks: Pathology review
Coronary artery disease: Clinical (To be retired)
Heart failure: Clinical (To be retired)
Syncope: Clinical (To be retired)
Pericardial disease: Clinical (To be retired)
Valvular heart disease: Clinical (To be retired)
Chest trauma: Clinical (To be retired)
Shock: Clinical (To be retired)
Peripheral vascular disease: Clinical (To be retired)
Leg ulcers: Clinical (To be retired)
Aortic aneurysms and dissections: Clinical (To be retired)
Cholinomimetics: Direct agonists
Cholinomimetics: Indirect agonists (anticholinesterases)
Muscarinic antagonists
Sympathomimetics: Direct agonists
Sympatholytics: Alpha-2 agonists
Adrenergic antagonists: Presynaptic
Adrenergic antagonists: Alpha blockers
Adrenergic antagonists: Beta blockers
ACE inhibitors, ARBs and direct renin inhibitors
Loop diuretics
Thiazide and thiazide-like diuretics
Calcium channel blockers
cGMP mediated smooth muscle vasodilators
Class I antiarrhythmics: Sodium channel blockers
Class II antiarrhythmics: Beta blockers
Class III antiarrhythmics: Potassium channel blockers
Class IV antiarrhythmics: Calcium channel blockers and others
Positive inotropic medications
Antiplatelet medications
Dermatology and plastic surgery
Blistering skin disorders: Clinical (To be retired)
Bites and stings: Clinical (To be retired)
Burns: Clinical (To be retired)
Endocrinology and ENT (Otolaryngology)
Diabetes mellitus: Clinical (To be retired)
Hyperthyroidism: Clinical (To be retired)
Hypothyroidism and thyroiditis: Clinical (To be retired)
Parathyroid conditions and calcium imbalance: Clinical (To be retired)
Adrenal insufficiency: Clinical (To be retired)
Neck trauma: Clinical (To be retired)
Insulins
Mineralocorticoids and mineralocorticoid antagonists
Glucocorticoids
Gastroenterology and general surgery
Abdominal pain: Clinical (To be retired)
Appendicitis: Clinical (To be retired)
Gastrointestinal bleeding: Clinical (To be retired)
Peptic ulcers and stomach cancer: Clinical (To be retired)
Inflammatory bowel disease: Clinical (To be retired)
Diverticular disease: Clinical (To be retired)
Gallbladder disorders: Clinical (To be retired)
Pancreatitis: Clinical (To be retired)
Cirrhosis: Clinical (To be retired)
Hernias: Clinical (To be retired)
Bowel obstruction: Clinical (To be retired)
Abdominal trauma: Clinical (To be retired)
Laxatives and cathartics
Antidiarrheals
Acid reducing medications
Hematology and oncology
Blood products and transfusion: Clinical (To be retired)
Venous thromboembolism: Clinical (To be retired)
Anticoagulants: Heparin
Anticoagulants: Warfarin
Anticoagulants: Direct factor inhibitors
Antiplatelet medications
Thrombolytics
Infectious diseases
Fever of unknown origin: Clinical (To be retired)
Infective endocarditis: Clinical (To be retired)
Pneumonia: Clinical (To be retired)
Tuberculosis: Pathology review
Diarrhea: Clinical (To be retired)
Urinary tract infections: Clinical (To be retired)
Meningitis, encephalitis and brain abscesses: Clinical (To be retired)
Bites and stings: Clinical (To be retired)
Skin and soft tissue infections: Clinical (To be retired)
Protein synthesis inhibitors: Aminoglycosides
Antimetabolites: Sulfonamides and trimethoprim
Antituberculosis medications
Miscellaneous cell wall synthesis inhibitors
Protein synthesis inhibitors: Tetracyclines
Cell wall synthesis inhibitors: Penicillins
Miscellaneous protein synthesis inhibitors
Cell wall synthesis inhibitors: Cephalosporins
DNA synthesis inhibitors: Metronidazole
DNA synthesis inhibitors: Fluoroquinolones
Herpesvirus medications
Azoles
Echinocandins
Miscellaneous antifungal medications
Anthelmintic medications
Antimalarials
Anti-mite and louse medications
Nephrology and urology
Hypernatremia: Clinical (To be retired)
Hyponatremia: Clinical (To be retired)
Hyperkalemia: Clinical (To be retired)
Hypokalemia: Clinical (To be retired)
Metabolic and respiratory acidosis: Clinical (To be retired)
Metabolic and respiratory alkalosis: Clinical (To be retired)
Toxidromes: Clinical (To be retired)
Medication overdoses and toxicities: Pathology review
Environmental and chemical toxicities: Pathology review
Acute kidney injury: Clinical (To be retired)
Kidney stones: Clinical (To be retired)
Adrenergic antagonists: Alpha blockers
Neurology and neurosurgery
Stroke: Clinical (To be retired)
Seizures: Clinical (To be retired)
Headaches: Clinical (To be retired)
Traumatic brain injury: Clinical (To be retired)
Neck trauma: Clinical (To be retired)
Lower back pain: Clinical (To be retired)
Spinal cord disorders: Pathology review
Anticonvulsants and anxiolytics: Barbiturates
Anticonvulsants and anxiolytics: Benzodiazepines
Nonbenzodiazepine anticonvulsants
Migraine medications
Osmotic diuretics
Antiplatelet medications
Thrombolytics
Opioid agonists, mixed agonist-antagonists and partial agonists
Opioid antagonists
Pulmonology and thoracic surgery
Asthma: Clinical (To be retired)
Chronic obstructive pulmonary disease (COPD): Clinical (To be retired)
Venous thromboembolism: Clinical (To be retired)
Acute respiratory distress syndrome: Clinical (To be retired)
Pleural effusion: Clinical (To be retired)
Pneumothorax: Clinical (To be retired)
Chest trauma: Clinical (To be retired)
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Pulmonary corticosteroids and mast cell inhibitors
Rheumatology and orthopedic surgery
Joint pain: Clinical (To be retired)
Anatomy clinical correlates: Clavicle and shoulder
Anatomy clinical correlates: Axilla
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Wrist and hand
Anatomy clinical correlates: Median, ulnar and radial nerves
Anatomy clinical correlates: Bones, joints and muscles of the back
Anatomy clinical correlates: Hip, gluteal region and thigh
Anatomy clinical correlates: Knee
Anatomy clinical correlates: Leg and ankle
Anatomy clinical correlates: Foot
Acetaminophen (Paracetamol)
Non-steroidal anti-inflammatory drugs
Glucocorticoids
Opioid agonists, mixed agonist-antagonists and partial agonists
Antigout medications
Assessments
Pneumonia: Clinical (To be retired)
USMLE® Step 2 questions
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Transcript
Content Reviewers
Rishi Desai, MD, MPHPneumonia is due to inflammation of the lung alveoli from an infection. Typically, fluid that’s filled with white blood cells starts to fill up the alveoli, and that inflammatory fluid essentially replaces the air that’s normally in the alveoli, and that fluid interferes with gas exchange.
Pneumonia typically causes a fever, cough, and shortness of breath, along with tachypnea and tachycardia, and occasionally hypoxemia. If the infection is near the pleural surface, it can cause pleuritic chest pain, which is pain that worsens with inspiration. On chest exam, there’s dullness on percussion; increased tactile fremitus, which is an increased sensation of vibration when palpating over the affected area and asking the individual to speak; and egophony, which is increased resonance of transmitted sounds and makes the letter “E” sound like the letter “A”. On auscultation, bronchial breath sounds or inspiratory crackles may be heard.
The diagnosis of pneumonia is based on having clinical signs and symptoms along with abnormal chest imaging, most commonly a chest x-ray. In pneumonia, a chest x-ray typically shows either a lobar consolidation or a diffuse, interstitial infiltrate. Pneumonia has to be distinguished from atelectasis which is when there’s collapse of a region of the lung, a complication that often occurs in individuals after surgery. On a chest x-ray, atelectasis shows up as a wedge-shaped region with it’s apex at the hilum with an ipsilateral shift of structures due to volume loss. In contrast, in a pneumonia there’s usually normal or increased volume with a consolidation that doesn’t have an apex at the hilum and no shift in structures. Now, in addition to imaging, some lab tests suggestive of pneumonia include an elevated white blood cell count, and elevated markers of inflammation like procalcitonin and C-reactive protein. It’s thought that these generally increase much more in bacterial pneumonia versus viral pneumonia.
Summary
Pneumonia is an infection of the lungs that results in air sacs being filled with fluid. It may be caused by bacteria, viruses, or fungal infections. Pneumonia is a serious condition that requires prompt diagnosis and treatment. It is diagnosed based on symptoms like cough and fever and an abnormal chest x-ray which might show a lobar consolidation or an interstitial infiltrate, and in some cases, there may be cavitation or pleural effusion.
Pneumonia is classified into community-acquired pneumonia, or CAP, and hospital-acquired or ventilator-associated pneumonia, or HAP and VAP. CAP is pneumonia in which the organism was acquired anywhere in the community outside the hospital. HAP and VAP are defined as pneumonia starting more than 48 hours after admission to a hospital or endotracheal intubation, respectively.
Decision-making tools like the CURB-65 are essential to determine whether a CAP patient should be treated outpatient, inpatient, or in the intensive care unit, and the antibiotic choice depends on the setting. Sputum samples for gram stain and culture as well as blood cultures should be obtained for individuals with CAP in the intensive care unit, as well as those with HAP or VAP. Complications of pneumonia include parapneumonic effusion, empyema, and lung abscess. Preventative measures to decrease the risk of acquiring pneumonia include providing pneumococcal and influenza vaccines.
Copyright © 2023 Elsevier, except certain content provided by third parties
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