detailed diagnosis of pnemonia

1. Slide 1
..
DIAGNOSIS OF PNEUMONIA
 Dr VINAY VERMA
 #512

2. Slide 2
Clinical Data Obtained at the
Patient’s Bedside
Vital signs
 Increased respiratory rate
 Increased heart rate, cardiac output,
blood pressure

3. Slide 3
Clinical Data Obtained at the
Patient’s Bedside
 Chest pain/decreased chest expansion
 Cyanosis
 Cough, sputum production, and hemoptysis
 Chest assessment findings
 Increased tactile and vocal fremitus
 Dull percussion note
 Bronchial breath sounds
 Crackles and rhonchi
 Pleural friction rub
 Whispered pectoriloquy

4. Slide 4
Figure 2-11.Figure 2-11. A short, dull, or flat percussion note is typically produced over areasA short, dull, or flat percussion note is typically produced over areas
of alveolar consolidation.of alveolar consolidation.

5. Slide 5
Figure 2-16.Figure 2-16. Auscultation of bronchial breath sounds over a consolidated lungAuscultation of bronchial breath sounds over a consolidated lung
unit.unit.

6. Slide 6
Figure 2-19.Figure 2-19. Whispered voice sounds auscultated over a normal lungWhispered voice sounds auscultated over a normal lung
are usually faint and unintelligible.are usually faint and unintelligible.

7. Slide 7Slide 7
Clinical Data Obtained
from Laboratory Tests and
Special Procedures

8. Slide 8
Diagnostic Methods
History, physical examination
Chest X-Ray
Sputum examination (gram stained)
Sputum , blood cultures
Serological tests
Peripheral blood analysis

9. Slide 9
Pulmonary Function Study:
Expiratory Maneuver Findings
FVC FEVFVC FEVTT FEFFEF25%-75%25%-75% FEFFEF200-1200200-1200
↓↓ N orN or ↓↓ N orN or ↓↓ NN
PEFRPEFR MVV FEFMVV FEF50%50% FEVFEV1%1%
N N orN N or ↓↓ N N orN N or ↑
FVC FEVFVC FEVTT FEFFEF25%-75%25%-75% FEFFEF200-1200200-1200
↓↓ N orN or ↓↓ N orN or ↓↓ NN
PEFRPEFR MVV FEFMVV FEF50%50% FEVFEV1%1%
N N orN N or ↓↓ N N orN N or ↑

10. Slide 10
Pulmonary Function Study
Lung Volume and Capacity
Findings
VT RV FRC TLC
N or ↓ ↓ ↓ ↓
VC IC ERV RV/TLC%
↓ ↓ ↓ N
VT RV FRC TLC
N or ↓ ↓ ↓ ↓
VC IC ERV RV/TLC%
↓ ↓ ↓ N

11. Slide 11
Arterial Blood GasesArterial Blood Gases
Mild to Moderate PneumoniaMild to Moderate Pneumonia
 Acute alveolar hyperventilation withAcute alveolar hyperventilation with
hypoxemiahypoxemia
pH PaCO2 HCO3
-
PaO2
↑ ↓ ↓ (Slightly) ↓

12. Slide 12
Time and Progression of Disease
100
50
30
80
0
PaCO
2
10
20
40
Alveolar Hyperventilation
60
70
90 Point at which PaO2
declines enough to
stimulate peripheral
oxygen receptors
Point at which PaO2
declines enough to
stimulate peripheral
oxygen receptors
PaO2
Disease OnsetPaO2orPaCO2
Figure 4-2. PaO2 and PaCO2 trends during acute alveolar hyperventilation.

13. Slide 13
Arterial Blood Gases
Severe PneumoniaSevere Pneumonia
 Acute ventilatory failure with hypoxemiaAcute ventilatory failure with hypoxemia
pH PaCO2 HCO3
-
PaO2
↓ ↑ ↓ (Slightly) ↓

14. Slide 14Slide 14
Time and Progression of Disease
100
50
30
80
0
PaO
2
10
20
40
Alveolar Hyperventilation
60
70
90
Point at which PaO2
declines enough to
stimulate peripheral
oxygen receptors
Point at which PaO2
declines enough to
stimulate peripheral
oxygen receptors
PaCO 2
Acute Ventilatory FailureDisease Onset
Point at which disease
becomes severe and patient
begins to become fatigued
Point at which disease
becomes severe and patient
begins to become fatigued
Pa02orPaC02
Figure 4-7. PaO2 and PaCO2 trends during acute ventilatory failure.

15. Slide 15
Abnormal Laboratory Tests and
Procedures
Sputum examination
 Gram-positive organisms
 Streptococcus
 Staphylococcus
 Gram-negative organisms
 Klebsiella
 Pseudomonas aeruginosa
 Haemophilus influenzae
 Legionella pneumophila

16. Slide 16
Radiologic Findings
Chest radiograph
 Increased density
 Air bronchograms
 Pleural effusions
CT scan
 Consolidation and bronchograms may be seen

17. Slide 17
Chest X-Ray
 Gold standart test for pneumonia
 For differencial diagnosis
 For grading pneumonia severity
 For examining complications

18. Slide 18
-First 24 hours
-Dehydration
-Elderly
-Neutropenia
-Pneumocystis carinii
Normal Chest X Ray in Pneumonia

19. Slide 19
Radiology:
lobar opacities,
interstitial images,
bronchopneumonic (patchy) opacities,
Others (absea, pneumatocele, pleurisy...)
Diagnosis

20. Slide 20
Figure 15-5. Chest X-ray film of a 20-year-old woman with
severe pneumonia of the left lung.

21. Slide 21
Figure 15-6. Air bronchogram. The branching linear lucencies within the consolidation in the right
lower lobe are particularly well demonstrated in this example of staphylococcal pneumonia. (From
Armstrong P et al: Imaging of diseases of the chest, ed 2, St. Louis, 1995, Mosby.)

22. Slide 22
Figure 15-7. Air bronchogram shown by CT in a patient with pneumonia. (From
Armstrong P et al: Imaging of diseases of the chest, ed 2, St. Louis, 1995, Mosby.)