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Pneumonia (49y/o F) (Symptoms (Cough (Ddx (CV (Ischemic Heart Disease,…

- - - - CV
        
        Ischemic Heart Disease
        
        Pulmonary embolism
      - Metabolic
        
        DKA
  - - - pathogen
        
        Fusobacterium necrophorum(most common)
      - complications
        
        sepsis
        
        septic embolism in organs (lung, heart, etc.)
        
        pneumonia
        
        meningitis
      - infection site
        
        oralpharngeal with internal jugular vein thrombosis
      - Epidemiology
        
        population
        
        child or young people
        
        underlying reasons
        
        IV drug users
        
        congenital or acquired coagulopathy
        
        antibiotics abuse
      - symptoms
        
        throat pain lasts more than 5 days (if it doesn't improve with antibiotics medication)
        
        pharyngitis
        
        tonsillitis
        
        fever
        
        muscle weakness
        
        neck swelling
        
        voice changes hoarse or muffled
      - Diagnosis
        
        CT(confirms blood clot in inner jugular vein)
        
        history
        
        blood culture
      - Treatment(for Fusobacterium spp.)
        
        clindamycin (Cleocin)
        
        cephalosporins
        
        metronidazole (Flagyl)
  - - - uveitis（including Endophthalmitis)
      - keratitis
      - acute glaucoma
      - acute maculopathy
      - chiasmal disorders
      - Retinal detachment
- - - - low pH, pCO2, pO2, HCO3
    - - high WBC (11.50x10^3/ul)
      - low platelet (82x10^3/ul)
      - high neutrophil (84.2%)
      - low lymphocyte (6.3%)
  - - - ground-glass pattern
      - blunting of the costophrenic angle
    - - Cavitation
      - Feeding Vessels Sign
      - Infiltration
      - Pleural Effusion
      - Peripheral nodules
- - - - Nephropathy
        
        prevention
        
        (1) improved glycemic control, (2) strict blood pressure control, and (3) administration of an ACE inhibitor or ARB.
        Dyslipidemia should also be treated.
        
        Screening for albuminuria should commence 5 years after the onset of type 1 DM and at the time of diagnosis of type 2 DM.
      - Foot
        
        prevention
        
        identification of high-risk patients, education of the patient, and institution of measures to prevent ulceration
        
        annual foot examination
        
        management
        
        off-loading
        
        debridement
        
        wound dressings
        
        appropriate use of antibiotics
        
        revascularization
        
        limited amputation
      - Neuropathy
        
        prevention
        
        Patients with signs of neuropathy should check feet daily
        
        take precautions (footwear) aimed at preventing calluses or ulcerations
        
        treatment
        
        Chronic diabetic neuropathy
        
        duloxetine, amitriptyline, gabapentin, valproate, pregabalin, or opioids
        
        Orthostatic hypotension secondary to autonomic neuropathy
        
        fludrocortisone, midodrine, clonidine, octreotide, and yohimbine
      - Immunocompromised
        
        common pathogens
        
        Candidas, K. Pneumoniae, P. aueruginosa, E. coli
        
        cause
        
        abnormalities in cell-mediated immunity and phagocyte function associated with hyperglycemia
        
        diminished vascularization.
        
        associated-diseases
        
        Pneumonia
        
        Urinary tract infections
        
        Skin and soft tissue infections
        
        Invasive otitis externa
      - Retinopathy
        
        prevention
        
        Intensive glycemic and blood pressure control
        
        Regular, comprehensive eye examinations
        
        treatment
        
        Macular edema
        
        Focal laser photocoagulation
        
        Anti–vascular endothelial growth factor therapy (ocular injection)
        
        Proliferative retinopathy
        
        Panretinal laser photocoagulation
      - Cardiovascular Risk Factors
        
        Dyslipidemia
        
        etiology
        
        hypertriglyceridemia and reduced high-density lipoprotein (HDL) cholesterol levels
        
        management
        
        lower LDL cholesterol(statins)
        
        raise HDL cholesterol
        
        decrease the triglycerides
        
        Hypertension
        
        treatment
        
        ACEI/ARBs
        
        associated-diseases
        
        nephropathy
        
        retinopathy
        
        CVD
- - - - IV drug use
      - Infected Catheters
      - Infective Endocarditis
      - Liver Abscess
    - - Dyspnea
      - Chest Pain
      - Cough
      - Fever
    - - Pneumothorax
      - Empyema
    - - S. aureus
      - K. pneumoniae
- - - - Pneumonia caused by K. pneumoniae
    - - DKA
    - - Septic pulmonary embolism