Acute bronchitis

This should be suspected in patients with an acute onset but persistent cough lasting one to three weeks who do not have clinical findings suggestive of pneumonia.

If nasal discharge, sore throat, or ear pain are present, upper respiratory infection is likely.

Community acquire pneumonia is pneumonia occurring outside of the hospital or occurring within 72 hours of admission to the hospital.

The most common organism is streptococcus pneumoniae also called pneumococcus. Other organisms include haemophilus influenza, legionella species, staphylococcus aureus and klebsiella.

Nosocomial pneumonia is pneumonia acquired after 72 hours of admission. There are two types. That which is ventilator related and non-ventilator related. They are termed , HAP and VAP.

Gram-positive cocci—ampicillin or amoxicillin/clavulanic acid, ampicillin/ sulbactam, or vancomycin for S. aureus. •

Anaerobes—clindamycin or metronidazole.

Gram-negative organisms are suspected, add a fluoroquinolone or ceftazidime.

•Bronchophony is normal if the sound of 99 is muffled and indistinct when repeated by the patient during auscultation.

•If there is consolidation in the lungs the sound of 99 will be very clear.

•Ego-phony is normal if the pronunciation of the letter “e” is muffled. However if the pronunciation of “e” sounds like “a” then there is consolidation in the lungs

•Whispered pecto-ri-lo-quy is the whispering of 1-2-3 by the patient during auscultation. If the lungs are normal , the sound will be heard faintly. If there is consolidation in the lungs the whisper will be heard loudly

•A person’s blood type is determined by the antigen on the surface of the RBC

•. There are four major ABO blood groups determined by the presence or absence of two red cell antigens (A and B).

•People who have neither A nor B antigens are classified as having type O blood.

•Those with A antigens are classified as having type A blood;

•those with B antigens, as having type B blood;

•and those with A and B antigens, as having type AB blood

•. The ABO blood groups are genetically determined.

• In the United States, types O and A are the most common.

Inherited bleeding disorders.

1. von Willebrand—deficiency or defect in vWF

2 HEMOPHILIA A—factor 8 deficiency,. Its an X-linked recessive disorder that primarily affect only males.

3. HEMOPHILIA B---factor 9 deficiency

•Thrombocytopenia may be due to:

•1. drugs such as aspirin,and atorvastatin,

•2. heparin . Ten percent of people treated with heparin develop a mild, transient thrombocytopenia within 2 to 5 days of starting the drug.

•3. Thrombotic Thrombocytopenic Purpura.

•4. immune thrombocytopenic purpura.-Primary ITP is an autoimmune disease in which platelets are directly destroyed or their formation inhibited by the immune system.

Bleeding because of platelet disorders reflects:

A decrease in platelet number because of decreased production,

Increased PLATELET destruction, or

Impaired function of platelets.

There are 5 types of white blood cells.

THE RATE AT WHICH THE RBCs FALL TO THE BOTTOM OF THE TUBE IS ACCELERATED IN THE PRESENCE OF FIBRINOGEN. FIBRINOGEN IS USUALLY INCREASED DURING INFLAMMATORY DISEASE.