Community acquired pneumonia: Investigation: 1. Sputum culture 2. Blood culture 3. Influenza PCR 4. Urine: a. Legionella b. Strep. pneumoniae 5.

CXR normal CXR URTI Classification: 1. Pneumonia severity index estimates mortality from CAP a. 1/2 low risk of readmission i. Discharge with antibiotics (Augmentin and clarithromycin) b. 3 high risk of readmission i. Admit for observation c. 4 mortality 10% i. Admit for treatment d. 5 mortality 20-30% i. Treat in ICU 2. CURB-65 score a. 0-1 discharge with antibiotics b. 2 admit with treatment c. >3 ICU d. Criteria: i. Confusion ii. Urea > 7 iii. RR > 30 iv. BP <95mmHg v. >65 years old Common causes: 1. Virus: a. Influenza 2. Bacteria: a. Strep. pneumoniae b. Mycoplasma pneumonae c. Moraxella d. Hemophillus influenza b (Hib) e. Legionella 3. Fungal: a. Meliodosis (treat with Meropenam and Ceftazidine) Treatment: If antibiotic treatment does not work for 3 days (no improvement seen) do a CXR to exclude pleural effusion/ empyema which may require chest tube drainage.

Risk factors for UTI: 1. Female 2. Urinary Procedures a. IDC 3. Stones 4. Neurogenic bladder: a. DM b. Spinal injury Investigations: 1. Urine culture: a. Look for bacteria, WBC, nitrates i. Anaerobes colovesical fistula ii. Nitrates +ve Gram-negative 2. Urine dipstick 3. UFEME: a. Casts b. Epithelial cells contamination c. WBC (Increased in infection) d. Nitrites e. Leukocyte esterase infection 4. Blood culture (x2 sample) 5. Inflammatory markers: a. Procalcitonin specific for bacteria infection i. >1 proceed to septic workout b. ESR chronic infection (not used for acute infection) i. Prosthetic valve monitoring (IE) ii. Chronic osteomyelitis c. CRP acute inflammation/infection. Rise and fall fast. Pathogens common in UTI: 1. E.coli 2. Proteus (Check urine pH increased in proteus) 3. Klebsiella 4. In pregnant women GBS 5. Staph. Saprophyticus Differentiate: Pyelonephritis v.s. Cystitis Pyelonephritis: Higher fever with chills and rigors Flank pain Other urinary symptoms common to both pyelonephritis and cystitis: Dysuria

Urgency Frequency Foul-smelling urine Discharge

Note: Young man should not have bacteria in the urine Young woman 10% have bacteria in the urine but asymptomatic Old man and woman 10-20% have bacteria in the urine but asymptomatic. Treatment: Antibiotics Cephazolin + gentamycin