Layer of the pleura that lines chest wall & covers the mediastinum.
Forms the pulmonary ligament.
Supplied by branches of the internal thoracic, superior phrenic, posterior intercostal, and superior
intercostal arteries
Insenstive to pain, but sensitive to stretch
Visceral layers
Inner layer of the pleura that covers the lung & lines its fissures.
Supplied by the bronchial arteries
Very sensitive to pain.
Neurovascular Supply
Physical Examination
Inspection
ill-looking
SOB
Diaphoresis
Chills/rigors
Respiratory distress
Cough
Palpation
Decreased chest expansion or asymetry
Lymphadenopathy
Tactile fremitus
Percussion
Dull
Decreased diaphragmatic excursion auscultation
Bronchial breath sounds in periphery
Decreased air entry
Crepitations
Bronchophony -voice heard abnormally clearly over consolidated lung
Egaphony - listen to patient's chest as they make "e" sound, if +'ve will hear an "a" sound
Whispering pectoriloquay - pt whispers "1, 2, 3, 4", if clear then extreme consolidation
Pleural friction rub
AKA pleuritis => inflammation of the pleura with exudate formation
It’s a symptom rather than a disease it self
Lack of breath sounds in a certain area of the chest, which may mean that air is not entering an area of
the lung.
Breathing sounds
Abnormal Breathing sounds
Auscultations
Lab investigations
Differential diagnosis of fever
Common cold
Pharyngitis
TB
Lung abscess
Bronchitis
Acute sinusitis
Influenza flue
Epiglottitis
Cryptoco-ccosis
Cancer
Whooping cough (pertussis)
X- ray findings
Sputum culture
Thick mucus or phlegm that is expelled from the lower respiratory tract through coughing
Bacterial sputum cultures detect the presence of disease-causing bacteria
What Abnormal Results Mean ?
Bronchitis
Lung abscess
Pneumonia
What is it?
An infection in one or both lungs. It can be caused by bacteria, viruses, or fungi. Bacterial pneumonia is
the most common type in adults. Pneumonia causes inflammation in the air sacs in your lungs, which
are called alveoli. The alveoli fill with fluid or pus, making it difficult to breathe.
Epidemiology
Etiology
Risk factors
In terms of age
Children who are 2 years old or younger
People who are age 65 or older
Others
Being hospitalized
Chronic disease.
Smoking.
Weakened or suppressed immune system
Classification
Location acquired
By area of Lung affected
lobar pneumonia
Only involves a single lobe
Often due to Streptococcus pneumoniae
Morphology
X-ray
Grossly
Microscopically
Multilobar pneumonia
Involves more than one lobe
Often causes a more severe illness
Bronchial pneumonia
Affects the lungs in patches around bronchi or bronchioles
Morphology
X-ray
Grossly
Microscopically
Interstitial pneumonia
Involves the areas in between the alveoli
It may be called "interstitial pneumonitis."
More likely to be caused by viruses or by atypical bacteria.
Ampicillin - Irreversible inhibitor of
the enzyme transpeptidase, which is
needed by bacteria to make the cell
wall. It inhibits the third and final
stage of bacterial cell wall synthesis
Prevention
Tuberculosis
Flare up of chronic obstructive pulmonary disease (COPD) or cystic fibrosis
Blood culture
Culture is positive for one of the following organisms:
Streptococci (non-viridans)
Anaerobic cocci
Aerobic and facultative gram-negative rods
Anaerobic gram-negative rods
Yeast
Negative growth does not rule out infection.
Complete blood count
Red blood cells, which carry oxygen
White blood cells, which fight infection
Hemoglobin, the oxygen-carrying protein in red blood cells
Hematocrit, the proportion of red blood cells to the fluid component, or plasma, in your blood