2. Acute Cough (<3 weeks)
(Productive/Unproductive)
Symptoms, Signs or Risk Factors for Pneumonia
Symptoms
Dyspnea, high fever, rigors, pleuritic chest pain, altered mental status
Signs
Abnormal vital signs: High fever >38°C, HR >100 bpm, RR >24 breaths
per minute, hypotension, hypoxia
Physical examination: Dullness to percussion, crackles, decreased breath
sounds, bronchophony, egophony
Risk Factors
Elderly patients, known COPD, heart failure, kidney failure, DM
Obtain chest film Lateral
and PA
Unlikely pneumonia
Treat patient
symptomatically
Likely pneumonia analyze
the results
Unlikely pneumonia
Treat patient
symptomatically
Any symptoms (+) None
Abnormal Normal
Chief complaint
APPROACH TO PATIENT WITH ACUTE COUGH
3. ANALYSING RADIOGRAPHIC AND CLINCAL CLUES
Chest X-ray with infiltrates
(Review chest film and clinical clues)
Chest film History
Probable diagnosis: CAP
Probable diagnosis: CAP
Also consider: Aspiration pneumonia
Probable diagnosis: CAP
Also consider: Influenza pneumonia
Lower/middle lobe infiltrate
Cavitary lesion
Lobar/bilateral infiltrates
Altered mental status,
alcohol abuse or other
aspiration risk factors
Non vaccinated patient,
influenza season
Radiographic clues Clinical clues
4. Clinical Presentation CAP (Our Leading
hypothesis)
Aspiration (Alternative) Influenza
(Alternative)
Acute bronchitis
(Alternative
Cough with mucopurulent
sputum
√ √ X √
Chest pain √ √ Mild √
Shortness of
breath/Difficulty in
breathing
√ √ √ √
High grade fever √ √ √ X
Neutrophilia √ √ √ √
Dullness in lung field √ √ X X
Consolidation √ √ √ X
Tachypnea √ √ √ √
DIFFERENTIAL DIAGNOSIS AND THEIR CLINICAL PICTURES
5. Acute Cough (<3 weeks)
(Yellow sputum)
Symptoms, Signs or Risk Factors for Pneumonia
Symptoms
Dyspnea, high fever, rigors, pleuritic chest pain, altered mental status
Signs
Abnormal vital signs: High fever >38°C, HR >100 bpm, RR >24 breaths
per minute, hypotension, hypoxia
Physical examination: Dullness to percussion, crackles, decreased breath
sounds, bronchophony, egophony
Risk Factors
Elderly patients, known COPD, heart failure, kidney failure, DM
Obtain chest film Lateral
and PA
CAP Pneumonia
(Primary impression)
Treatment coverage: CAP
Chest X-ray with infiltrates
(Review chest film and clinical clues)
Chest film History
(+) for many symptoms
Consolidation
Radiographic clues Clinical clues
Chief complaint
CBC Test
Right lung basal field
consolidation
No history of current
hospitalization, No
substance/alcohol abuse
Bacterial
infection
Sputum test
S.Pneumoniae
PRIMARY IMPRESSION
