Harrison Medicina Interna 18 Edizione Pdf Download (Updated 2022)

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Harrison Medicina Interna 18 Edizione Pdf Download

 

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 . . Volume 1: . . . Chapter 15:  Classification of pneumonic illnesses . . . Título:  Infecciones pulmonares en síntesis.

  Agradecimiento:  Traducción al español:  María Elvira Morales, Silvia Salvador y Pedro Ignacio Martín.

“The physician must begin with an accurate diagnosis, but can not offer guidance until the patient’s complaint, signs and symptoms, and past medical history are accurately recorded. A pathologic diagnosis is usually not possible until the patient’s disease has progressed sufficiently to allow specimen collection.

“The initial clinical diagnosis of community-acquired pneumonia is based upon the patient’s history, examination findings and previous illness. The physician must not, however, rely solely on the history or physical examination in making the diagnosis. In adults, the most useful history to aid in the diagnosis of pneumonia is the patient’s chief complaint, including fever and cough. The patient’s previous illnesses and medical history should be thoroughly reviewed. The differential diagnosis of community-acquired pneumonia, therefore, begins with an extensive review of the patient’s medical history, physical examination and history of recent respiratory infection, and symptoms.

“The physical examination should include a careful evaluation of the lung fields for evidence of localized rales, bronchial breath sounds, diminished air entry, and auscultation for crackles. If the patient is severely ill, the examination may reveal findings consistent with septic shock, including hypotension, cyanosis, bradycardia, and hypothermia. A focused examination should be performed, however, and any abnormality of vital signs, such as tachycardia or fever, should be noted.

“If the patient has pneumonia, the physician must be alert to other concurrent illnesses. Asthma is the most common coexisting respiratory disease. However, the clinician should be alert to other possible coexisting illness, including pneumonia due to Bordetella pertussis, Listeria monocytogenes, Chlamydia pneumoniae, and other infections. Chest radiographic findings in adult patients with community-acquired pneumonia may be normal, but the radiographic appearance of the chest may be abnormal in more severe cases. Signs of acute bacterial pneumonia include the presence of pulmonary infiltrates, edema, and the absence of infiltrate of the pleura. Edema should

 

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