tasneembanu
Forum Guru
Topics: 96
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i think,Chest X-ray for both pneumonia and TB would be teh best initial test.
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| sk
Forum Senior
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well..thats what i thought....but then i cam across a question in Qbank....which of the following would be the best initial test in a pt with pneumonia etc etc....and in the options..there was x ray and gram stain as well as otherrs.. the answer was gram stain...and the thinking behind it was that gram staining doesnt take a lot of time..while and x ray would take longer...
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| joyti khatri
Forum Newbie
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i think in pneumonia theres is non productive cough so diagnose we 1st look for chest changes by X RAY
and in TB we would go 4 X ray and sputum but while awaiting 4 sputum we get XRAY
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| noelle
Forum Elite
Topics: 59
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for all patients cxr is also one of routine investigations. shows you info abt chest .also u see the area of involvement n then can make a decision on type of  bug!!
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| cache
Forum Guru
Topics: 130
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its a kind of no brainer, you ideally would want a chest xray in hand , before going on to bigger things....sic... like gram staining, and sputum culture. 
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| chd_guy
Forum Newbie
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this is a stupid question just to confuse the candidate. it is just like what will u get first in a patient of renal derangement urea or creatinine.
practically all necessary test are ordered when u get in touch with the patient. It does not have to be done in a step wise fashion. But from examination point of view there is an answer.
Pneumonia- x ray inflitrates are essential for diagnosis of punemonia. Cough in pneumonia is mostly productive and gram stain and culture is done but is is frequently negative in communtiy aquired pneumonia. but it is still done to guide for organism senstivity so answer is X ray
TB- diagnostic critera include both inflitrates on Xray ie apical , cavitation extra and also acid fast bacili in sputum and positive culture. positive culture is highly specific for TB
But the culture has to be obtained over three consectuive days and then the report is prepared so obviously we will have in hand CXR before the sputum report. Many times TB is diagnosed accidentaly from feature in chest x ray. Answer is X ray only
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| tuesday
Forum Senior
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To help out with the confusion about CXR & Gram staining::::::
Always do CXR FIRST for all respiratory infections!
Study the ff. & guaranteed u'll ace all the questions on resp. infections.
1. fever+cough+(-/+)sputum,CXR Normal=BRONCHITIS Tx: Amoxicillin
2.fever +cough+alcoholic+bad smell,CXR lobar infiltrates =ABSCESS(sec. to anaerobes aspirated)
Tx. inf. above the diaphragm-Clindamycin
Tx. inf. below the diaphragm-Metronidazole
3.fever+cough+sputum,CXR lobar infiltrates
in a young, healthy person=Pneumonia sec. to Pneumococcus Tx. for Outpts:-Macrolides, Inpts.-Quinolones
4.above sxs. +healthy older pts.-Pneumococcal Pneumonia Tx. macrolides
5.above sxs. older pts. + COPD,(+) smoker,immunodef.= Pneumococcal Pneumonia
Tx. MACROLIDES
6. fever+cough+sputum prod'n +CXR bilateral interstitial infiltrates =atypical Pneumonias( MYCOPLASMA,H.FLU,CHLAMYDIA,LEGIONELLA,
VIRAL,Pneumocystis etc...)
7. RESP.INF.+GI manifestations=Legionella
Most specific Dxc.test=Urinary Ag
8.Mycoplasma most specific test: Serology x IgG & IgMl
Hope this helps. It's easy to digest.
REMEMBER: THE MC etiologic organism, #1 cause is always the same(STREP.PNEUMONIA),#2 & #3
causes changes.
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