Welcome back to the Hospital Medicine Podcast. I'm your host, Dr. Gil Parrott. And today's topic is

pneumonia. At the outset, I should say, I have not met with a pharmaceutical rep in probably almost a

decade, so I have no conflicts of interest. And with that being said, we'll just dive into the topic. When it comes to pneumonia,

I think one of the first questions you need to ask yourself is whether the patient actually

has pneumonia, because we can get into this problem of anchor bias, where we rely too heavily

on the first diagnosis offered, and that can misguide us just because

the ER doctor or the primary care doctor that's calling for direct admit says it's pneumonia. It's your

job to think twice and then make your own decision about the diagnosis.

And indeed, it can be challenging.

And sometimes patients have two things.

For example, you could have a neoplastic disorder coexist with pneumonia,

so a bronchogenic carcinoma may be causing obstruction,

which is then causing pneumonia.

Sometimes with your patients who have heart failure, it can be very difficult to determine is this heart failure or is it pneumonia or sometimes is it both.

And then there's the diseases we don't see nearly as often as we see pneumonia,

such as vasculitis, w Wegener's granulomatosis,

sarcoidosis, systemic lupus. And needless to say, a lot of these other disease processes

can present with some very similar overlapping symptoms and signs that pneumonia does.

So let's talk a little bit about what's going on when you do have a lower respiratory tract infection.

And what's going on is basically a balance between your immune system and immune functions

trying to get rid of microbes, and yet sometimes it can

also overreact where there's too much inflammation, and then you develop acute lung injury

...