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Low-grade fever, nonproductive cough, rare bullous myringitis, cold agglutins Mycoplasma PNA
Young adults, college settings Mycoplasma PNA
Alcohol Abuse PNA Klebsiella PNA
Cystic Fibrosis Pseudamonas
Air Conditioning/Aerosolized Water Legionella
Leukemia,lymphoma Fungus
Children <1 yr RSV
Children, <2yr Parainfluenza
Abrupt high fever, rigor, myalgias, rusty sputum, productive cough, pleuritic chest pain, CXR: lobar consolidation Strep Pneumo
Acute Bronchitis, symptomtic relief Bronchodilator (albuterol)
Bilateral Hilar adenopathy, no parenchymal abnrl, dry cough, suspect sarcoid Bx mediastinal LN
Transmitted by droplet nuclei Mycobacterium TB, Influenza
Currant Jelly Sputum, alcohol abuse, hemoptysis, SOB, CXR: cavitations Klebsiella PNA
Mycoplasma PNA tx Macrolides (erythromycin)
Chlamydia Infection Tetracycline
Hospital Acquired Cefepime, Ticarcillin/Clauvanic acid, Piperacilline/tazobactam, meropenem
Increased LDH, hypoxemia, CXR: interstial infiltrates Pneumocystis jiroveci
Hyponatremia, diarrhea, chronic cardiac or respiratory dz Legionella PNA
Longer prodrome, sore throat, hoarseness Chlamydia PNA
Community Acquired PNA Tx Macrolides (clarithromycin)
CXR: hilar adenopathy, infiltrates or single or multiple nodules, anorexia, weight loss, asthenia and cough Bronchogenic Carcinoma
CXR: Hyperinflation of lungs and flattended diaphragms Asthma, COPD
CXR: dilated, thickened bronchi, scattered opacities, and atelectasis Bronchiectasis
h/o COPD, retrosternal CP, narrow splitting S1, systolic ejection click, accentuation of 2nd heart sound CXR: pruning of large pulmonary arteries. Pulmonary Hypertension
Pneumocystis Jiroveci Tx Bactrim
Eggshell calcification of hilar or mediastinal LN silicosis
CXR: cavitation lung abscess or progressive primary TB
CXR: pleural thickening mesothelioma
CXR: Hilar and mediastinal abnormalities Lung Cancer
CXR: Hyperinflation (and bullae) Emphysema
Rapid, deep labored Breathing Kussmaul
Irregular and varying depth breathing ataxic
Periods of deep breathing alternate with periods of apnea Cheyne-Stokes Breathing
CXR: indistinct heart border appearance, ground glass Asbestosis
CXR: irregular opacities- reticular to nodular pattern Coal Miners
CXR: patchy fibrosis, produced from spores, and hypersensitive pneumonitis Farms lungs
PNA Physical Exam Findings inspiratory crackles, bronchial breath sounds, incr tactile fremitus, transmitted voice sounds
Lung Cancer with worst prognosis Small cell lung cancer
TB Tx for immunocompetent persons Minimum 6 mo INH and RIF, with initial 2 mo PZA and SM or EMB
Atypical PNA CXR Diffuse infiltrates, unilateral lower lung infiltrates
Legionella Tx for immunocompromised patients: TOC Azithro or Clarithromycin, or fluoroquinolone (levofloxacin)
Gold Standard Imaging for DVT Contast Venography
PE tx in hemodynamically unstable patient thrombolysis with tissue plasminogen activator (t-Pa)
Inflammed nasal turbinates, nonproductive cough, postnasal drip, cobblestoning of posterior pharynx, diffuse bilateral end expiratory wheezes: Lab test for diagnosis Spirometry for asthma
Asthma: nighttime symptoms and daily exacerbations Severe Persistent
Long acting bronchodilators Ie. Salmeterol
LABA long-term prevention of asthma, nocturnal sx, and prevention of exercise induced bronchospasm
Inhaled Corticosteroid Fluticasone
Anticholinergic Agent for asthma Ipratropium – used to reverse vagally mediated bronchospasm but not allergen or exercise induced spasm
Sx: chronic cough, purulent sputum, hemoptysis, recurrent PNA and CF associated Bronchiectasis
Most sensitive to detect small amount of pleural fluid Chest CT
Transudative Fluid CHF
Tranusdative Fluid Labs Gluc >60, Protein <3.0, WBC <1000, LDH <200
Exudative Fluid Carcinoma
Exudative Fluid Labs Gluc <60, Protein >3.0, WBC <1000, LDH >200
CXR: expiratory film shows a visceral pleural line. Pneumothorax
Pneumothorax PE Findings Decrease Tactile Fremitus, hyperresonance
Small Pneumothorax CXR type Expiratory
Right ventricular hypertrophy, due to COPD Findings Cor Pulmonale: distended neck veins, prominent epigastric pulsations
Cystic Fibrosis MC initial presentation Failure to Thrive
2-3 weeks cough, coryza without fever, high pitched inspiratory sound Pertussis
Pertussis Tx Erythromycin, clarithromycin or azithromycin
Pertussis HM Treat household contacts
Coal worker's penumoconiosis (CWP) lab finding Decreased FEV1
Idiopathic pulmonary fibrosis Tx no treatment improves survival. Oral corticosteroids with an immunosuppresive agent is Rx
Preterm Infant with apneic events Tx Methylxanthines ie caffeine citrate (20mg/kg loading dose, then 5-10 mg/kg/day)
Preterm Infant with Respiratory distress: rapid shallow breathing, grunting retractions, duskiness of skin. CXR: bilateral atelectasis Hyaline Membrane Disease
Bronchiolitis Agent RSV
Erythema Infectiosum Agent Parvovirus
Influenza A Treatment Inhaled zanamivir or oral oseltamivir
Pertussis Stages: congestion, rhinnorhea, low grade fever, and sneezing 1st stage: Catarrhal
Pertussis Stages: onset of coughing 2nd stage: paroxysmal
Perstussis Stages: number, severity, and duration of coughing episodes diminish 3rd stage: convalescent stage
Aphonia inability to vocalize, sign of complete obstruction
Horner Syndrome ipsilateral ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (hemifacial loss of sweating); found in patients with lung cancer
Acute Exacerbations of chronic bronchitis Macrolides, fluoroquinolones and Augmentin
Penicillin Allergy No Cephalosporins
Healthy males 20-40 yo are at risk for Spontaneous Pneumothorax
Recently converted, Previous untreated TB patient Tx Isonizid, Rifampin, pyrazinamide and ethambutol
60 yo, insidious onset of DOE, and nonproductive cough, and fatigue. PE: bibasilar inspiratory crackles, and clubbing of fingers. CXR: reticular pattern of densities in the lower lung fields. Diagnosis with what labs? Interstitial pulmonary fibrosis: Surgical Lung Biopsy
Abnrl permanent enlargement of air spaces distal to the terminal bronchioles accompanied by destruction of their walls and without obvious fibrosis Emphysema
"Posttussive Rales", dry cough progresses to productive cough, fever, drenching night sweats, anorexia and WL TB
Biopsy revealing caseating granulomas (necrotizing granulomas) TB
LTBI Tx INH x 9mo or RIF 4 mo or RIF and PZA for 2 mo.
Active TB INH/RIF/PZA/EMB x 2 mo, followed by INF/RIF x 4 mo
INH side effects (isoniazid) hepatitis, peripheral neuropathy, coadminister B6 to reduce risk
RIF side effects (Rifampin) hepatitis, flu sendrome, orange body fluid (orange urine)
EMB (ethambutol) optic neuritis (red-green vision loss)
PZA pyrazinamide
Active TB Tx duration 6-9 mo
HIV with active TB Tx duration 1 yr
TB Skin Test Positive: >/= 5 mm HIV+, Recent contacts to those with active TB, CXR evidence, immunosuppressed pts on steroids
TB Skin Test Positive: >/= 10 mm Recent immigrants from High TB areas, HIV – IVDU, laboratory personnel, Residents/employees of high risk congregate settings, Persons with certain medical conditions: DM, CRF, children <4yo, or infants/children/adoles exposed to adults at high risk
TB Skin Test Positive: >/= 15 mm No risk facts for TB
MC type of bronchogenic carcinoma Adenocarcinoma
Bronchial in origin, centrally located mass, p/w hemoptysis Squamous cell carcinoma
Appears in periphery of lungs, arises from mucous glands, mets to distant organs Adenocarcinoma
Bronchoscopy reveals a pink or purple central lesion that is well vascularized Carcinoid Tumor
Lung Cancer Complications SPHERE: SVC syndrome, Pancoast's tumor (tumor of lung apex, causes Horner's syndrome) Horner's syndrome, Endocrine (carcinoid syndrome: flushing, diarrhea, telangiectasias), Recurrent Laryngeal Nerve (hoarseness) Effusions (exudative)
Lights Criteris for Exudative Fluid Protein:Serum protein >0.5; Fluid LDH:serumLDH >0.6, Fluid LDH greath than 2/3 ULN for serum LDH
COPD and asthma Airflow obstruction FEV1/FVC:<75%.
Asthma Intermittent Lung Function FEV1>80%, FEV1/FVC normal
Asthma Mild Persistent >2xweek, Night: sx 3-4/mo, rescue >2 days per week, not more than 1xper day
Asthma Moderate Persistent Daily Sx, Night: >1xweek, daily use of rescue
Asthma Moderate Persistent Lung Function 60%<FEV1<80%, FEV1/FVC reduced 5%
Asthma Mild Persistent Lung Function FEV1>80% predicted, FEV1/FVC normal
Severe Persistent Continual Sx, Extremely limited activities, Night: 7x/wk, Rescue: several x/day
Severe Persistent Lung Function FEV1<60% predicted, FEV1/FVC reduced >5%
Parenchymal bulllae and subpleural blebs pathogno. Emphysema
Nonspecifc peribronchial and perivascular markings Chronic Bronchitis
Sweat Chloride Test Positive >60 mEq/L
Exudative effusion "leaky capillaries" infection, malignancy, trauma
Transudative Fluid "intact capillaries" increased hydrostatic or decr oncotic pressure ie. CHF, atelectasis, renal or liver disease (cirrhosis)
Mediastinum is shifted away or towards side of effusion away
Visceral pleural line Pneumothorax
Mediatinal shift to the contralateral side Tension Pneumothoras
Pneumothorax CXR Expiratory – look for visceral line
PE test Spiral CT
Definitive Test for diagnosis of PE Pulmonary Angiography
Virchows Triad For PE: hypercoagulable state, venous stasis, and vascular initmal inflammation or injury
Idiopathic pulmonary fibrosis CT diffuse, patchy infiltrates with honeycombing
Idiopathic pulmonary fibrosis PFT restrictive pattern: decr Lung volume with normal to incr FEV1/FVC ratio
Elevated ACE and paratracheal lymph nodes Sarcoidosis

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