Rapid, deep labored breathing
Kussmaul breathing (DKA, Metabolic acidosis)
Deep breathing alternating w/ apnea
Cheyne-Stokes breathing (heart failure, brain damage)
Cavitations on CXR
Infections (lung abscess, TB)
caseating granulomas, Apical infiltrates, Fever, Chills, dry cough, night sweats
Pleural thickening on CXR
Hilar mass on CXR
Eggshell pattern on CXR
Ground glass appearance on CXR
Asbestosis (shipbuilders, building demolition)
Reticular to nodular pattern on CXR
Coal Miner's lung
Patchy fibrosis on CXR
Non caseating Granulomas and inflammation of alveoli, small bronchi and small blood vessels
Dyspnea after surgery, travel (airplane), LE Fx. May have c/o calf pain also.
Lung scan with perfusion defects
Venous stasis, vessel wall injury, hypercoagulability
DVT/PE (Virchow's triad)
Pediatric with barking cough, stridor
viral croup (Tx w/ racemic epi and glucocorticosteroids if stridor at rest)
lower respiratory FB, asthma
Drooling, sniffing position, tripod, toxic
viral croup (laryngotracheobronchitis)
FB, viral croup
Premature infant with respiratory distress
Hyaline Mb Disease
Preemie CXR w/ hypoexpansion (ATX), air bronchograms
Hyaline Mb Disease
Smoker, chronic productive cough. NO hemoptysis or weight loss
Hyperinflation on CXR, tear drop heart
Wheezing, prolonged expiration
Airway edema with eosinophils, neutrophils, lymphocytes
Fever, cough, sputum. Crackles, decreased breath sounds, dullness to percussion, +egophony, pectoriloquy. CXR - infiltrates or consolidation
>35yo with PNA. Rusty colored or yellow-green sputum. Acute onset F/C
<35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches
Mycoplasma or chlamydia pneumonia
PNA w/ Smokers, COPD
PNA w/ DM, immunocompromised, EtOH, current jelly sputum.
PNA w/ Water, late summer, construction site. Diarrhea. Toxic looking
PNA from Nursing homes, chronic care facility. Purulent sputum
PNA & HIV+, AIDS, Immunocompromised. Sx out of proportion to exam. Diffuse interstitial & alveolar infiltrates
Pneumocystis jerovecii (TMP-SMX = Drug of choice)
PNA & decreased mental status, poor dental hygiene, dentures, foul smelling sputum, bronchiectasis. Patchy infiltrates in dependant lung zones
Pediatric with Hx recurrent lung infections, pancreatitis, reproductive problems, FTT, thick, green sputum
Cystic fibrosis (Staph & Pseudomonal infections usually cause of death)
Sweat chloride test
Cystic fibrosis w/ PNA
Pseudomonas aueroginosa causative agent
< 2 days post-op with fever
Stab wound or broken ribs, hyperresonance to percussion, decreased breath sounds, tympany
Stab wound, dullness to percussion, decreased breath sounds.
Tall, skinny, male, band student, acute onset one-sided chest pain, dyspnea
Stab wound to chest. Hypotension, tracheal shift
Poor sleeping, obese, daytime fatigue & drowsy, snoring, HTN, PM wakening
Obstructive sleep apnea
s/p thoracic trauma. Multiple rib fractures. Chest wall moves in with inspiration, out with expiration.
Flail chest (pain control, incentive spirometry, pulmonary toilet, intubation)
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