Pneumo
A 60-year-old with COPD, DM, and CKD presents with signs of pneumonia. CXR shows left lower lobe consolidation. Due to comorbidities, this is the preferred outpatient antibiotic regimen.
What is levofloxacin monotherapy or beta-lactam plus doxycycline?
A 45-year-old man who recently explored caves in Kentucky presents with fever, nonproductive cough, chest pain, and hepatosplenomegaly. CXR shows patchy infiltrates with calcified hilar nodes. Urine antigen is positive.
What is acute pulmonary histoplasmosis?
A 65-year-old man with a 30-year history working in shipbuilding presents with chronic dyspnea. CXR shows calcified pleural plaques. HRCT shows subpleural linear opacities and honeycombing in the lower lobes.
What is asbestosis (a pneumoconiosis)?
A 65-year-old COPD patient presents with worsening dyspnea. CXR reveals hyperinflated lungs and a deep costophrenic angle lucency on the right side.
What is a deep sulcus sign suggesting pneumothorax in a supine patient?
A 55-year-old obese man presents with chronic daytime sleepiness and poor concentration. His partner reports loud snoring and periods where he stops breathing at night.
What is obstructive sleep apnea (OSA)?
These are three key extrapulmonary features commonly seen in Mycoplasma or Legionella pneumonia but rarely in typical pneumonia.
What are diarrhea, rash, and confusion (also: hemolytic anemia or hyponatremia)?
This fungal pneumonia is known to disseminate to skin, bones, and genitourinary tract, and may present with verrucous skin lesions.
What is Blastomycosis?
A 52-year-old woman with joint stiffness, morning pain >1 hour, and positive anti-CCP presents with worsening exertional dyspnea. PFT shows reduced DLCO and FVC. HRCT reveals peripheral ground-glass opacities with early fibrosis.
What is rheumatoid arthritis-associated ILD?
Thoracentesis reveals pleural fluid with high protein and LDH, and low glucose. Gram stain is negative. CXR shows loculated effusion.
What is an exudative effusion, likely from malignancy or empyema?
A 42-year-old woman presents with daily productive cough, especially in the mornings, and frequent lower respiratory infections. HRCT shows “tram-track” appearance and dilated bronchi.
What is bronchiectasis?
This classic hospital-acquired pathogen can cause necrotizing, cavitating pneumonia with currant jelly sputum.
What is Klebsiella pneumoniae?
A 38-year-old man with untreated HIV (CD4 86) presents with subacute dyspnea, dry cough, and low-grade fever. O2 saturation drops with exertion. CXR shows bilateral ground-glass opacities. LDH is elevated.
What is Pneumocystis pneumonia (PCP)?
A 70-year-old man with no smoking history presents with 6 months of progressive dyspnea and dry cough. Auscultation reveals bilateral fine end-inspiratory crackles ("Velcro crackles"). HRCT shows subpleural reticulation, honeycombing, and traction bronchiectasis, predominantly in the lower lobes. No known exposures.
What is idiopathic pulmonary fibrosis (IPF)?
A 67-year-old male with CHF presents with increasing dyspnea. Physical exam reveals decreased tactile fremitus, dullness to percussion, and reduced breath sounds at the right base. CXR shows blunting of the right costophrenic angle.
What is a transudative pleural effusion secondary to CHF?
A 58-year-old man with pancreatitis develops worsening hypoxia, crackles on auscultation, and bilateral infiltrates on imaging. Cardiac echo is normal. PaO₂/FiO₂ ratio is 160.
What is moderate ARDS?
A 60-year-old with COPD, DM, and CKD presents with signs of pneumonia. CXR shows left lower lobe consolidation. Due to comorbidities, this is the preferred outpatient antibiotic regimen.
What is levofloxacin monotherapy or beta-lactam plus doxycycline?
This encapsulated yeast can cause pneumonia and meningitis in HIV patients and is detected by India ink stain or serum antigen.
What is Cryptococcus neoformans?
A 35-year-old woman reports 3 weeks of painful, red eyes with photophobia and blurry vision. Exam reveals bilateral anterior uveitis. She also reports mild cough and fatigue. Chest X-ray shows hilar and right paratracheal lymphadenopathy. Labs reveal elevated serum ACE and hypercalciuria.
What is ocular sarcoidosis with pulmonary involvement?
A 72-year-old retired shipyard worker presents with chest pain and worsening dyspnea. Imaging shows pleural thickening and nodular mass encasing the lung. Biopsy shows spindle cells and positive calretinin.
What is malignant mesothelioma (from asbestos exposure)?
A 23-year-old female with chronic sinusitis, digital clubbing, and daily thick productive cough presents with worsening fatigue, low-grade fever, and purulent green sputum. CXR shows hyperinflated lungs with peribronchial thickening. Sputum culture grows mucoid Pseudomonas aeruginosa. She had a positive sweat chloride test in childhood.
What is a cystic fibrosis exacerbation due to chronic Pseudomonas infection?
A 34-year-old female presents with 6 days of cough following an upper respiratory illness. She has no fever, clear lungs on auscultation, and a normal CXR. CBC shows no leukocytosis. Albuterol improves symptoms. This diagnosis should be favored.
What is acute bronchitis?
A 55-year-old man undergoing chemotherapy for AML develops fever and cough. CT chest reveals nodular lesions with surrounding ground-glass halo (halo sign). Galactomannan assay is positive.
What is invasive pulmonary aspergillosis?
A 56-year-old former coal miner with a 10-year history of rheumatoid arthritis presents with worsening cough and dyspnea. He has multiple firm rheumatoid nodules on his elbows and hands. CXR shows multiple, round peripheral nodules in both lung fields. RF is positive, and PFTs reveal a mixed obstructive-restrictive pattern.
What is Caplan’s syndrome (rheumatoid pneumoconiosis)?
A 22-year-old tall, thin man presents to the ED with sudden left-sided chest pain and shortness of breath after standing up from bed. He is a smoker. Vitals: HR 112, RR 24, O2 sat 96%. Exam reveals decreased breath sounds and hyperresonance on the left. CXR shows a 25% apical air pocket without vascular markings.
What is a primary spontaneous pneumothorax?
An 8-month-old male presents with rhinorrhea, wheezing, poor feeding, and progressive respiratory distress. He was born full-term with no complications. Exam reveals nasal flaring, intercostal retractions, and bilateral expiratory wheezes. Pulse ox is 88% on room air. CXR shows peribronchial cuffing and hyperinflated lungs. RSV antigen is positive.
What is moderate bronchiolitis (likely RSV-induced lower respiratory tract infection)?