Voluminous watery sputum 

Squamous cell carcinoma 

So can be detected w/cytologic studies

Hypertrophic pulmoary osteoarthroatphy is caused by what tumor

(this is enlargement of the extremities and swollen joints)

***This is a medical emergency***

Immediately give corticosteroids 

Do MRI

If MRI positive then radiation + corticosteroid treament 

• X-ray → CT-scan or LDCT if high grade NSCLC → PET if you want to know if the nodule is metabolically active 
• Sputum = easy way to see if there is a squamous cell carcinoma 
• Bronchoscopy for central tumors
• Transthoracic needle biopsy w/CT guide for peripheral tumors 
• If tumors are undiagnosed with bronchoscopy or transthoracic needle biopsy then perform VATS-thoracococpy 

Cancer patients with pleural effusion

Also used as diagnositic tool, if this is negative for cancer after 2 times → then use thorscopy 

• Malignancy
• Benign tumors 
• Granulomas 

"halo" 

This is going to indicate infection w/ invasive Aspergillus 

Less common:

CMV

TB

Herpes

• Obstruction 
• Are vascular and can cause bleeding = hemopytsis

Group D-streptococci 

they are part of the normal gut florae

Pair-chainn-staining pattern

Beaded + filamentous anaerobic 

Part of normal GI flora 

Form abscesses 

Form sulfur granules 

Partially acid-fast bacillus 

Weakly gram-positive 

Forms beaded, branching, thin filaments 

Can lung abscesses 

Can cause lung cavitations 

Can erode into pleura and cause hematologic spread

Pseudomoans 

Haemophilus 

Pneumocococcal

Legionella 

More than 50% have GI symptoms

Hyponatremia is also implicated

(can also have hemoptysis or cavitations)

• C = confusion 
• U = uremia 
• R = respiratory rate > 30 
• B = systolic < 90 or diastolic < 60 
• 65 = Age > 65 

Score 0-1 = outpatient treatment

Score 2 = admission to medical ward 

Score 3 or higher = ICU 

Culture or sputum

X-ray:  NEED to find infilitrate to make diagnosis 

H. Influenzae 

> 50% of these have a pleural effusion associated with them

Lobar:

• S. pneumoniae is a common cause
• Air-bronchiograms are visible 

Lobular:

• Bronchograms are usually absent 
• Pathogens that cause this are usually going to be destructive (abscesses, pnumatoceles, pulmonary gangrene) (staph aureus is a good example) 
• Lead to abscesses, cavitations, half of these can also cause empyemas (cavitation and pleural effusions are also seen in anaerobic infectinons, gram-negative infections, and TB)

Legionella 

Pneumonoccous

Mycoplasm

Chlamydia

Legionella 

Coxiella

Predilection for the skin, soft tissue, and meningis 

Although most people are asymptomatic, dissemination can occur especially in immunocompromised, pregnant women, and in certain racial groups (blacks + filipinos)

PCR 

Always do an X-ray

But diagnosis is made by observing spherules that have endospores in the sputum. They are ID on smears by using calcofluor white or cytologic staining

What is going to be elevated in a patient with PCP

CXR?

LDH > 220 

CXR youcan see diffuse bilateral infiltrate in perihilar region

Pneumothorax may occr in patiets using aerosolized pentamidine

Apical disease might be there for patients using pentamidine for porphylaxis 

Cresyl violet

Giemsa

Diff-Quick

Wright stain 

Detect both the trpohozoite and cyst form but NOT the cyst wall 

TMP-SMX 

Corticosteroids in HIV + patients only if they have severe PCP defined by < 70 mmHg arterial O2 concentration or Aa gradient > 35

WG

B/c of the granulomas

• Nodular lesions on the lungs, 50% with cavitations
• DAH may be present

• Corticosteroids
• Cyclophosphamide:  Caues hemorrhagic cystitis, bladder cancer, other malignancies, cytopenia, infertility, opporutnistic infections b/c of leukoplakia
• Rituximab is an alternative to cyclophosphamide 

• Plasmaphereisis
• Corticosteroid + cyclophosphamide
• Remove offending agent
• TMP-MPX sometimes b/c PCP develops b/c of steroids 

acute = viral

Chronic = asthma or sinusitis 

Mycoplasma 

Hypersensitity pneumoniits

Pertusis for PCR

Can also do this for viral infections

Chronic cough 

Suspected pneumonia

Asthma complications suspected

Croup 

Epiglotitis

viral = coughing 

Bacterial = not as much coughing

Dexamethasone 

If severe: 

Epinephrine to reduce subglottic edema via vasoconstriction

Ceftriaxone 

Cefotaxime 

(3rd gen)

Laryngeal web 

can also have difficulty breathing that is proportional to the obstruction

• C = Absence of cough
• C = Cervical lymphadenopathy 
• E =  Tonsilar exudate 
• F =  Fever 

0-1 = no treatment 

2-3 = culture + antibiotics if +

4 = antibiotic eperically