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jstaylor
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Restrictive PFTs
- Decreased FEV1
- FEV1/FVC >80%
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Obstructive PFTs
- Decreased FEV1 and FVC
- FEV1/FVC ratio <80%
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recurrent pneumonia
- same region: local anatomic obstruction, recurrent aspiration
- different region: sinopulmonary disease, non-infectious, immunodeficiency
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Aspiration pneumonia
risk, bugs, tx
- altered consciousness
- neurologic dysphagia
- disruption of the gastroesophageal junction
- mechanical disruption of the glottic closure
- sedation for procedures
- bugs: oral flora (aerobic and anaerobic)
- tx: clindamycin, amp-sulbactam
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Atypical pneumonia
- mycoplasma pneumonia, chlamydia pneumonia, legionella, coxiella, influenza
- mycoplasma is the most common in ambulatory setting
- indolent course: non-productive cough, extrapulmonary symptoms (headache, sore throat, skin rash)
- Skin rash is typical of mycoplasma, also does not gram stain
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asthma exacerbation
sign of severe attack
- normal Pco2: indicates retaining, as normally patients are hyperventilating and will have low Pco2
- speech difficulty
- diaphoresis
- altered sensorium
- cyanosis
- "silent" lungs
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idiopathic pulmonary fibrosis
- PFTs: restrictive lung pattern
- diffusing capacity is reduced, due to V/Q mismatch: A-a gradient increased
- honeycomb pattern
- pulmonary vascular congestion in the hilum
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modified Wells criteria
for PE
- 3 points: clinical signs of DVT, alternative diagnosis less likely than PE
- 1.5 points: previous PE or DVT, HR >100, recent surgery or immobilization
- 1 point: hemoptysis, cancer
- >4 points: PE likely
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