1. Diagnosing consolidation on lung exam:
-Egophony: patient says E sound, examiner hears A
-Tactile fremitus: examiner puts palms on b/l posterior rib cage, patients says "oi" sound (toy boat, or 99 in german). Increased vibration implies consolidation, decreased vibration implies effusion.
-Dullness to percussion: can imply consolidation or effusion or large mass
-Whispered pectoriloquy: when the patient whispers words, you hear them louder through the stethoscope on areas of consolidation or cavity.
-Crackles (high frequency, short duration)
-Rales (like crackles, but lower frequency and longer duration)
2. Diagnosing strep throat (Centor criteria) 
-Tonsillar exudates or erythema
-Anterior cervical lymphadenopathy
-Fever (>38 C/100.4 F)
-Absence of cough
-Age <15
One point for each of the above symptoms; subtract a point if they are aged over 44
-0 to 1 points: risk of strep throat <10% (ER) <5% clinic)
-2 to 3 points: risk of strep throat  15% for 2 criteria, 32% for 3 criteria; should do rapid strep test and treat with antibiotics if test is +. If it's negative, go to throat culture.
-4-5 points: Risk of strep throat 56%, empirical antibiotics.
3. Lower respiratory tract infections: Bronchiolitis
-Symptoms: begins as viral illness, progresses to wheezing, cough, dyspnea, cyanosis.
-Population: Peak incidence at 3-6 mos of age, rare in children over 2 years of age. 90% of hospitalizations for bronchiolitis occur in children <12 mos old.
-Common causal organism(s): RSV
-Treatment: neb racemic epinephrine PRN (better than scheduled), oxygen.
4. Lower respiratory tract infections: Bacterial Pneumonia 
-Symptoms: Usually no prodromal symptoms. In children, can present abruptly with fever and sputum. In adults, can present gradually with chest pain, fever, chills, dyspnea.
-Population: Very young, very old.
-Physical exam findings: Fever (>38), vital sign changes (RR, SpO2, HR), crackles, esp focal, pan-inspiratory crackles. Can also see focal wheezing, decreased lung sounds. 50% will have a accompanying pleural effusion.
-Common causal organism(s): S.pneumo
-Treatment: for kids, amox 90mg/kg/day divided into three doses per day for 7-10 days.
5. Lower respiratory tract infections: Viral Pneumonia 
-Symptoms: atypical respiratory symptoms (fever chills, dry cough) and a lot more systemic symptoms like myalgias, arthralgias, GI symptoms.
-Population: children aged 4 mos to 5 years.
-Common causal organism(s): In the winter, usually influenza, although can be caused by RSV in immunocompromised adults, measles/varicella in unimmunized people, and by "common cold" viruses like adenovirus, rhinovirus, parainfluenza. Common in children aged 4 mos to 5 years.
6. Lower respiratory tract infections: Atypical pneumonia
-Symptoms: classic pneumonia symptoms plus systemic symptoms-- GI disturbances (nausea, vomiting, diarrhea), myalgias, headaches, otalgia/otitis, pharyngitis.
-Population: young adults
-Common causal organisms: Mycoplasma, C.pneumonia
-Treatment: In children, azithromycin 10mg/kg/day on day 1, 5mg/kg/day on days 2-5.
7. Lower respiratory tract infections: Acute Bronchitis
-Etiology: viral infection of large airways leading to irritation, edema, obstruction with mucus and edema.
-Symptoms: URI symptoms + productive cough lasting longer than 5 days (with common cold, usually <5 days). 50% will have purulent mucus.
-Physical exam: wheezing, ronchi. Sometimes lung exam will be normal.
-Treatment: albuterol if there is wheezing.
8. Upper and lower respiratory tract infections: Influenza
-Symptoms: extremely abrupt onset of fevers (can go to 104), chills, myalgias, arthralgias, headache, weakness, followed by respiratory symptoms
-Population: everyone; worse in children. Affects 15-40% of school aged children; children under 2 generally have more complications and higher hospitalization rates.
-Exam: can hear ronchi, if the airways are inflamed.
-Prognosis: Fever, headache, sore throat usually last 3-5 days, but lethargy and cough can go on for weeks. Kids should stay out of school for 24 hours after the fever ends.
9. Antivirals for influenza:
-Decrease duration of illness by 24 hours only if given within first 48 hours.
-Only give after 48 hours if the person is clinically worsening at the exam, or if there are signs of a viral pneumonia (crackles, decreased sats/hypoxia sign, abnormal vitals). People who are particularly prone to influenza pneumonia-- kids with chronic lung disease like CF, asthma, BPD; people who are immunocompromised or immunosuppressed, adults with chronic diseases, people over 65.
10. Complications of infuenza:
-Bacterial superinfection with s.pneumo (most common-- staph is less common). 2-3% of kids with influenza will present with this, 14% of adults. T
-Progression to viral pneumonia
-Viral spread or bacterial superinfection to ears
-Rarely, neurological effects like guillain-barre, viral meningitis, febrile seizures (young kids)