1. Sore throat, fever, stridor, hot potato voice
-Epiglottitis.
-Dx with lateral CXR or direct laryngoscopy.
-Now with the HiB vaccine its more common in adults than kids.
-H.flu- cover with ceftriaxone.
-Can be complicated by retropharyngeal abscess
2. Fever, cough, lobar consolidation on CXR in a young person
-Strep pneumo or atypicals,
-Azithro, respiratory quinolone (levo, moxi), augmentin.
-PORT score and CURB65 - clinical decision tools on whether to admit someone with CAP.
-If you admit, add ceftriaxone for better coverage of pneumococcus because thats whats going to kill her.
3. Fever, cough, disseminated white crap on CXR
-viral CAP, mycoplasma, PCP.
-If there are myalgias, influenza PNA more likely.
-Rule out HIV/PCP before you give them a z-pack and send them home.
4. Fever, cough, dyspnea in a person from a nursing home
-HCAP.
-Higher likelihood of GNR pneumonia
-Need ceftriaxone in addition to azithro
-Consider pseudomonal coverage unless you're pretty sure its not psuedomonas.
5. Flu --> pneumonia. Staph. Vanc. Done.
6. Bilateral lower lobar consolidation on CXR
-Aspiration
-Polymicrobial, mouth anaerobes.
-Clinda. or Augmentin.
7. Lesion in upper lung lobe
-reactivation TB. (primary TB is usually middle and lower lobe).
-TB acquired a long time ago that reactivated with immunosuppression at old age is usually not-resistant.
8. Diffuse cotton-ball/ping pong ball on CXR
-septic emboli
9. Fever, back pain, new heart murmur
-acute endocarditis, sudden onset new murmur, usually the patient has an infected line, or is an IV drug user. Staph. Treat immediately. Vanc + gent for synergy, and some GN coverage.
-subacute endocarditis: symptoms have been going on for weeks, osler nodes, janeway lesions, back pain, etc. Usually strep (viridians) or HACEK organisms. Wait 24 hours to get sequential blood draws to improve yield for cultures, start antibiotics.
-complications: heart block, valve failure, septic emboli
-when to call the cardiac surgeons for a new valve-- not getting better (got bug, got sensitivities, right abx, but still have repeated + blood cx), prosthetic valve (hard to clear infx from here), fungal infection (grows too slow for drugs to work)
10.Fever, RUQ pain, +murphys sign 
-cholecystitis
-dx with u/s
-enteric GNR (e.coli, enterococci, pseuds)
-treat with broad spectrum anti-GN (Zosyn/Timentin cover pseuds, Unasyn doesn't)
-Sanford guide recommendations
Zosyn (pip-taz), 3.375 g IV q6h or 4.5 g IV q8h
Unasyn (amp-sul), 3 g IV q6h
Meropenem 1 g IV q8h
In severe life-threatening cases, the Sanford Guide recommends imipenem/cilastatin (Primaxin, 500 mg IV q6h).
-Consider surgery soon.