13- chronic cough Flashcards Preview

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Flashcards in 13- chronic cough Deck (27):
1

acute vs chronic cough

acute- <4 weeks- infectious, trauma/choke

chronic >4 wks- infection, inflamm, irritation, anatomic, psychogenic (usually viral)

2

dry cough examples

environmental irritant
asthma
fungal infection

3

wet cough example

lower-respiratory infection

4

barking cough examples

croup
subglottic disease
foreign body

5

brassy honking cough

habitual cough
tracheitis

6

paroxysmal cough

pertussis
chlamydia
mycoplasma
foreign body

7

worse at night cough

asthma
sinusitis (sometimes with HA)

8

Disappears at night cough

habit

9

Associated with gagging or choking cough

GERD

10

change in voice with cough

laryngeal irritation due to chronic rhinitis or gastroesophageal reflux.

11

allergic shiners

Darkening of the lower eyelids as a result of venous stasis

12

allergic salute

A gesture that involves pushing the nose upward and backward with the hand to relieve nasal itching and obstruction. Over time, this may result in the development of a transverse nasal crease.

13

dennie morgan lines

Infraorbital creases that appear due to intermittent edema caused by allergies

14

clubbing

Change in the appearance of the fingers so that the distal phalanx is rounded and bulbous and the angle between the nail plate and the nail fold is increased past 180 degrees. This phenomenon is suggestive of chronic hypoxia.

15

tracheal deviations suggest

a mediastinal mass,
pneumothorax, or
foreign body aspiration.

16

retractions on lung exam

severe obstructive airway disease in children, including asthma, bronchiolitis, and foreign body obstruction.

17

kids on long term inhale steroid therapy should be monitored for...

elevation in blood pressure, serum blood sugar, growth delay, and cataract development.

18

PFT findings in obstructive lung disease

low FEV1/FVC ratio, the FEV1 (%), which produces the scalloped shape on the exhalation limb of the flow-volume curve.

19

PFT findings in restrictive lung disease

low FEV1, but a proportionate reduction in the FVC maintains a normal FEV1/FVC ratio

20

refer kid with asthma to pulomonolgist when...

Has had a life-threatening asthma exacerbation.
Is not meeting the goals of asthma therapy after 3-6 months of treatment, or earlier if the child appears unresponsive to treatment.
Signs and symptoms are atypical.
Other co-morbid medical conditions complicate asthma management.
Additional testing is needed (i.e., allergy testing, bronchoscopy) or immunotherapy is being considered.
Additional patient education regarding adherence to medications or allergen avoidance.
Patient is young (< 3 years old) or has severe asthma.

21

intermittent asthma

<2 days/week of symptoms
<2 nights/month

treat: SABA

22

mild persistent asthma

>2 days/week but not daily
1-2 nights/month if under 4, 3-4 nights if over 4

treat: low dose inhaled steroids + SABA

23

moderate persistent asthma

daily
3-4 nights/month if under 4, 1/week nights if over 4

treat: medium dose inhale corticosteroids

24

severe persistent asthma

throughout day
1/week nights if under 4; 7x/week if over 4

treat: medium dose ICS if under 4
medium or high dose ICS + LABA/montelueklast if over 4

25

other symptoms to consider on differential for asthma/cough

Pneumonia- fever?
sinusitis- HA? sore throat?
GERD- change in voice, chest pain, spit up
CHF- chest pain
Chronic rhinitis- change in voice
Foreign body- choking

26

hyper resonance heard when

localized air trapping behind a mucus plug, foreign body or mass.

27

egophany heard when

lobar consolidation