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Junior - Pulm Mod 1 > 4 - Cough > Flashcards

4 - Cough Flashcards

(60 cards)

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1
Q

What are the 3 main subtypes of cough?

A

Acute: < 3 weeks
Subacute: 3-8 weeks
Chronic: >8

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2
Q

Physiologic effects of cough?

A

Sudden, forceful and sometimes frequent -> increased intrathoracic and intrabdominal pressure

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3
Q

Symptoms that go along with coughs?

A 
Cough syncope
Dysrhythmias
Headache
Subconjunctival hemorrhage
Inguinal hernia
GRD
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4
Q

MC cause of acute cough?

A

Viral respiratory tract infection (RTI)/acute bronchitis

  • pneumonia
  • pulmonary embolism
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5
Q

Acute bronchitis causes

A 
Influenza
Parainfluenza
Coronavirus
Rhinovirus
Respiratory synchytial virus 
Pertussis
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6
Q

Clinical features of acute cough and acute bronchitis?

A 
Cough (+/-) sputum
Few/no systemic sxs
Chest wall tenderness
Wheezing possible
Rhonchi clearing after cough
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7
Q

What testing is required for acute cough?

A

Usually a good hx and pe is all that you need

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8
Q

Who gets a CXR?

A

Suspected pneumonia

Pulse > 100
R >24
T > 100.4
Crackles on PE
Consolidation
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9
Q

Do old people get fevers with pneumonia?

A

Sometimes they do not. You must focus on:

  • respiration rate
  • SpO2
  • Mental status
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10
Q

What treatments do we do for symptomatic acute cough?

A

Antitussive
Anti-inflammatory mucolytics
Antihystamine-decongestant
Bronchodilators

Dont really help

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11
Q

When do sub-acute coughs usually present?

A

Post infection

- may linger long after RTI sxs resolve

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12
Q

MC causes of chronic cough?

A

Post-nasal drainage (PND) (90%)
Asthma
GERD

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13
Q

Less common causes of chronic cough?

A 
ACEI
Bronchiectasis and cystic fibrosis
Chronic bronchitis
Bronchiolitis
Neoplasm
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14
Q

S/S of PND?

A

Rhinorrhea
Nasal congestion
Throat “tickle”
Throat clearing

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15
Q

PE for PND?

A

Nasal bogginess/congestion
Oropharyngeal mucus “cobblestoning”
“Silent” (sometimes)

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16
Q

Sinusitis s/s?

A

Copious sputum

Sinus mucosal thickening

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17
Q

What is upper airway cough syndrome (UACS)

A

New name for PND

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18
Q

Tx for PND/UACS?

A 
Avoid allergens
Intranasal corticosteroids
Oral antihistamines
Oral decongestants
Oral montelukast 
Abx: only from proven sinusitis (image)
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19
Q

How long does chronic cough usually take to get better with tx?

A

1-2 weeks

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20
Q

2nd MC cause of chronic cough?

A

Cough variant asthma

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21
Q

What is required for a Dx of asthma?

A

A response to therapy (SABA)

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22
Q

How long does the cough for cough variant asthma usually take to improve?

A

6-8 weeks of asthma therapy

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23
Q

What may cause 40% of cough?

A

GERD

It will be on the pance

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24
Q

Does sputum color matter?

A

Not at all

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25
When does GERD cough get worse?
Night While supine After eating
26
Tx for GERD cough?
Treat the GERD ``` Avoid fatty foods, caffeine, chocolate, ETOH Stop smoking Lose wt Elevate head of bed PPI ```
27
How long does tx of GERD take to get rid of the cough?
3 months should do it
28
When does the ACEI cough usually start?
1 week after initiation. It could be up to 1 year
29
Bronchiectasis ?
Chronic inflammation or infection leading to progressive airway damage Permanent abnormally dilated bronchi Chronic inflammatory cells -> mucus pooling
30
S/s of bronchiectasis?
``` Large volume of sputum (2tbsp +) Dyspnea Hemoptysis Pleuritic chest pain Wt loss Anemia ```
31
CXR for bronchiectasis shows?
Tubular or cystic structures “Tracks” or “rings” Dilated mucus filled bronchi
32
What about bronchiectasis pts with non diagnostic CXR?
CT is preferred
33
What is the accuracy of CT for diagnosing bronchiectasis?
95% The study of choice
34
Tx for bronchiectasis?
Abx 10-14 days Chest physiotherapy Postural drainaige Inhaled bronchodilators
35
Do bronchiectasis patients get cough suppressants?
No
36
What is a common bug that causes bronchiectasis?
Pseudomonas
37
What is the MC cause of severe chronic lung disease in young adults?
Cystic fibrosis
38
What is the death rate of Cystic fibrosis?
1:32000 it is the MC fatal hereditary dz of whites in the United States
39
Carriers of cystic fibrosis?
1:25 people are carriers
40
What is the classic presentation of Cystic fibrosis?
Chronic lung disease and pancreatic insufficiency resulting from thick mucus secretions
41
What is a common pathology of cystic fibrosis?
Mucus plugging of various exocrine ducts and inflammation | - MC at lungs, pancreas and testes
42
Pulmonary symptoms of cystic fibrosis?
``` Cough Sputum Decreased exercise tolerance Recurrent hemoptysis Clubbing A/P diameter increased Hyperresonance Crackles at apex ```
43
Non pulmonary S/S of cystic fibrosis?
``` Sinus tenderness Nasal polyps Steatorrhea Diarrhea Abdominal pain Congenital bilateral absence of vas deference Gallstones ```
44
PFTs for cystic fibrosis?
Mixed obstructive > restrictive - decreased FVC, FEV1 and TLC - elevated RV to TLC ration - reduced DLCO
45
Labs for cystic fibrosis?
ABG’s - hypoxemia - compensated respiratory acidosis
46
What do Cystic Fibrosis centers do?
``` Clear/reduce secretions Reverse bronchoconstriction Treat RTI’s Replace pancreatic enzymes Nutritional/psychosocial support ```
47
Cystic fibrosis treatment?
Postural drainage, percussion/vibration, cough Inhaled recumbent human deoxyribonuclease (rhDNAse) Inhaled hypertonic saline Short/long term abx SABA Ivacaftor Long transplant
48
What is the goal of rhDNAse?
Decrease sputum viscosity which improves FEV1
49
What is ivacaftor?
Oral medication for specific gene mutation
50
Do lung transplants help with CF?
Yeah but the 3 yr post transplant survival is only 55%
51
What usually causes death in CF patients?
Pulmonary complications
52
What is bronchiolitis?
Genetic term for inflammatory processes affecting bronchioles Airways are <2mm
53
Who gets bronchiolitis?
MC in infants and children
54
What causes bronchiolitis?
Usually its RSV
55
Do adults get bronchiolitis?
Yes but its less common and they have many subtypes
56
What do adults with bronchiolitis usually have?
A hx of exposure to something
57
S/S of bronchiolitis?
Insidious onset of cough and dypsnea not following asthma/COPD pattern Tachypnea, crackles and wheezing
58
What about radiology for bronchiolitis?
CXR: nothing CT: air trapping, similar to asthma
59
How is bronchiolitis diagnosed?
Lung biopsy | Or clinically
60
How is bronchiolitis treated?
``` Cease the exposure Corticosteroids Bronchiodilators Cough suppressaants O2 to keep above 88 ```

Junior - Pulm Mod 1 (4 decks)

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