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MC > Cough > Flashcards

Cough Flashcards

1
Q

_______ is the commonest manifestation of lower

respiratory tract infection

A

Cough

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2
Q

Cough is the cardinal feature of ______

A

chronic bronchitis

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3
Q

Cough may persist for many weeks following an
acute upper respiratory tract infection (URTI) as
a result of persisting ______ or ______

A

bronchial inflammation and

increased airway responsiveness

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4
Q

______ is the commonest cause of a
persistent or chronic cough, especially causing
nocturnal cough due to secretions (mainly from
chronic sinusitis) tracking down the larynx and
trachea during sleep

A

Postnasal drip

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5
Q

The commonest causes of haemoptysis are
1
2
3

A

URTI (24%), acute or chronic bronchitis (17%),

bronchiectasis (13%), TB (10%).

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6
Q

A _______ is suggestive of cancer: the explosive
nature of a normal cough is lost when laryngeal paralysis
is present, usually resulting from bronchial carcinoma
infiltrating the left recurrent laryngeal nerve.

A

bovine cough

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7
Q

Chronic cough may be the first presentation of

_____pneumonia in an HIV-infected pt

A

Pneumocystis jiroveci

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8
Q

Red flags for cough

A
  • Age >50 years
  • Smoking history
  • Asbestos history exposure
  • Persistent cough
  • Overseas travel
  • TB exposure
  • Haemoptysis
  • Unexplained weight loss
  • Dyspnoea
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9
Q

Pulmonary infiltration
with fibrosis may result from some cytotoxic drugs,
especially_______

A

bleomycin

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10
Q

Cough can be a feature of some of the ACE inhibitors

and _____,______,______

A

beta blockers, inhaled steroids and sulfasalazine

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11
Q

A typical

‘psychogenic’ cough is barking in quality—the ‘__________. It does not occur during sleep

A

Cape

Barren goose’ cough

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12
Q

Occupational list for causes of cough

mining ______

aircraft manufacturing________

farming (‘farmer’s lung’—allergic pneumonitis from mouldy hay)

and bird handling (‘bird fancier’s lung’—allergic alveolitis or psittacosis from pigeons or budgerigars

A

(pneumoconiosis),

(asbestosis and mesothelioma),

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13
Q

PE of pt with cough

_______ on auscultation indicate pulmonary oedema
of heart failure, interstitial pulmonary fibrosis and
early lobar pneumonia,

while coarse crackles indicate
_______, _______, ______

A

Fine crackles

resolving pneumonia, bronchiectasis and TB

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14
Q

Important radiologic procedures for pts with cough

— plain chest X-ray (shows many problems)
— ____________helps more precise localisation
of lesion, may show cavitation
— ________: shows bronchiectasis (a very
unpleasant procedure)
— CT scanning (more sensitive than plain X-ray)
— CT pulmonary angiogram
— ___________: for
pulmonary infarction
— echocardiogram (pulmonary hypertension)

A

tomography:

bronchography

ventilation/perfusion isotope scan

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15
Q

Character of the cough
• _________→ tracheitis and bronchitis (major
bronchi); extrinsic pressure on trachea
• __________ → laryngeal disorders (e.g. laryngitis)

A

Brassy

Barking

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16
Q

Character of the cough

• _________ → laryngeal disorders (e.g.
laryngitis, croup)
• _________ → vocal cord paralysis (leftrecurrent
laryngeal nerve)
• Weak cough → indicates bronchial carcinoma
• _______ → whooping cough
• _______→ tracheitis; left ventricular failure

A

Croupy (with stridor)

Bovine (no power)

Paroxysmal with whoops

Painful

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17
Q

Causes of nocturnal cough

A 
— asthma
— left ventricular failure
— postnasal drip
— chronic bronchitis
— whooping cough
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18
Q

Causes of waking cough

A

— bronchiectasis
— chronic bronchitis
— GORD

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19
Q

cough associated with changing posture

A

— bronchiectasis

— lung abscess

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20
Q

Cough with meals

A

— hiatus hernia (possible)
— oesophageal diverticulum
— tracheo-oesophageal fistula

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21
Q

A healthy, non-smoking individual produces

approximately ______ of mucus a day

A

100–150 mL

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22
Q

This
normal bronchial secretion is swept up the airways
towards the trachea by the________
mechanism and is usually swallowed.

A

mucociliary clearance

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23
Q

The commonest cause of excess mucus production is

_______

A

cigarette smoking.

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24
Q

Character of sputum

_________ → due to cellular
material (neutrophils or eosinophil granulocytes)

_______ → lobar pneumonia ( S. pneumoniae ): due
to blood

A

Yellow or green (purulent)

Rusty

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25
Q

Character of sputum

  • Profuse, watery → ______
  • Thin, clear mucoid → ______
  • Redcurrant jelly → ______
  • Profuse and offensive →_____
A

alveolar cell carcinoma

viral infection

bronchial carcinoma

bronchiectasis; lung abscess

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26
Q

Character of sputum

Thick plugs (cast-like) → \_\_\_\_\_
• Pink frothy sputum → pulmonary oedema
A

allergic bronchopulmonary Aspergillus;

bronchial carcinoma

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27
Q

Rare causes of hemoptysis

A

Idiopathic pulmonary haemosiderosis
Goodpasture syndrome
Blood disorders including anticoagulants

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28
Q

Several clinicians describe the _______as the commonest cause of cough

A

catarrhal child

syndrome

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29
Q

This refers to children who develop a postnasal drip
following acute respiratory infection and allergic
rhinitis

A

catarrhal child

syndrome

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30
Q

Habit cough can occur in children, especially those

with a history of ______

A

school phobia

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31
Q 
One study found the
causes of chronic cough in the elderly to be 
1
2
3
A

postnasal drip syndrome 48%,
gastro-oesophageal reflux 20%
and asthma 17%.

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32
Q

Combined URTI and LRTI include
1
2
3

A

influ enza, measles, whooping cough and laryngotracheobronchitis

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33
Q

This highly infectious URTI, which is often mistakenly
referred to as ‘the flu’, produces a mild systemic upset
and prominent nasal symptoms

A

The common cold (acute coryza

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34
Q

The
incubation period is usually 1–3 days and the illness
commences abruptly with a fever, headache, shivering
and generalised muscle aching

A

Influenza

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35
Q

Causes of common cold

A 
Rhinoviruses
Parainfluenza
Influenza B, C
Coronavirus
RSV
36
Q

Common cause of influenza

A 
Influenza A
Influenza B
Novel strains
influenza A
e.g. H5N1
37
Q

Where is sorethroat more common, common cold or influenza?

A

common cold

38
Q

Antiviral agents for influenza

A

Neuraminidase inhibitors (cover influenza A and B):
zanamivir (Relenza) 10 mg by inhalation bd
oseltamivir (Tamiflu) 75 mg (o) bd

39
Q

How to give antiviral in influenza

A

commenced within 36 hours of

onset and given for 5 days.

40
Q

Influenza vaccination offers some protection for up

to ____ of the population for about 12 months

A

70%

41
Q

This strain presents with typical influenza
symptoms commonly accompanied by gastrointestinal
symptoms (especially diarrhoea)

A

(The swine variety of H1N1 influenza A)

42
Q

Tx of (The swine variety of H1N1 influenza A)

A

The treatment is the same as for influenza in
general with neuraminidase inhibitors. A vaccine is
now available

43
Q

This is acute inflammation of the tracheobronchial
tree that usually follows an upper respiratory
infection. Although generally mild and self-limiting,
it may be serious in debilitated patients

A

Acute bronchitis

44
Q

etiology of complicated acute bronchitis

A

often due to

Haemophilus influenzae and Streptococcus pneumoniae

45
Q

Abx for acute bronchitis

A

amoxycillin 500 mg (o) 8 hourly for 5 days
or
doxycycline 200 mg (o) statim, 100 mg

46
Q

This is a chronic productive cough for at least 3

successive months in 2 successive years

A

Chronic bronchitis

47
Q

CAP is usually caused by a single

organism, especially______

A

Streptococcus pneumoniae

48
Q

Tx duration for pneumonia

Treatment is usually for __days for most bacterial causes,
2 weeks for_______nfection and
2–3 weeks for Legionella

A

5–10

Mycoplasma or Chlamydia i

49
Q

Xray of atypical Pnx

A

Chest X-ray (diffuse infiltration) incompatible

with chest signs

50
Q

MC cause of atypical Pnx

A

Mycoplasma pneumoniae

51
Q

Tx of Mycoplasma pneumoniae

A

roxithromycin 300 mg (o) daily
or
doxycycline 100 mg bd for 14 days

52
Q

What atypical Pnx

— related to cooling systems in large buildings
— incubation 2–10 days

A

Legionella pneumophila (legionnaire disease

53
Q

Dx criteria for Legionnaires disease

1
2
3
4
5
A
  • prodromal influenza-like illness
  • a dry cough, confusion or diarrhoea
  • very high fever (may be relative bradycardia)
  • lymphopaenia with moderate leucocytosis
  • hyponatraemia
54
Q

Tx of Legionella

A

azithromycin IV (first-line) or erythromycin
(IV or oral)
plus (if very severe)

ciprofloxacin or rifampicin

55
Q

Tx of Chlamydia psittaci (psittacosis):

A

treat with roxithromycin or erythromycin or

doxycycline

56
Q

Tx of Coxiella burnetti (Q fever)

A

treat with doxycycline 200 mg (o) statim then

100 mg daily for 14 days

57
Q

Mx of mild Pnx

A

amoxycillin/clavulanate 875/125 mg (o)
12 hourly for 7 days especially if S. pneumoniae
isolated or suspected
plus (especially if atypical pneumonia suspected)
roxithromycin 300 mg (o) daily for 7 days

58
Q

Guidelines for severe pneumonia

and hospital admission

A

• Altered mental state/acute onset confusion
• Rapidly deteriorating course
• Respiratory rate >30 per minute
• Pulse rate >125 per minute
• BP <90/60 mmHg
• Hypoxia P a O 2 <60 mm Hg or O 2 saturation
<92%
• Leucocytes <4 × 10 8 L or >20 × 10 9 /L

59
Q

Pnx in children

  • _______ are the most common cause in infants.
  • _______ are common in children over 5 years.
  • ________ is a cause in all age groups
A

Viruses

Mycoplasma

S. pneumoniae

60
Q

When to admit infants with severe pnx

Infants:
1
2
3

Older children
1
2
3

A
  • RR>70 •
  • Intermittent apnoea
  • Not feeding

RR>50
• Grunting
• Signs of dehydration

61
Q

A cough lasting 2 months or more

is defined as a ______

A

chronic cough

62
Q

Organisms for chronic persistent cough

A 
Haemophilus influenzae (the
most common), S. pneumoniae and Moraxella
63
Q

Haemophilus influenzae (the most common), S. pneumoniae and Moraxella

How to Tx?

A

most susceptible to amoxycillin or

amoxycillin/clavulanate or parenteral cephalosporins

64
Q

Indications for 24-hour ambulatory oesophageal

pH monitoring in chronic cough include

A 
• unexplained chronic cough after clinical
assessment
• symptomatic gastro-oesophageal reflux
• chronic cough with known aetiology
unresponsive to therapy
65
Q

_______accounts for 25% of cancer deaths in
men and 24% of cancer deaths in women (rapidly
rising),

A

Lung cancer

66
Q

MC cause of lung CA

A

cigarette smoking

67
Q

________accounts for over

95% of primary lung malignancies

A

Bronchial carcinoma

68
Q

Sx of lung CA

A
  • Cough (42%)
  • Chest pain (22%)
  • Wheezing (15%)
  • Haemoptysis (7%)
  • Dyspnoea (5%)
69
Q

Causes of a solitary pulmonary nodule

(on X-ray

A

Bronchial carcinoma
Solitary metastasis
Granuloma (e.g. TB)
Hamartoma

70
Q

______ is not an
option for SCLC since it metastasises so rapidly (80% have
metastasised at the time of diagnosis).

A

Surgery

71
Q

________
is suitable for the deadly SCLC but currently only extends
life expectancy from 3 to 20 months (at best).

A

Chemotherapy

72
Q

________ is a malignant tumour of mesothelial
cells usually at the pleura. It is associated with prior
asbestos exposure, possibly decades earlier (90%
report exposure

A

Mesothelioma

73
Q

Prognosis of mesothelioma

A

Prognosis is poor and treatment is palliative

support.

74
Q

________ is dilatation of the bronchi when their
walls become inflamed, thickened and irreversibly
damaged, usually following obstruction followed
by infection

A

Bronchiectasis

75
Q

The_______ and ______ are the

commonest sites for localised disease in Bronchiectasis

A

left lower lobe and lingula

76
Q

Main pathogens for bronchiectasis

A

Streptococcus pneumoniae,
Pseudomonas aeruginosa, Haemophilus influenzae
(commonest)

77
Q

CT of for bronchiectasis

A

can show bronchial wall thickening

78
Q

Gold standard for bronchiectasis dx

A

high resolution CT scan is the new gold standard

for diagnosis

79
Q

______ or ______ is

recommended for first presentation of bronchiectasis

A

Amoxycillin 500 mg

(o) tds for 2–3 weeks or roxithromycin

80
Q

Examples of opiod cough supressants

A 
Opioid:
Codeine
Dihydrocodeine
Hydrocodone
Pholcodine
Ethylmorphine
Normethadone
81
Q

Examples of expectorants/mucolytics

A

Senega
Ammonia
Guaiphenesin
Bromhexine

82
Q

Unexplained cough over the age of 50 is ________until proved otherwise (especially if
there is a history of smoking

A

bronchial

carcinoma

83
Q

______ is essential to exclude adequately a

suspicion of bronchial carcinoma when the chest

A

Bronchoscopy

84
Q

Bright red haemoptysis in a young person may be

the initial symptom of_____

A

pulmonary TB.

85
Q

The presence of _____ in the sputum renders it
yellow or green (purulent) but does not necessarily
imply infection

A

white cells

MC (90 decks)

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