FM 13 - Cough

Question 1

Common causes of persistent cough (9)

Answer 1

UACS, vocal cord dysfunction, asthma, GERD, ACE-I, tobacco, post-infectious, COPD, non-asthmatic eosinophilic bronchitis

Question 2

Serious, less common causes of persistent cough (4)

Answer 2

• pulmonary: bronchogenic carcinoma, sarcoidosis, TB

- cardiac: CHF

Question 3

Causes of Wheezing (8)

Answer 3

• asthma

- COPD, CHF, Foreign body aspiration, persistent bronchitis, UACS, vocal cord dysfunction, pulmonary embolism

Question 4

Co-morbid conditions of asthma (4)

Answer 4

GERD, obesity/overweight, OSA, rhinitis/sinusitis, stress/depression

Question 5

Acute sinusitis symptoms

Answer 5

• opaque/mucopurulent nasal discharge
• symptoms persist 7-10 days following viral URI
• nasal congestion/obstruction <12 wks

Question 6

Chronic sinusitis symptoms

Answer 6

• similar to acute sinusitis but lasting >12wks
• facial pain/pressure/fullness
• decreased sense of smell

Question 7

Prevalence of aspirin-induced asthma

Answer 7

• 21% of adults with asthma

- should avoid NSAIDS

Question 8

How to use MDI + spacer (6)

Answer 8

1. shake inhaler 5-6 times
2. Remove mouthpiece cover, place spacer over end of mouthpiece
3. Put lips and teeth over the spacer and breathe in slowly, squeezing top of canister once
4. Continue inhaling slowly and deeply. 5. After inhaling, remove spacer from mouth and hold breath for up to 10 seconds.
5. Repeat previous steps if additional dose is required.

Question 9

Asthma diagnosis criteria (3)

Answer 9

• episodic symptoms of airflow obstruction or hyperresponsiveness
• obstruction is at least partially reversible
• exclusion of alternative diagnoses

Question 10

Components for classification of asthma severity

Answer 10

• frequency of symptoms
• frequency of nighttime awakenings
• frequency of SABA use
• interference with normal activity
• FEV1 value
• FEV1/FVC ratio

Question 11

Asthma pathophys

Answer 11

Chronic inflammation -> hyperresponsiveness and obstruction -> edema/remodeling/loss of lung gunction

Question 12

Long-term effects of uncontrolled asthma

Answer 12

-airway remodeling, inflammation, mucous hypersecretion, aireay smooth muscle hypertrophy, angiogenesis, subepithlial fibrosis, decreased reversibility of obstruction

Question 13

Asthma management

Answer 13

• inhaled bronchodilator

- inhaled corticosteroid

Question 14

Allergic Rhinitis management

Answer 14

• oral antihistamine

- nasal corticosteroid

Question 15

Steps in initial asthma evaluation

Answer 15

• classify asthma severity
• assess patient’s knowledge/skills for self-management
• identify and control environmental factors/comorbid conditions
• offer appropriate medications

Question 16

Reducing Allergen exposure

Answer 16

• allergen-proof pillow/matress covers
• carpet removal
• reduce clutter
• wash bedding in hot water
• frequent vacuuming with HEPA filter or microfilter bag
• humidifier/dehumidifier as appropriate
• keep windows closed
• stay inside when pollen counts are highg

Question 17

Tdap vaccination in adults

Answer 17

• no Tdap hx: Tdap with Td booster q10 years

- no vaccine hx: 3 dose primary vaccine series including Tdap (first 2 doses 4wks apart, 3rd dose 6-12mos later)

Question 18

Who gets PPSV23 vaccine

Answer 18

• SCD kids

- Adults with chronic heart disease, chronic lung disease, chronic liver disease, alcoholism, or DM