Chronic Cough/Asthma Flashcards Preview

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Flashcards in Chronic Cough/Asthma Deck (38)
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0
Q

Chronic cough in a smoker vs non smoker (Ddx)?

A

COPD or bronchogenic carcinoma versus postnasal drip, GERD, asthma

1
Q

Acute cough? Most common cause? Other causes?

A

Call for less than three weeks. Usually by upper respiratory infection. Also caused by CHF, pneumonia, PE.

2
Q

Asthma?

A

Bronchial hyperactivity and smooth muscle hypertrophy leading to chronic inflammatory condition with widespread bronchospasm

3
Q

Cobblestone appearance of the oropharynx may represent?

A

Lymphoid hyperplasia

4
Q

End expiratory wheezing versus localized wheezing?

A

Active bronchospasm versus foreign body/bronchogenic tumor

5
Q

Suspect postnasal drip, asthma, or GERD if?

A

Negative chest x-ray in immunocompetent non-smoker

6
Q

Initial treatment for nonallergic postnasal drip Versus allergic rhinitis?

A

First generation antihistamine decongestant for three weeks

Vs new generation antihistamine and nasal corticosteroid

7
Q

Patients postnasal drip does not improve with treatment, How to examine for sinusitis? Tx?

A

Sinus radiographs. Look for opacification, air-fluid levels, or mucosal thickening. Treat with antibiotics

8
Q

Cough variant asthma?

A

Presents with dry cough occurs throughout the day and night – worsened by URIs, allergies, cold or exercise

9
Q

Confirmatory test results for asthma?

A
  1. Reduced FEV1 and FEV1/FVC
  2. Increased FEV1 after Beta agonist inhalation
  3. Methacholine challenge
10
Q

PFT changes after albuterol vs Methacholine challenge?

A

Increase in FEV1 of 12+ percent after bronchodilator treatment

Decrease in FEV1 of 20+ percent after methacholine

11
Q

Treatment for asthma?

A

Bronchodilators and inhaled/oral corticosteroids

12
Q

GERD lifestyle changes?

A
Low-fat diet
Elevation of head in bed
Avoid caffeine, alcohol, peppermint, chocolate
Weight-loss
Smoking cessation
13
Q

If GERD cough does not resolve with lifestyle changes, treatment?

A

H2 receptor antagonists (famotidine) or PPI

14
Q

If acid suppression does not resolve GERD, treatment?

A

Metoclopramide to increase gastric motility

16
Q

Types of asthma?

A
  1. mild intermittent (Less than twice a week)
  2. Mild persistent (More than twice a week but less than once a day)
  3. Moderate persistent (Daily)
  4. Severe persistent (Continual)
17
Q

Daily medications for mild intermittent asthma?

A

None

18
Q

Daily medications for mild persistent asthma?

A

Low-dose steroids (preferred) or from cromolyn, leukotriene modifiers, sustained release theophylline, nedocromil

19
Q

Daily medications for moderate persistent asthma?

A

Preferred – long-acting Beta two agonist or low to medium dose inhaled steroids

Steroids and leukotriene modifiers/theophylline

20
Q

Daily medications for severe persistent asthma?

A

High-dose inhaled steroids and long-acting inhaled beta two agonist

21
Q

Patients with GERD who remain symptomatic after maximal medical treatment should get?

A
  1. 24-hour esophageal pH monitoring

2. Endoscopy to show esophagitis or reflux

22
Q

Quick relief medications for all classes of asthma?

A

Short acting inhaled beta two agonist and oral steroids

23
Q

Intrinsic vs extrinsic asthma?

A

Not atopic (cold, stress, cough-variant )

Vs

Due to environmental triggers - Produce IgE, associated with eczema and hay fever

24
Q

Dz with wheezing?

A
  1. CHF - edema
  2. COPD - inflamed airways
  3. Cardiomyopathies - edema around bronchi
  4. Lung cancer
25
Q

Montelukast - MoA? Use?

A

Leukotriene modifiers. Prophylaxis for asthma.

26
Q

Associated findings in patients with asthma?

A
#Symptoms worse at night
#Polyps and sensitivity to aspirin
#Eczema/atopic dermatitis
27
Q

Exploratory phase in asthma?

A

Increased

28
Q

Best initial diagnostic test in acute asthma exacerbation?

Most accurate diagnostic test in pt with no symptoms?

A

Peak expiratory flow or atrial blood gas

Methacholine challenge

29
Q

Role of CXRs in asthma exacerbation?

A
#Exclude pneumonia
#Exclude pneumothorax
#Exclude CHF
30
Q

CBC finding in asthma?

A

Increased eosinophils

31
Q

Increased IGE levels in asthmatic suggests? Treatment?

Increased IGE levels in non-asthmatic pulmonary patient?

A

Allergic etiology; omalizumab

Allergic bronchopulmonary aspergillosis

32
Q

Cromolyn/nedocromil MoA? Use in asthma?

A

Inhibits mast cell mediator release and eosinophil recruitment

Asthma ppx

33
Q

Adverse effects of systemic corticosteroids?

A
#Osteoporosis
#cataracts
#Adrenal suppression
#thinning skin, striae, easy bruising
#Hyperlipidemia, hyperglycemia, acne, hirsutism
34
Q

Role of ipratropium in:

general asthma management?

Acute exacerbation?

A

Unclear (effective in COPD)

Useful (But slower than albuterol)

35
Q

Gave which vaccines to asthma patients?

A

Influenza and pneumococcal vaccine

36
Q

Best indication of severity of acute asthma exacerbation?

A

Respiratory rate > accessory muscle use

37
Q

Peak expiratory flow based on? Approximation for?

A

Height and age

FVC

38
Q

Drugs of last resort in acute asthma exacerbation?

A

Epinephrine and Mg (bronchodilation)

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