Chronic Cough/Asthma Flashcards Preview

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

Acute cough? Most common cause? Other causes?

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

1

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

COPD or bronchogenic carcinoma versus postnasal drip, GERD, asthma

2

Asthma?

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

3

Cobblestone appearance of the oropharynx may represent?

Lymphoid hyperplasia

4

End expiratory wheezing versus localized wheezing?

Active bronchospasm versus foreign body/bronchogenic tumor

5

Suspect postnasal drip, asthma, or GERD if?

Negative chest x-ray in immunocompetent non-smoker

6

Initial treatment for nonallergic postnasal drip Versus allergic rhinitis?

First generation antihistamine decongestant for three weeks

Vs new generation antihistamine and nasal corticosteroid

7

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

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

8

Cough variant asthma?

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

9

Confirmatory test results for asthma?

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

10

PFT changes after albuterol vs Methacholine challenge?

Increase in FEV1 of 12+ percent after bronchodilator treatment

Decrease in FEV1 of 20+ percent after methacholine

11

Treatment for asthma?

Bronchodilators and inhaled/oral corticosteroids

12

GERD lifestyle changes?

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

13

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

H2 receptor antagonists (famotidine) or PPI

14

If acid suppression does not resolve GERD, treatment?

Metoclopramide to increase gastric motility

16

Types of asthma?

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

Daily medications for mild intermittent asthma?

None

18

Daily medications for mild persistent asthma?

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

19

Daily medications for moderate persistent asthma?

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

Steroids and leukotriene modifiers/theophylline

20

Daily medications for severe persistent asthma?

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

21

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

1. 24-hour esophageal pH monitoring
2. Endoscopy to show esophagitis or reflux

22

Quick relief medications for all classes of asthma?

Short acting inhaled beta two agonist and oral steroids

23

Intrinsic vs extrinsic asthma?

Not atopic (cold, stress, cough-variant )

Vs

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

24

Dz with wheezing?

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

25

Montelukast - MoA? Use?

Leukotriene modifiers. Prophylaxis for asthma.

26

Associated findings in patients with asthma?

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

27

Exploratory phase in asthma?

Increased

28

Best initial diagnostic test in acute asthma exacerbation?

Most accurate diagnostic test in pt with no symptoms?

Peak expiratory flow or atrial blood gas

Methacholine challenge

29

Role of CXRs in asthma exacerbation?

#Exclude pneumonia
#Exclude pneumothorax
#Exclude CHF

30

CBC finding in asthma?

Increased eosinophils

31

Increased IGE levels in asthmatic suggests? Treatment?

Increased IGE levels in non-asthmatic pulmonary patient?

Allergic etiology; omalizumab

Allergic bronchopulmonary aspergillosis

32

Cromolyn/nedocromil MoA? Use in asthma?

Inhibits mast cell mediator release and eosinophil recruitment

Asthma ppx

33

Adverse effects of systemic corticosteroids?

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

34

Role of ipratropium in:

general asthma management?

Acute exacerbation?

Unclear (effective in COPD)

Useful (But slower than albuterol)

35

Gave which vaccines to asthma patients?

Influenza and pneumococcal vaccine

36

Best indication of severity of acute asthma exacerbation?

Respiratory rate > accessory muscle use

37

Peak expiratory flow based on? Approximation for?

Height and age

FVC

38

Drugs of last resort in acute asthma exacerbation?

Epinephrine and Mg (bronchodilation)

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