Cough and Hemoptysis

Question 1

A cationic channel found on rapidly adapting receptors and C-fibers, which is the receptor for capsaicin; its expression is increased in patients with chronic cough

Answer 1

Type-1 vanilloid receptor

Question 2

This afferent nerve is also known as the Arnold nerve

Answer 2

Auricular branch of the vagus nerve

Question 3

Sensory signals from the respiratory tract travel through these nerves (2) to a region of the brainstem in the nucleus tractus solitarius, vaguely identified as the “cough center”

Answer 3

Vagus and superior laryngeal nerves

Question 4

Surrogate marker for cough strength

Answer 4

Peak expiratory flow or maximal expiratory pressure at the mouth

Question 5

Subacute cough is defined as lasting for this duration

Answer 5

3-8 weeks

acute if less than 3 weeks, chronic if more than 8 weeks

Question 6

Most common causes of chronic cough (4) when initial assessment with chest examinatio and radiograph is normal

Answer 6

Cough-variant asthma, GERD, nasopharyngeal drainage, and medications (ACE inhibitors)

Question 7

Diagnosis: characteristic inspiratory whoop after a paroxysm of coughing

Answer 7

Pertussis

Question 8

Irritation of the tympanic membrane can result in cough by stimulation of this nerve

Answer 8

Arnold’s nerve

Question 9

Mechanism of ACE inhibitor cough may involve sensitization of sensory nerve endings due to accumulation of this peptide

Answer 9

Bradykinin

Question 10

Cough due to asthma in the absence of wheezing, shortness of breath, and chest tightness

Answer 10

Cough-variant asthma

Question 11

In a patient capable of making reliable measurements, this can be used as a cost-effective method to support or discount a diagnosis of asthma

Answer 11

Home expiratory peak flow monitoring

Question 12

Chronic eosinophilic bronchitis causes chronic cough with a normal CXR and is characterized by absence of airflow obstruction or bronchial hyperresponsiveness and sputum eosinophilia in excess of this percentage

Answer 12

3%

Question 13

Treatment for chronic eosinophilic bronchitis

Answer 13

Inhaled glucocorticoids

Question 14

Most effective drugs for chronic idiopathic cough

Answer 14

Narcotic cough suppressants (e.g., codeine or hydrocodone)

Question 15

An over-the-counter, centrally acting cough suppressant with fewer side effects and less efficacy than narcotic cough suppressants

Answer 15

Dextromethorphan

Question 16

This cough suppressant is thought to inhibit neural activity of sensory nerves in the cough-reflex pathway and is generally free of side effects; however, its effectiveness is variable and unpredictable

Answer 16

Benzonatate

Question 17

Most common etiology of hemoptysis

Answer 17

Infection of the medium-sized airways

Question 18

Most common cause of hemoptysis worldwide

Answer 18

Tuberculous infection

Question 19

Diagnosis: sudden-onset dyspnea with hemoptysis and hypoxemia in the first 100 days after a bone marrow transplant

Answer 19

Diffuse alveolar hemorrhage

Question 20

Most common cause of noninflammatory alveolar hemorrhage

Answer 20

Direct inhalational injury (thermal injury, illicit substances, toxic chemicals)

Question 21

Pneumonia due to these organisms (2) are more likely to cause necrotizing lung infections and, thus, are more often associated with hemoptysis

Answer 21

Staphylococcus aureus and gram-negative rods (e.g., Klebsiella pneumoniae)

Question 22

Risk factors (2) that would warrant chest CT scan in a patient with mild hemoptysis

Answer 22

Smoking, age >40

Question 23

Management for patients with massive hemoptysis and continuous bleeding after securing the airway

Answer 23

Embolization or resection

Question 24

Diagnosis: monthly hemoptysis in a woman

Answer 24

Catamenial hemoptysis from pulmonary endometriosis

Question 25

Definition of massive hemoptysis

Answer 25

> 200-600 cc in 24 h