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Outpatient Medicine > Cough and Smoking > Flashcards

Cough and Smoking Flashcards

1
Q

What defines acute cough?

What defines chronic cough?

A

Acute: 3 weeks or less
Chronic: 8 weeks or less

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2
Q

Where are airway cough receptors located?

A

larynx
trachea
bronchi

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3
Q

Name some viruses tht can cause cough

A 
influenza A+B 
parainfluenza virus 3
RSV
coronavirus
adenovirus
rhinovirua
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4
Q

What is the effect of anti-influenza drugs on disease prognosis?

A

If started within 48 hours of symptom onset, can shortned illness by 1 day and shorten function impairment by 12 hours

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5
Q

what is antiviral chemoprophylaxis?

A

a way to provide immediation protection against flu virus if havent had the vaccine or got vaccine

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6
Q

Which antivirals work against H1N1?

A

Oseltamivir, zanamivir

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7
Q

Name some viruses that can cause cough

A 
influenza A+B 
parainfluenza virus 3
RSV
coronavirus
adenovirus
rhinovirus
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8
Q

What are the criteria for diagnosing influenza virus?

A
  1. Temp >100 deg F (>37.7)
  2. Cough, pharyngitis, OR rhinorrhea
  3. Viral cultures of secretions OR immunofluo OR PCR OR enyme assay
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9
Q

who should get antiviral chemoprophylaxis?

A
  1. residents in assisted living facility during an outbreak
  2. persons at high risk for flu complications who had close contact with a person with proven flu
  3. health care workers who contacted someone with H1N1
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10
Q

Cough is viral most of the time, but what are the 3 most common NON-viral causes of cough?

A
  1. Bordetella petussis
  2. Mycoplasma pneumoniae
  3. Chlamydophila pnuemoniae

antibiotics don’t work well against these (excet bordetella kind of) and gram stains dont pick them up

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11
Q

What symptoms would make you think of bordetella pertussis, and thus cause you to consider treating cough with antibiotics?

A

Cough >6 weeks OR cough during a documented bordetella outbreak

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12
Q

what is the gold standard for diagnosing bordetella?

A

culture or PCR

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13
Q

why do we treat bordetella pertussis with antibiotics?

A

To decrease shedding and spread of the bacteria. NOT to decrease symptoms. Antibiotics dont help symptoms unless started before 7-10 days of symptoms, which is never done unless you know its a bordetella outbreak

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14
Q

HOW CAN YOU EXCLUDE PNEUMONIA AS A CAUSE OF ACUTE COUGH?

A 
Absence of vital sign abnormalities:
HR greater than 100
RR greater than 28
Temp greater than 100 deg F 
Crackles or diminished breath sounds on physical exam
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15
Q

List the common causes of cough in order of likelihood (roughly)

A
  1. Viral URI
  2. Bacterial URI
  3. Pneumonia
  4. Asthma
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16
Q

When would you use a SABA to treat cough?

A

Only if they had cough and wheezing. If no wheezing, there is no clear benefit

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17
Q

How long after an acute bronchitis do you have to wait to diagnose asthma?

A

8 weeks. Because asthma-like spirometry changes which are NOT actually asthma can be present up to 8 weeks after the episode

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18
Q

What are the 3 most common causes of hemoptysis in ambulatory patients?

A

Bronchitis
Malignancy
Pneumonia

*memory: When people cough up blood, think “BMP”

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19
Q

What diagnostic test should all patients with hemoptysis get?

A

CXR

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20
Q

In a patient with hemoptysis, what factors increase the likelihood of malignancy?

A

Male
Age>40
Smoking>40 pack yrs
Symptoms>1 week

If they have these risk factors, they should get a CXR and a chest CTand bronchoscopy

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21
Q

What diagnostic test must all patients with hemoptysis and malignancy risk factors (male, age>40, smoking 40 pck yrs, symptoms for a week) get?

A

Chest CT and fiberoptic bronchoscopy - even if their CXR was normal!

22
Q

What is the first step for working up chronic cough (lasting >8 weeks)?

A

First, discontinue smoking and an ACE inhibitor, and wait 4 weeks. If still coughing, continue to work-up

If not a smoker or on an ACE inhibitor, get a chest X-ray

23
Q

What are the most common causes of chronic cough in patients with a normal CXR who do not smoke or take an ACE-I?

A

Upper airway cough syndrome
Asthma
GERD

These together make up 90% of cases. So, empirically treat for one of these in these patients (consider spirometry for astham though)

24
Q

What symptoms are usually present in UACS?

A
  • Postnasal drainage
  • Frequent throat clearing
  • Nasal discharge
  • Cobblestone appearance of oropharynx
  • Mucus dripping down oropharynx
25
Q

How do you treat UACS?

A

Best option: First-generation antihistamines
+ decongestant

If allergic rhinitis…

  • avoid allergens
  • intranasal steroids daily
  • cromolyn sodium
26
Q

What should you do if the etiology of a chronic cough is unclear?

A
  1. Empirically treat for UACS (antihistamines + decongestant)
  2. If even THAT doesn’t work, get a sinus CT to look for “silent” chronic sinusitis
27
Q

If you thought asthma was the cause of chronic cough, how would you treat?

A
  1. Spirometry
  2. Inhaled steroid (Flonase)
  3. Bronchodilator (Albuterol?)
  4. Leukotriene receptor agonist (LTRA)

*memory: FAL for asthma (Flonase, Albuterol, LTRA)

28
Q

If you thought non-asthmatic eosinpholic bronchitis was the cause of chronic cough, how would you treat?

A
  1. Sputum induction or bronchial lavage to look for eosinophilia in the sputum
  2. Inhaled steroid (Flonase)
29
Q

Is bronchoprovocation testing sensitive or specific for asthma?

A

100% sensitive (if negative, it CANT be asthma) but not very specific (COPD can cause a positive test too)

30
Q

How does GERD cause cough?

A

Distal esophageal-tracheo-bronchial reflex by the vagus nerve?

31
Q

How many patients with GERD-induced cough have other GERD symptoms?

A

25% (so for 75%, cough is their only symptom)

32
Q

When should you consider Non-asthmatic eosinophilic bronchitis (NAEB) as an etiology for chronic cough?

A

When CXR is normal, spirometry is normal, methacholine challenge test is normal

33
Q

How do you treat chronic bronchitis (cough with sputum)?

A
  1. IPTRATROPIUM to decrease sputum production
  2. systemic STEROIDS during exacerbation
  3. systemic ANTIBIOTICS during exacerbation
34
Q

What is the definition of bronchiectasis?

A

It is a type of chronic bronchitis were you get >30 mL/day of sputum and it gets purulent during exacerbation

35
Q

How can you diagnose bronchiectasis with imaging?

A

CXR or chest CT can show thickened bronchial walls

36
Q

How do you treat bronchiectasis?

A
  1. Culture the sputum and use targeted antibiotics

2. Chest physiotherapy

37
Q

How many patients who stop smoking also stop coughing? How long does it usually take?

A

94-100%. Takes less than 4 weeks for half of people

38
Q

What is the median time it takes for an ace inhibitor cough to resolve?

A

26 days (about a month)

39
Q

What effect does nicotine have on the brain?

A

Stimulates Ach receptors and increases dopamine release in the nucleus accumbens and prefrontal cortex

40
Q

How many people who smoke would like to quit? How many can quite without therapy?

A

Like to quit: 70%

Can quit without therapy: 8%

41
Q

When is nicotine replacement therapy contra-indicated?

A

Recent MI
Severe angina (but stable angina is okay)
Life-threatening arrhythmia

42
Q

What is the only nicotine replacement therapy that delays weight gain?

A

gum

43
Q

What are contraindications to bupropion?

A

seizure disorder, alcohol withdrawal, benzo withdrawal, recent MAOI use

44
Q

What is varenicline (chantix)?

A

blocks nicotine binding to its receptor. Reduces cravings felt by quitting smoking

45
Q

What is the FDA warning on bupropion and varenicline?

A

serious psychiatric symptoms (changes in behavior, hostility, agitation, depressed mood, suicidal thoughts)

46
Q

How do you treat acute bronchitis?

A

NSAIDs, albuterol (only if wheezing)

47
Q

In a patient with COPD exacerbation, what are the indications for antibiotics?

A
  1. Increased sputum volume
  2. Increase sputum purulence
  3. Increase dyspnea

(kind of the definition of an exacerbation)

48
Q

How long does acute bronchitis last?

A

Less than 3 weeks of coughing usually. If longer, prob need a CXR

49
Q

What PFT values define obstructive disease?

A 
low FEV1 (less than 80% predicted)
low FEV1/FVC (less than 70% predicted)
50
Q

What effect does quitting smoking have on lung function?

A

Improves lung function and decreases the rate of decline. Does not stop the decline. DOES improve lung function a little.

Outpatient Medicine (16 decks)

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