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CPR Exam 2 > Cough DSA > Flashcards

Cough DSA Flashcards

1
Q

Acute cough lasts ______ and is usually _______.

A

Less than 3 weeks

Self-limited.

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2
Q

Sub-acute cough lasts _________ and indicated what?

A
  • 3-8 weeks
  • Prolonged acute cough or early presentation of chronic cough.
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3
Q

Chronic cough lasts ______.

A

More than 8 weeks.

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4
Q

What are the most common causes of acute cough?

Which is the MOST common?

A
  • 1. Viral URI (common cold)
    1. Lower respiratory infection (bronchitis and pneumonia)
    1. Bacterial sinusitis
    1. Rhinitis d/t allergens or environmental irritants
    1. Asthma or COPD
    1. Cardiogenic pulmonary edema
    1. Aspiration or foreign body
    1. ACE inhibitor
    1. PE
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5
Q

Which viruses are associated with cough and URI?

A

1. Coronavirus

2. Adenovirus

3. Rhinovirus

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6
Q

Which viruses are associated with cough and LRI?

A
  • 1. Influenza A/B
  • 2. Parainfluenza
  • 3. Respiratory syncytial virus (RSV)
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7
Q

How are most viral causes of cough treated?

A

Symptomatically

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8
Q

Influenza is characterized by:

Clinical Dx requires:

Dx:

A
  • -Sudden onset of fever and weakness, followed by cough, HA, muscle aches and nasal/pulmonary sx during the app season.
  • -T: >100 (3.7 C) and one of the following sx: [cough, pharyngitis or rhinorrhea]
    • Viral culture of secretions or rapid diagnostic tests (PCR, immunoflurouesce. enzyme immunoassay).
      • Rapid tests help in confirming +, but sensitivity is limited and (-) results do not exclude dx.
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9
Q

When is anti-viral therapy indicated for patients with influenza?

A
  • Hospitalized patients
  • Those with severe, complicated or progressive illness.
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10
Q

________ are given to treat Influenza A and B.

When should it be administered and what effect do they have?

A

Neuraminidase inhibitors.

Give within first 2 days of sx and can reduce duration and complications.

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11
Q

What are the preventative treatments for Influenza A and B?

A
  1. Vaccination
  2. Antiviral chemoprophylaxis (NA inhibitors); only for:
  • patients living in an assissted living facility when there is an influenza outbreak,
  • ppl who have higher risk of influenza related complications and have had recent contact with confirmed case,
  • unvaccinated health care workers who had a recent contact with confirmed case.
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12
Q

H1N1 is a emerging _________ virus

  • Symtoms:
  • Treat:
A
  • Influenza A
  • Cough, fever and rinorrhea
  • Chemoprophylaxis (NA inhibitors)
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13
Q

What are the non-viral causes of uncomplicated

[acute bronchitis** and **cough] in adults?

A
  1. B. pertussis
  2. Mycoplasma pneumonia
  3. Chlamdophila pneurmoniae
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14
Q

How do we detect cause of acute bronchitis?

How do we treat acute bronchitis?

A
  • Diagnostic tests are not recommended: gram stain and culture of sputum does not reliably detect
    • GOLD STANDARD: + bacterial culture or PCP
  • Abx is not recommended, unless you think adult pertussis. However, nothing can tell us if its pertussis unless there is a HIGH probability (cough that last more than 2 weeks without an apparent cause + [paroxysms of coughing, inspiratory whoop or posttussive emesis or cough >2 weeks when there is a documented outbreak].
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15
Q

If acute bronchitis is d/t pertussis, how do ABX help?

A

Decrease the spread of the disease because does not stop sx if given after 7-10 days of onset.

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16
Q

What is the PRIMARY diagnostic goal when evaluating a patient for acute cough?

A

Rule out pneumonia: it is the 3 MCC and the most severe.

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17
Q

How do we rule out pneumonia as the cause of acute cough?

A

Pneumonia would have abnormal vital signs:

    1. HR: over 100/min
    1. RR: over 28/min
    1. T: over 100 F (37.7)
    1. Crackles
    1. Decrease breath sounds

If patient does not have these, end diagnosing for pneumonia.

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18
Q

How do we dx asthma as a cause of acute cough?

A

Hard to diagnose unless there is a reliable hx of asthma and episodes of wheezing + SOB in addition to the cough.

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19
Q

Why is asthma so hard to dx with [transient bronchial hyperresponsiveness] and [abnormal spirometry]?

A

Occur in all causes of acute bronchitis

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20
Q

When should inhaled- short acting B agonists be used as a treatment?

A

Patients with [cough + wheezing];

no benefit in cough without wheezing.

21
Q

Acute worsening of chronic bronchitis and bronchiectasis presents how?

A

-abrupt increase from baseline in cough, sputum production and purulence and SOB

22
Q

How do we treat acute cough?

What is their effectiveness?

A

Main indications: cant sleep, painful cough and debilitating cough

  • Self-limited but: antitussive agents, expectorants, mucolytic agents, antihistamines and nasal anticholinergic agents
    • Little evidence supports OTC and prescription antitussive meds; placebo
    • Guaifenesin has some benefit
24
Q

What are the most common causes of chronic cough?

A

In most patients, chronic cough is caused by more than 1 thing.

  • 1. Upper airway cough sydrome (UACS)
  • 2. Asthma
  • 3. GERD
    1. Non-asthmatic eosinophillic bronchitis
    1. Medication reaction (ACE-i)
    1. Chronic bronchitis d/t smoking
25
**ALL patients** that we suspect with **chronic cough** should be given what?
* **1. Chest radiography** * **2. Careful history and physical exam findings for ALL common causes.**
26
All patients with **chronic cough** should do what, before workup?
**Stop smoking** and **ACE inhibitors** _4 weeks before._
27
How do we determine the cause of **chronic cough**?
**Look at which therapy eliminates symptoms** associated with cough.
28
What is UACS?
* **Upper airway cough syndrome:** _recurrent_ cough that occurs when mucus from the nose drains down the oropharynx =\> triggers cough receptors.
29
Symptoms of **UACS**?
* **1. Post nasal drainage** * **2. Clears throat alot** * **3. Nasal discharge** * **4. Cobblestone stone appearane on oropharyngeal mucosa** * **5. Mucus dripping from oral mucosa**
30
Treatment of **UACS**? Dx:
* **Tx**: non-sedating antihistamines + decongestant * **Dx**: If drugs treat discharge and cough
31
How do we treat an **unknown chronic cough?**
**Nonsedating antihistamines** + **decongestant** to see if it is UACS
32
What is **cough-varient asthma** and how is it dx?
* **Asthma** (airway hypersensitivity) where **cough is the main symptom.** * Dx when asthma meds treat cough; takes 6-8 weeks.
33
Which test result can exclude **cough-variant asthma** as a diagnosis?
-**Bronchoprovacation test:** (-) test is 100% sensitive to rule out, but a positive test does not indicate, because test is not specific.
34
How does **GERD** cause **chronic cough?**
* **Most common:** vagal mediated distal esophageal tracheobronchial reflex. * Aspiration
35
How do we treat **chronic cough** caused by **GERD**
* First, give **PPI** because noninvasive * Then: **24 hour- esophageal pH monitoring** (most sensitive and specific) * Sx decrease **3 months** after.
36
When do we diagnose **chronic cough** due to **NAEB** (nonasthmatic eosinophillic bronchitis)?
* NL CXR * NL spirometry * (-) methacholine challenge test
37
What is **NAEB?**
**Chronic cough** with **eosinophils in airway,** obtained by sputum or bronchial lavage during bronchoscopy.
38
If a patient has **NAEB**, what should we ask on exam? How do we _treat_?
* - Occupational exposure to sensitizer * - Inhaled glucocorticoids and avoid allergens.
39
What is a hallmark symptom of **chronic bronchitis** caused by **smoking**? Treatment?
* **Cough + sputum.** * Tx: **Stop smoking** to decrease sputum production and airway inflammation. * **Inhaled anticholinergic agents (tiotropium and ipratropium):** decrease sputum production * **Systemic glucocorticoids and ABX:** decrease cough when bad exacerbations
40
What is bronchiectasis? Dx? Tx?
* Chronic bronchitis that causes chronic/recurrent cough with voluminous (\>30 mL/day) of sputum and purulent exacerbations. * **Dx**: CXR and CT show thick bronchial walls and tram-line pattern * **Tx**: ABX, based of sputum culture and chest radio
41
Is stopping smoking good at stopping chronic cough?
**Yes**: decrease in almost 100% of patients.
42
**Cough d/t ACE inhibitors** is related to ________ and occurs when? ## Footnote **Dx:** **Tx:**
* **Class**, not dose. * Hours - weeks/months after 1st dose of ACE inhibitor. * **Dx:** cough stops around 26 days after stopping ACE inhibitors * **Tx:** switch ACE inhibitor with angiotensin receptor blocker.
43
Does **hemoptysis** occur in acute or chronic cough? What is the most common causes?
* Either * Infection (bronchitis or pneumonia) followed by malignancy.
44
What can cause **hemoptysis**?
1. -High pulmonary pressure d/t left sided HF 2. -PE 3. -Lower respiratory causes 4. -Upper airway souces of bleeding (nose) and and GI bleeding
45
All patients with hemoptysis need \_\_\_\_\_\_. What increase risk of malignancy?
* Chest radiography * M, over 40YO, smoking \>40-pack years, sx last longer than 1 week.
46
Pts with increase risk of **malignancy** who have **hemoptysis** need to be reffered where, **if cause of hemoptysis on chest radiography is not IDd?**
* Chest CT * Fiberoptic bronchopy * NECESSARY bc CT doesnt always show lesions
47
**Hemoptysis** patient with history of _LRT infection_ and _NL chest radiograph_ should be treated with \_\_\_\_\_\_\_\_
* **Oral ABX** to see if treats.. * If recurs or persists, get a **broncoscopy**.
48
Patient with massive hemoptysis (over 200mL/day) requires what?
* **1. Urgent impatient eval** * **2. Early consultation with pulomonologist** * 3. **ICU** * **-Airway management** to prevent ASPHYXIATION, not exsanguition/
49

CPR Exam 2 (29 decks)

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