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CRRAB II- Week 5 > Johns: Chronic Cough and Hemoptysis > Flashcards

Johns: Chronic Cough and Hemoptysis Flashcards

(50 cards)

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1
Q

What is a chronic cough?

A

One that persists for 3 weeks or longer

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2
Q

What happens to intrathoracic pressures and expiratory velocity during the chronic cough?

A

Intrathoracic pressures may reach 300 mmHg.

Expiratory velocities approach 500 mph.

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3
Q

What is the complex reflex arc associated w/ the chronic cough?

A

Receptors in the nose, sinus, posterior pharynx, ear canals and diaphragm>
Medullary cough center>
Expiratory muscles, diaphragm, larynx

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4
Q

What is the MCC of the chronic cough?

A

Postnasal drip
asthma
GI reflux

Chronic URI

**most pts have more than 1 cause

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5
Q

What else should you consider in a pt w/ chronic cough?

A

ACE inhibitors

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6
Q

What percent of smokers have a chronic cough?

A

25%

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7
Q

What is the MCC of of chronic cough?

A

Post nasal drip

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8
Q

What causes postnasl drip?

A

Allergic
Vasomotor rhinitis
Sinusitis

(Silent drip)

**no definitive criteria for diagnosis

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9
Q

How do you treat post nasal drip?

A

Ipratropium nasal spray
Nasal corticosteroids
Antibiotics (if sinusitis present)

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10
Q

How is asthma associated with a cough?

A

Usually associated w/ wheezing but there is a cough variant type (cough w/ few other symptoms)

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11
Q

What is the best way to confirm an asthma related chronic cough?

A

Demonstrate improvement w/ one week of inhaled beta-agonist therapy

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12
Q

How do you treat an asthma related cough?

A

Inhaled bronchodilators/ inhaled corticosteroids.

Short course of prednisone.

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13
Q

How does gastroesophageal reflux cause a chronic cough?

A

Receptors stimulated in larynx, lower RT and distal esophagus–> chronic cough

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14
Q

How do you work up GERD?

A

24 hr esophageal pH monitoring

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15
Q

How do you treat GERD? How long do you usually treat GERD?

A

Empirically!

dietary changes (smaller meals, no evening snacks)

elevation of head of bed

Proton pump inhibitor

**6-12 mos of Rx

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16
Q

Besides post nasal drip, what is another very common cause of chronic cough?

A

GERD

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17
Q

What are less likely causes of a chronic cough?

A

Lung cancer
Bronchiectasis
Eosinophilic bronchitis

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18
Q

What are centrally acting cough medications and when are they used?

A

Short acting:
Codeine
Dextromethorphan

Both are superior to placebo

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19
Q

What would be your overall treatment plan for a pt w/ a chronic cough?

A

Establish etiology

If no cause found then try dextromethorphan and inhaled ipratropium or inhaled corticosteroid.

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20
Q

What are the top three MCC of cough?

A

Asthma, GERD, post-nasal drip

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21
Q

What is hemoptysis?

Study These Flashcards
A

Can be pure blood or mixed w/ sputum

Rarely massive

22
Q

What is the origin of hemoptysis?

Study These Flashcards
A

Vascular!

Bronchial arteries (supply airways, hilar LNs, visceral pleura)>
Are at systemic pressure unlike the pulmonary arteries>
can cause MASSIVE bleeding

23
Q

How do you evaluate a pt w/ hemoptysis?

Study These Flashcards
A

H and P
Chest Xray!
CBC, UA, creatinine, coags (plts, INR, PTT)
Bronchoscopy

24
Q

When do you pursue a bronchoscopy in a pt w/ chronic cough?

Study These Flashcards
A

In pts w/ normal CXR you will find a tumor in less than 5%, so generally, it won’t be very helpful to do a bronchoscopy in an individual w/ a normal CXRAY.

25
What are RFs for a tumor that would indicate that a bronchoscopy is necessary in a pt w/ chronic cough?
Male sex older than age 40 smoking hx w/ over 40 ppy Hemoptysis greater than one week
26
What is the source of most PEs? Other sources?
Iliofemoral thrombi Also consider pelvic veins as source Less likely- right heart, renal veins, upper extremities
27
Do calf vein thrombi commonly embolize?
No, but we DO treat them, mostly to prevent chronic damage to the veins which could cause venous insufficiency down the line.
28
What are RF for PE?
``` Immobilization Surgery w/in three months Stroke Hx of thromboembolism Malignancy Air travel over 3000 miles ```
29
What are RF for PE in women?
``` Obesity heavy smoking HTN BCP pregnancy ```
30
What can cause PE w/out RFs?
Factor V leiden mutation in up to 40% of cases High concentrations of factor VIII
31
Why might you worry about an occult malignancy as a cause of PE w/ out RFs?
Occult malignancy can occur in up to 17% of people | pancreatic and prostate
32
A pt presents w/ dyspnea, pleuritic pain, cough and hemoptysis. What do they have?
PE
33
What are signs of a PE?
``` Tachypnea Crackles Tachycardia LOUD P2 Fever ```
34
What is a loud P2 associated w/ a PE?
Pulmonary artery pressures increase d/t the emboli. An increase in pulmonary artery pressure causes a louder closure sound.
35
What does a loud P2 mean?
Pulmonary HTN
36
What is the wells criteria?
``` Clinical sxs of DVT Other diagnosis less likely HR Immopbilization or surgery in previous 4 wks Previous DVT/PE Hemoptysis Malignancy ``` **calculate points to determine risk
37
How do you work up a PE?
ABG ECG- insensitive CXR- may show atelectasis or pleural effusion, many are normal D-Dimer
38
What is usually seen on an ABG
Decreased p02, pCO2 and respiratory alkalosis. Can be normal.
39
Describe the sensitivity, specificity and PV of a D Dimer.
Low specificity High sensitivity NPV is HIGH in pts w/ a low pretest probability of PE
40
What is pre and post test probability?
Determine pre-test probability based on RFs--> shows you post-test probability Curves indicate likelihood ratios which can be positive or negative.
41
How does a D dimer relate to post test probability?
A D dimer is very good for a NEGATIVE LIKELIHOOD TEST and can decrease the likelihood significantly. It is good at ruling OUT but not ruling IN.
42
What is the specificity and sensitivity of a lung CT?
Sensitivity 70-87% Specificity 90% Can't detect small emboli beyond normal segmental arteries **too many are ordered
43
If you have a pt with a low pretest probability and a normal D dimer do you need to anticoagulate?
No
44
What do you do if you have a pt with a moderate or high pretest probability?
Proceed w/ a CT
45
What do you do if you have a pt with a normal CT and a high pretest probability?
Consider angiography
46
How do you treat a PE?
Heparin (unfractionated vs. LMW) 5 days of heparin overlapping w/ warfarin. Continue w/ warfarin for 6 mos
47
What are the advantages of LMW?
Once daily fixed dose no lab monitoring needed less likely to cause decreased platelets
48
When are thrombolytics used?
Massive PEs w/ hypotension
49
When is an IVC filter used?
In pts w/ PE and contraindication for anti-coagulation or recurrent PE despite anti-coaulation
50
What is the MC source of PE?
Ileo-femoral veins

CRRAB II- Week 5 (3 decks)

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