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MYE SPE (Cough) Flashcards

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1
Q

What is the MC etiology and pathogen associated with Common Cold/URI?

A

Viral

- Rhinovirus

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2
Q

What four sxs are often seen with Common Cold/URI? When is it most contagious?

A
  • NON-productive cough
  • Clear/watery rhinorrhea
  • Nasal congestion
  • Sore throat (dry/scratchy)

First 2-3 days

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3
Q

What three PE findings are often seen with Common Cold/URI? What PE finding is NOT seen?

A
  • Swelling and discharge of nasal mucosa
  • Pharyngeal erythema (mild)
  • Conjunctival injection

NO LAD

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4
Q

What are two possible complications of Common Cold/URI?

A
  • Acute rhinosinusitis

- AOM

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5
Q

What is the typical course of Common Cold/URI, and what is the treatment (2)?

A

SELF-LIMITING (1-2 weeks)

  • NSAIDs/Acetaminophen
  • Antihistamines (Sudafed)
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6
Q

What four sxs/group of sxs are seen with COVID-19?

A
  • Fever
  • Cough +/- SOB
  • URI sxs (myalgias, diarrhea, HA, sore throat, N/V, abd. pain)
  • Loss of sense of smell and/or taste
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7
Q

What is the dx test of choice for COVID-19?

A

NAAT nasal swab

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8
Q

What is the recommended tx for COVID-19 (outpatient (2) vs. inpatient (2))?

A
  • OP: ISOLATE, supportive care

- IP: steroids (Dexamethasone), Remdesivir

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9
Q

What is the most common etiology associated with Acute Rhinosinusitis? What age group is most often affected?

A

VIRAL

- Age 45-64 years (mostly female)

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10
Q

How is Acute VIRAL Rhinosinusitis typically diagnosed?

A

Clinically

- <10 days of sxs, NOT worsening

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11
Q

What is the most common cause of Acute BACTERIAL Rhinosinusitis?

A

VIRAL

- Mucosal edema/sinus inflammation causes obstruction with bacteria, leading to secondary bacterial infection

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12
Q

When are abx indicated in the treatment of Acute BACTERIAL Rhinosinusitis (3)?

A
  • Persistent sxs for 10+ days, no improvement
  • Onset of severe sxs
  • Viral URI that initially improved THEN worsened (“double worsening”)
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13
Q

What is the first line treatment for Acute BACTERIAL Rhinosinusitis? What if the patient is high risk?

A

Augmentin for 5-7 days

- High risk = inc. Augmentin dose for 7-10 days

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14
Q

What is the gold standard diagnostic test for Acute BACTERIAL Rhinosinusitis?

A

Sinus Aspirate culture (by ENT)

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15
Q

What are the four cardinal symptoms associated with Chronic Rhinosinusitis? How does this differ for children?

A
  • Mucopurulent drainage
  • Nasal obstruction/congestion
  • Facial pain/pressure/fullness
  • Reduced/loss sense of smell

In children, cough rather than smell

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16
Q

What is the diagnostic criteria for Chronic Rhinosinusitis (3)?

A 
- 2/4 cardinal sxs present
AND
- Sxs for 12+ weeks
AND
- Disease on CT or Nasal Endoscopy
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17
Q

What three symptoms are often seen with Influenza? What is the typical onset, and when is it most contagious?

A

ABRUPT onset of…

  • Fever
  • Myalgias
  • Malaise
  • HA

First 2 days

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18
Q

If outpatient, when is testing recommended for Influenza (3)? If inpatient, when is it recommended?

What additional test is also often ordered as the gold standard?

A

OP: NOT recommended unless high risk = 65+, children <5 years or IC

IP: ANY patient with sxs upon admission or during admission

Gold standard = viral culture (3-10 days for results)

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19
Q

What is the preferred test for Influenza?

A

NAAT (Rapid Molecular Assay)

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20
Q

What is the recommended treatment for Influenza if severe or high-risk, and what is the window for giving it? How does this affect prognosis (2)?

A

Tamiflu (Oseltamivir) within 48 hours

- Reduces complications and shortens course by 1-2 days

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21
Q

How does Influenza vaccination differ for children 6 months to 8 years vs. 18-64 years vs. 65+ years?

A
  • 6 months-8 years = for first dose, TWO standard dose trivalent IM that are 4+ weeks apart
  • 18-64 years = standard dose trivalent IM
  • 65+ years = HIGH dose trivalent IM
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22
Q

What is the major complication associated with Influenza, and in what population is this a leading cause of mortality?

A

PNA

- Native Americans

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23
Q

What is the most common etiology of Pharyngitis?

A

VIRAL

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24
Q

What is the most common bacterial pathogen associated with Pharyngitis?

A

GAS (Strep pyogenes)

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25
How does viral pharyngitis differ from bacterial pharyngitis on PE? What two viral pathogens are the exception to this?
Viral = NO pharyngeal exudate | - Exceptions: Adenovirus, Mononucleosis
26
What four symptoms are often seen with GAS Pharyngitis? What three other non-specific sxs may be seen?
- Fever - Sore throat - Malaise - Odynophagia (painful swallowing) Also, non-productive cough, N/V, myalgias
27
What cardiac condition is primarily associated with cough? How does this cough often present?
CHF | - Typically CHRONIC cough
28
What are the two types of CHF? Describe each.
- Systolic = HFrEF | - Diastolic = HFpEF
29
What four symptoms are seen with LEFT-sided CHF?
LEFT: - DOE - PND - Orthopnea - Fatigue
30
What four symptoms are seen with RIGHT-sided CHF?
RIGHT: - JVD - Hepatic congestion - Ascites - Edema
31
What condition can present with pulsus altercans?
LEFT-sided (ventricular) CHF
32
What heart sounds may be presents with CHF (2)?
- S3 | - S4
33
What three findings may be seen with CHF on x-ray?
- Kerley B lines - Effusion - Cardiomegaly
34
What is the GOLD standard dx test used for CHF?
Echo
35
What is the recommended treatment for ACUTE exacerbation of CHF (5)?
LMNOP - Lasix - Morphine - Nitrates - O2 - Position (sit up)
36
What four drugs/groups of meds can be used to treat CHF? What other patient education should be provided to CHF patients (4)?
- Loop diuretics - ACE-I - BBs - Entresto (Sacubitril/Valsartan) Can consider... - Aldosterone Antagonists - Hydralazine/Nitrates Education: weight loss, low sodium, lower fluids, daily weight monitoring
37
Compare high-output CHF to low-output CHF.
- HIGH = high CO; demand > supply | - LOW = low EF, low CO
38
What group of medications is associated with an SE of dry cough? When will this typically present? What group of medications can be used as an alternative?
ACE-Is can cause dry cough within 1 week of starting the med | - Alternative = ARBs (Losartan); be sure to D/C ACE-I
39
What are three major RF associated with COPD, and which is most common?
- SMOKING = MC - Secondhand smoke - Alpha-1 Antitrypsin Deficiency
40
What three sxs are often seen with COPD?
- Excess sputum production - Cough - DOE
41
What is the recommended screening test for Lung CA? In what population would screening be recommended (hint: __ AND __ or __)?
CT | - Annually if 55-80 years old with 30+ year pack history AND currently smoking or smoked within past 15 years
42
How do you define Chronic Bronchitis?
Productive cough for 3 months for 2 consecutive years
43
What are two subtypes of COPD?
- Chronic Bronchitis | - Emphysema
44
How can you differentiate sxs of Chronic Bronchitis from Emphysema (2 sxs for each)?
- Chronic Bronchitis: productive cough, respiratory acidosis | - Emphysema = SOB, respiratory alkalosis
45
What spirometry results are indicative of COPD (2)?
- FEV1/FVC = <70% | - FEV1 = <80%
46
What value are the four grades of COPD based on (GOLD), and what are the four grades?
Based on FEV1... - GOLD 1 = FEV1 of 80%+ - GOLD 2 = FEV1 of 50-70% - GOLD 3 = FEV1 of 30-49% - GOLD 4 = FEV1 of <30%
47
What is the #1 recommended tx for COPD?
STOP SMOKING
48
What three classes of drugs are used to treat COPD, and what is an example of each?
- SABA = Albuterol - LABA/ICS = Salmeterol - LAMA = Tiotropium
49
What are the four categories of treatment of COPD (1, 12 or 2, 2 or 3, 1)
- Category A = SABA - Category B = SABA + LABA, SABA + LAMA - Category C = SABA + LAMA - Category D = SABA + LAMA, SABA+ LABA + LAMA
50
What is the most common etiology and pathogen associated with Acute Bronchitis?
VIRAL | - Adenovirus
51
What is the primary sxs associated with Acute Bronchitis? What other three sxs may present?
Non-productive cough - Wheezing - Rhonchi - Pharyngitis
52
How do you dx Acute Bronchitis?
CLINICAL
53
What is the recommended tx for Acute Bronchitis (3)?
Supportive care - Rest - Hydration - NSAIDs
54
Compare mild intermittent, mild persistent, moderate persistent and severe persistent Asthma (3 components each)?
- Mild intermittent = <2 days/week, night awake <2 x/month, FEV1 80%+ - Mild persistent = 2+ days/week, night awake 3-4 x/month, FEV1 80%+ - Moderate persistent = daily, night awake 1 x/week, FEV1 60-80% - Severe persistent = throughout day, awake nightly, FEV1 <60%
55
What three sxs are associated with Asthma?
- SOB - Wheezing - Cough (worse at night)
56
When is the cough in Asthma worst?
AT NIGHT
57
What two physical exam findings are seen with Asthma?
- Prolonged expiration | - Hyperresonance to percussion
58
What are the three components of Samter's Triad?
- Asthma - Sinus disease with nasal polyps - ASA/NSAID allergy
59
What is the GOLD standard dx test for Asthma?
Spirometry
60
What two findings may be seen on sputum culture with Asthma?
- Curschmann's spirals | - Charcot-Leyden crystals
61
What is the bronchodilator test and what does it indicate in Asthma?
Asthma = reversible | - Reversible if FEV1 increases by 12%
62
What are the three components of Atopic Triad?
- Asthma - Allergic rhinitis - Atopic dermatitis
63
What are the six steps of Asthma treatment, and how do they relate to the Asthma classifications (1, 2, 3, 3, 2, 3)?
- Step 1 = Mild Intermittent: SABA PRN - Step 2 = Mild Persistent: low-dose ICS daily OR LTRA (Montelukast) - Step 3 = Moderate Persistent: medium-dose ICS daily OR low-dose ICS + LABA; consider referral - Step 4 = Severe Persistent: medium-dose ICS + LABA OR medium-dose ICS + LTRA; REFER - Step 5 = been referred: high-dose ICS + LABA - Step 6 = been referred: high-dose ICS + LABA + oral steroids
64
What is the MC type of Interstitial Lung Disease?
Idiopathic Pulmonary Fibrosis
65
What two sxs are associated with Idiopathic Pulmonary Fibrosis?
- Gradual SOB | - NON-productive cough
66
What is the recommended dx test for Idiopathic Pulmonary Fibrosis, and what two findings may be seen?
HRCT - Ground glass opacities - Honeycomb
67
What is the recommended tx for Idiopathic Pulmonary Fibrosis?
EARLY REFERRAL for lung transplant
68
What are the three types of Pneumoconiosis, and what causes each type (hint: think occupation)?
- Silicosis = miners, males - Coal Worker's (Black Lung) = coal miners, males - Asbestosis = construction, males
69
What condition presents with "crazy paving" pattern on HRCT?
Silicosis | - Type of Pneumoconiosis
70
What is the primary sxs and PE finding seen with Silicosis?
- Sxs = NON-productive cough | - PE = crackles
71
What finding will be seen with chronic SIMPLE Silicosis and Coal Worker's (Black Lung) on CXR/HRCT? What about chronic COMPLICATED? What part of the lung do these typically show?
- Chronic simple = eggshell - Chronic complicated = angel wings UPPER LOBES
72
Which type of Pneumoconiosis is associated with increased risk of TB?
Silicosis | - Type of Pneumoconiosis
73
What condition involves black masses, occasionally with liquified center?
Coal Worker's (Black Lung) | - Type of Pneumoconiosis
74
What specific finding is seen on CXR/HRCT with Asbestosis? What part of the lung do these typically show?
- Pleural plaques LOWER LOBES
75
Which type of Pneumoconiosis is associated with increased risk of Bronchogenic Carcinoma and Malignant Mesothelioma?
Asbestosis
76
What two condition are you at increased risk for with Asbestosis?
- Bronchogenic Carcinoma | - Malignant Mesothelioma
77
What is the most common body system affected with Sarcoidosis? What other two body systems are affecteD?
LUNGS | - Also skin and eyes
78
What are two common sxs associated with Sarcoidosis? What are three common skin sxs and one ocular sxs associated with Sarcoidosis?
- SOB - Dry, non-productive cough - SKIN = erythema nodosum, lupus pernio - EYES = anterior uveitis
79
What is the pathognomonic sxs associated with Sarcoidosis?
Lupus pernio (violaceous, raised discoloration of face)
80
What does the "typical" Sarcoidosis patient look like (3, think RF)?
African American female that does NOT smoke
81
What lab finding is seen with Sarcoidosis?
Elevated serum ACE
82
What is the 1st line tx for Sarcoidosis? What is the 2nd line tx?
- 1st line = observation +/- steroids | - 2nd line = immunomodulators
83
What is the primary RF associated with Solitary Pulmonary Nodules (SPNs)?
Thymomas
84
How can you differentiate a nodule from a mass with Solitary Pulmonary Nodules (SPNs)? What is there increased chance of with a mass? What are the MC type of SPN?
- Nodule = <3 cm - Mass = 3+ cm; greater change of CA MC = infectious granulomas (TB, Cocci, abscess)
85
What three findings are indicative of a BENIGN Solitary Pulmonary Nodule (SPN)?
- SLOW growth - Round/smooth - Calcifications
86
What three findings are indicative of a MALIGNANT Solitary Pulmonary Nodule (SPN)?
- RAPID growth - Irregular/speculated - Cavitation with thick walls
87
What is a Carcinoid Tumor? What is the MC site affected?
Neuroendocrine tumors | - GI tract (or lungs)
88
What is the greatest RF associated with Bronchogenic Carcinoma?
SMOKING
89
What are the two types of Bronchogenic Carcinoma, and what are the subtypes of each (1, 3)?
SCLC - Oat Cell NSCLC - Adenocarcinoma - SCC (Squamous Cell) - LCC (Large Cell)
90
Which subtype of Bronchogenic Carcinoma typically presents with cough, and WHY? What other subtype also presents with cough
SCLC (Oat Cell CA) - Arises in central airway Also Squamous Cell CA (type of NSCLC)
91
Which subtype of Bronchogenic Carcinoma typically presents with peripheral nodules/masses?
Adenocarcinoma (type of NSCLC)
92
Which subtype of Bronchogenic Carcinoma typically occurs centrally/in main bronchus?
Squamous Cell CA (type of NSCLC)
93
Which subtype of Bronchogenic Carcinoma typically presents with central nodules/masses?
Large Cell CA (type of NSCLC)
94
Which two subtypes of Bronchogenic Carcinoma typically metastasize to DISTANT organs?
- Adenocarcinoma (type of NSCLC) | - Large Cell CA (type of NSCLC)
95
Which subtype of Bronchogenic Carcinoma typically presents with hemoptysis?
Squamous Cell CA (type of NSCLC)
96
Which two subtypes of Bronchogenic Carcinoma present most often with cough?
- SCLC (Oat Cell CA) | - Squamous Cell CA (type of NSCLC)
97
What are the preferred tx for each type of Bronchogenic Carcinoma?
- SCLC = chemo | - NSCLC = surgery
98
What is the MC pathogen associated with bacterial PNA, and what color sputum does it present with?
S. pneumoniae | - Rust-colored sputum
99
When does CAP present, and what pathogen is MC?
Within 48 hours of hospital or OP | - S. pneumoniae
100
What four sxs present with bacterial PNA?
- Productive cough - Fever - SOB - Pleuritic CP
101
What is the gold standard dx test for bacterial PNA?
CXR (PA and lateral)
102
What is CURB-65 and what condition is it associated with? What is it used to determine?
If 2+ present = admit for PNA - Confusion - Urea of 7+ - RR of 30+ - BP <90/60 - 65+ years old
103
What is the recommended OUTPATIENT tx for bacterial PNA if uncomplicated (1, 1) vs complicated (2, 1)?
- OP uncomplicated = Azithro OR Doxy | - OP complicated = Augmentin + Azithro OR Levofloxacin
104
What is the recommended INPATIENT tx for bacterial PNA (2, 2)?
- Augmentin + Azithro | - Augmentin + Levofloxacin
105
What two vaccinations are recommended for bacterial PNA?
- Influenza | - Pneumococcal
106
What is the MC VIRAL pathogen associated with PNA?
Influenza
107
What four sxs present with viral PNA?
- NON-productive cough - Fever/chills - Rhinorrhea - HA, sore throat
108
What type of PNA is MC associated with HIV, and what specific pathogen?
Unicellular/Fungal PNA | - Pneumocystis jirovecii
109
What is the tx for Unicellular/Fungal PNA?
Bactrim
110
What is Bronchiectasis? What is the MC pathogen?
Permanent and abnormal dilation of major bronchi (airways) | - H. flu
111
What are four sxs associated with Bronchiectasis?
- Copious/thick/foul-smelling sputum - Chronic daily cough - Hemoptysis - Recurrent lung infections
112
What is the recommended tx for Bronchiectasis (2)?
Abx (Ampicillin) + Bronchodilator
113
What is Virchow's Triad, and what condition is it associated with?
PE - Venous stasis - Injury to vessel wall - Hypercoagulation
114
What four sxs are commonly associated with PE?
- SOB (sudden onset) - Pleuritic CP - Hemoptysis - Cough/wheezing
115
What two EKG findings are seen with PE?
- Sinus tachy | - S1Q3T3
116
What is the gold standard dx test for PE? What is the BEST dx test for PE?
- Gold = CTPA (pulmonary angiography) | - BEST = spiral CT
117
What are the general recommended tx for PE (3)?
1. O2 2. IV fluids 3. Anticoagulation
118
For tx of PE, what are the four classes of anticoagulation, and what is an example of each (2, 2, 1, 1)?
- Antithrombin III = Heparin or LMWH - Facto Xa Inhibitor = Xarelto, Eliquis - Direct thrombin inhibitor = Pradaxa - Vitamin K inhibitor = Warfarin
119
What are two PE findings seen with PE?
- JVD | - S3 and S4 sounds
120
What finding is seen on CXR with Unicellular/Fungal PNA aka P. jirovecii?
"Batwing" appearance
121
What is the pathogen associated with Pertussis? What three sxs (triad) are associated with this condition?
Bordetella pertussis - Coughing spells (paroxysms of cough) - Inspiratory whoop - Posttussive emesis
122
What are the three phases of Pertussis (describe each), and how long does each last?
1. Catarrhal = URI sxs, fever for 1-2 weeks 2. Paroxysmal = triad of sxs for 2-6 weeks 3. Convalescent = cough gradually improves for weeks/months
123
What dx test is the GOLD standard for Pertussis?
Culture (bacterial)
124
What is the recommended tx for Pertussis? What is an alternative option?
Macrolides = Azithromycin | - Bactrim
125
How do you contract Cryptococcosis? What is the primary pathogen?
Inhalation of spores from FRICKIN PIGEON SHIT | - Cryptococcus neoformans
126
What is the recommended tx for Cryptococcosis (1+1)?
Amphotericin B + Flucytosine
127
What five sxs are often associated with Tuberculosis?
- Fever - Cough (dry) - Hemoptysis - CP (often pleuritic) - Weight loss
128
What is the classic finding seen with TB?
Posttussive crackles
129
What is the primary dx test used for TB, and how do you interpret it?
TST (Mantoux Tuberculin Skin Test) | - Measure INDURATION, not erythema
130
How can you differentiate ACTIVE vs. LATENT TB (3, hint: think sxs, contagious, dx test)?
Active: - Sxs of cough for 3+ weeks, CP, hemoptysis - Contagious - Abnormal CXR AND +sputum smear/culture Latent: - Asxs - NOT contagious - Normal CXR and -sputum smear/culture
131
What is the recommended tx for ACTIVE TB (4), and for how long?
RIPE for 6-12 months - Rifampin - Isoniazid - Pyrazinamide - Ethambutol
132
What is the recommended tx for LATENT TB, and for how long (2)?
Isoniazid + Rifapentine
133
What is the primary transmission of Histoplasmosis?
Bird or bat poop (ex. spelunking)
134
What is the tx for mild/moderate Histoplasmosis (2) vs. severe Histoplasmosis (1)?
- Mild/moderate = Itraconazole | - Severe = Amphotericin B
135
What are the two MC types of Esophageal CA?
- SCC (MC worldwide) | - Adenocarcinoma (MC in U.S.)
136
What is the primary sxs associated with Esophageal CA?
Solid food dysphagia (then fluid dysphagia)
137
What is the recommended dx test for Esophageal CA?
Endoscopy with biopsy
138
What is the primary sxs associated with GERD?
Heartburn (30-60 min post-prandial) | - Can have CHRONIC cough
139
What is the recommended dx test for GERD?
Upper endoscopy
140
What is the recommended tx for GERD (2)?
1. Lifestyle modifications | 2. H2 Blockers (Ranitidine) vs. PPIs (Omeprazole)
141
What four sxs may present with Non-Hodgkins Lymphoma?
- Cough - SOB - Edema - Mediastinal mass
142
What is the MC TYPICAL pathogen associated with CAP? What about ATYPICAL CAP?
- Typical: Streptococcus pneumoniae | - Atypical: Mycoplasma pneumoniae
143
What is the MC etiology of CAP (and what pathogen? What is the 2nd MC etiology (and what pathogen)?
- MC = BACTERIAL: Streptococcus pneumoniae | - 2nd MC = VIRAL: Influenza

Clinical Year Exams (3 decks)

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