13- chronic cough Flashcards
acute vs chronic cough
acute- <4 weeks- infectious, trauma/choke
chronic >4 wks- infection, inflamm, irritation, anatomic, psychogenic (usually viral)
dry cough examples
environmental irritant
asthma
fungal infection
wet cough example
lower-respiratory infection
barking cough examples
croup
subglottic disease
foreign body
brassy honking cough
habitual cough
tracheitis
paroxysmal cough
pertussis
chlamydia
mycoplasma
foreign body
worse at night cough
asthma
sinusitis (sometimes with HA)
Disappears at night cough
habit
Associated with gagging or choking cough
GERD
change in voice with cough
laryngeal irritation due to chronic rhinitis or gastroesophageal reflux.
allergic shiners
Darkening of the lower eyelids as a result of venous stasis
allergic salute
A gesture that involves pushing the nose upward and backward with the hand to relieve nasal itching and obstruction. Over time, this may result in the development of a transverse nasal crease.
dennie morgan lines
Infraorbital creases that appear due to intermittent edema caused by allergies
clubbing
Change in the appearance of the fingers so that the distal phalanx is rounded and bulbous and the angle between the nail plate and the nail fold is increased past 180 degrees. This phenomenon is suggestive of chronic hypoxia.
tracheal deviations suggest
a mediastinal mass,
pneumothorax, or
foreign body aspiration.
retractions on lung exam
severe obstructive airway disease in children, including asthma, bronchiolitis, and foreign body obstruction.
kids on long term inhale steroid therapy should be monitored for…
elevation in blood pressure, serum blood sugar, growth delay, and cataract development.
PFT findings in obstructive lung disease
low FEV1/FVC ratio, the FEV1 (%), which produces the scalloped shape on the exhalation limb of the flow-volume curve.
PFT findings in restrictive lung disease
low FEV1, but a proportionate reduction in the FVC maintains a normal FEV1/FVC ratio
refer kid with asthma to pulomonolgist when…
Has had a life-threatening asthma exacerbation.
Is not meeting the goals of asthma therapy after 3-6 months of treatment, or earlier if the child appears unresponsive to treatment.
Signs and symptoms are atypical.
Other co-morbid medical conditions complicate asthma management.
Additional testing is needed (i.e., allergy testing, bronchoscopy) or immunotherapy is being considered.
Additional patient education regarding adherence to medications or allergen avoidance.
Patient is young (< 3 years old) or has severe asthma.
intermittent asthma
<2 days/week of symptoms
<2 nights/month
treat: SABA
mild persistent asthma
> 2 days/week but not daily
1-2 nights/month if under 4, 3-4 nights if over 4
treat: low dose inhaled steroids + SABA
moderate persistent asthma
daily
3-4 nights/month if under 4, 1/week nights if over 4
treat: medium dose inhale corticosteroids
severe persistent asthma
throughout day
1/week nights if under 4; 7x/week if over 4
treat: medium dose ICS if under 4
medium or high dose ICS + LABA/montelueklast if over 4
other symptoms to consider on differential for asthma/cough
Pneumonia- fever? sinusitis- HA? sore throat? GERD- change in voice, chest pain, spit up CHF- chest pain Chronic rhinitis- change in voice Foreign body- choking
hyper resonance heard when
localized air trapping behind a mucus plug, foreign body or mass.
egophany heard when
lobar consolidation
