13- chronic cough

Question 1

acute vs chronic cough

Answer 1

acute- <4 weeks- infectious, trauma/choke

chronic >4 wks- infection, inflamm, irritation, anatomic, psychogenic (usually viral)

Question 2

dry cough examples

Answer 2

environmental irritant
asthma
fungal infection

Question 3

wet cough example

Answer 3

lower-respiratory infection

Question 4

barking cough examples

Answer 4

croup
subglottic disease
foreign body

Question 5

brassy honking cough

Answer 5

habitual cough

tracheitis

Question 6

paroxysmal cough

Answer 6

pertussis
chlamydia
mycoplasma
foreign body

Question 7

worse at night cough

Answer 7

asthma

sinusitis (sometimes with HA)

Question 8

Disappears at night cough

Answer 8

habit

Question 9

Associated with gagging or choking cough

Answer 9

GERD

Question 10

change in voice with cough

Answer 10

laryngeal irritation due to chronic rhinitis or gastroesophageal reflux.

Question 11

allergic shiners

Answer 11

Darkening of the lower eyelids as a result of venous stasis

Question 12

allergic salute

Answer 12

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.

Question 13

dennie morgan lines

Answer 13

Infraorbital creases that appear due to intermittent edema caused by allergies

Question 14

clubbing

Answer 14

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.

Question 15

tracheal deviations suggest

Answer 15

a mediastinal mass,
pneumothorax, or
foreign body aspiration.

Question 16

retractions on lung exam

Answer 16

severe obstructive airway disease in children, including asthma, bronchiolitis, and foreign body obstruction.

Question 17

kids on long term inhale steroid therapy should be monitored for…

Answer 17

elevation in blood pressure, serum blood sugar, growth delay, and cataract development.

Question 18

PFT findings in obstructive lung disease

Answer 18

low FEV1/FVC ratio, the FEV1 (%), which produces the scalloped shape on the exhalation limb of the flow-volume curve.

Question 19

PFT findings in restrictive lung disease

Answer 19

low FEV1, but a proportionate reduction in the FVC maintains a normal FEV1/FVC ratio

Question 20

refer kid with asthma to pulomonolgist when…

Answer 20

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.

Question 21

intermittent asthma

Answer 21

<2 days/week of symptoms
<2 nights/month

treat: SABA

Question 22

mild persistent asthma

Answer 22

> 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

Question 23

moderate persistent asthma

Answer 23

daily
3-4 nights/month if under 4, 1/week nights if over 4

treat: medium dose inhale corticosteroids

Question 24

severe persistent asthma

Answer 24

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

Question 25

other symptoms to consider on differential for asthma/cough

Answer 25

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

Question 26

hyper resonance heard when

Answer 26

localized air trapping behind a mucus plug, foreign body or mass.

Question 27

egophany heard when

Answer 27

lobar consolidation