13- cough Flashcards
causes of wheezing
asthma Chronic obstructive pulmonary disease Congestive heart failure Foreign body aspiration Persistent bronchitis Upper airway cough syndrome Vocal cord dysfunction Pulmonary embolism
Vocal Cord Dysfunction
present similar to asthma, but dont respond to asthma meds
On spirometry, patients with vocal cord dysfunction have flattening on the inspiratory loop
nasal mucus in acute sinusisits
nasal discharge is opaque and mucopurulent, not clear. (
timing of acute vs chronic sinusitis
acute: symptoms for a minimum of seven to 10 days following a viral URI (feel like improving after virus and then sink back down), less than 4 weeks
chronic: Nasal congestion or obstruction persisting for more than 12 weeks
symptoms of acute sinusitis
purulent or colored nasal drainage,
with either nasal congestion/blockage and/or facial pain/pressure (or toothache)
can have fever
symptoms of chronic sinusitis
must have 2:
nasal obstruction or congestion
mucopurulent drainage (anterior, posterior or both)
facial pain, pressure or fullness
decreased sense of smell
when is CXR indicated in cough?
persistent cough to rule in or rule out a suspected infection such as pneumonia
when is CT chest indicated?
lung mass
pulmonary embolus,
when is methacholine challenge indicated
if the spirometry findings are normal
when is Ventilation-perfusion scan indicated
diagnosing pulmonary embolism
For longstanding allergic rhinitis management
Oral antihistamine
Nasal corticosteroid
nonasthmatic eosinophilic bronchitis diagnosis
sputum eosinophilia on induced sputum or bronchial wash obtained at bronchoscopy.
will patients with nonasthmatic eosinophilic bronchitis respond to corticosteroids?
yes
what are cxr and spirometry for nonasthmatic eosinophilic bronchitis
normal
vocal cord dysfunction diagnosis
visualizing abnormal vocal cord movement during an episode of wheezing.
vocal cord dysfunction on spirometry
flattening of the inspiratory loop on spirometry, but do not typically have reversible obstructive findings on spirometry like patients with asthma.
is COPD reversible on spirometry with bronchilators?
no
who gets pneumo23 vaccine?
Adults aged 19 through 64 years with :
- chronic heart disease (including congestive heart failure and cardiomyopathies, excluding hypertension),
- chronic lung disease (including chronic obstructive lung disease, emphysema, and asthma),
- chronic liver disease (including cirrhosis), alcoholism, -diabetes mellitus:
peak flow percentages at green yellow and red zone
green- 100-80%
yellow: 50-79%
red: >50
red zone presentation
very short of breath, including when walking or talking and signs of cyanosis
not improve with short-acting beta2-agonists.
Long-Term Effects of Uncontrolled Asthma
Airway remodelling Inflammation Mucous hypersecretion Airway smooth muscle hypertrophy Angiogenesis Subepithelial fibrosis
should antibiotics be used in chronic sinusitis?
no evidence it helps, only acute exacerbations
what % of adults who have asthma have aspirin-induced asthma
21%
what comorbid conditions needs to be controlled in order to improve asthma symptoms?
gastroesophageal reflux (GERD),
chronic sinusitis/uncontrolled allergic rhinitis, stress/depression,
obstructive sleep apnea,
obese.
