13- cough

Question 1

causes of wheezing

Answer 1

asthma
Chronic obstructive pulmonary disease
Congestive heart failure
Foreign body aspiration
Persistent bronchitis
Upper airway cough syndrome
Vocal cord dysfunction
Pulmonary embolism

Question 2

Vocal Cord Dysfunction

Answer 2

present similar to asthma, but dont respond to asthma meds

On spirometry, patients with vocal cord dysfunction have flattening on the inspiratory loop

Question 3

nasal mucus in acute sinusisits

Answer 3

nasal discharge is opaque and mucopurulent, not clear. (

Question 4

timing of acute vs chronic sinusitis

Answer 4

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

Question 5

symptoms of acute sinusitis

Answer 5

purulent or colored nasal drainage,
with either nasal congestion/blockage and/or facial pain/pressure (or toothache)

can have fever

Question 6

symptoms of chronic sinusitis

Answer 6

must have 2:

nasal obstruction or congestion
mucopurulent drainage (anterior, posterior or both)
facial pain, pressure or fullness
decreased sense of smell

Question 7

when is CXR indicated in cough?

Answer 7

persistent cough to rule in or rule out a suspected infection such as pneumonia

Question 8

when is CT chest indicated?

Answer 8

lung mass

pulmonary embolus,

Question 9

when is methacholine challenge indicated

Answer 9

if the spirometry findings are normal

Question 10

when is Ventilation-perfusion scan indicated

Answer 10

diagnosing pulmonary embolism

Question 11

For longstanding allergic rhinitis management

Answer 11

Oral antihistamine

Nasal corticosteroid

Question 12

nonasthmatic eosinophilic bronchitis diagnosis

Answer 12

sputum eosinophilia on induced sputum or bronchial wash obtained at bronchoscopy.

Question 13

will patients with nonasthmatic eosinophilic bronchitis respond to corticosteroids?

Answer 13

yes

Question 14

what are cxr and spirometry for nonasthmatic eosinophilic bronchitis

Answer 14

normal

Question 15

vocal cord dysfunction diagnosis

Answer 15

visualizing abnormal vocal cord movement during an episode of wheezing.

Question 16

vocal cord dysfunction on spirometry

Answer 16

flattening of the inspiratory loop on spirometry, but do not typically have reversible obstructive findings on spirometry like patients with asthma.

Question 17

is COPD reversible on spirometry with bronchilators?

Answer 17

no

Question 18

who gets pneumo23 vaccine?

Answer 18

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:

Question 19

peak flow percentages at green yellow and red zone

Answer 19

green- 100-80%

yellow: 50-79%
red: >50

Question 20

red zone presentation

Answer 20

very short of breath, including when walking or talking and signs of cyanosis

not improve with short-acting beta2-agonists.

Question 21

Long-Term Effects of Uncontrolled Asthma

Answer 21

Airway remodelling
Inflammation
Mucous hypersecretion
Airway smooth muscle hypertrophy
Angiogenesis
Subepithelial fibrosis

Question 22

should antibiotics be used in chronic sinusitis?

Answer 22

no evidence it helps, only acute exacerbations

Question 23

what % of adults who have asthma have aspirin-induced asthma

Answer 23

21%

Question 24

what comorbid conditions needs to be controlled in order to improve asthma symptoms?

Answer 24

gastroesophageal reflux (GERD),
chronic sinusitis/uncontrolled allergic rhinitis, stress/depression,
obstructive sleep apnea,
obese.