19.8.2013(cough) Flashcards
Tracheobronchial causes of hemoptysis
Bronchogenic Ca,bronchial carcinoid,kaposi sarcoma Bronchitis(acute and chronic) Bronchiectasis Broncholithiasis Airway trauma Foreign body
Infectious causes of hemoptysis
Staphylococcus
Pseudomonas
Aspergillus
Influenza
Pulmonary parenchymal sources of bleeding
Pneumonia Lung abscess Tuberculosis Mycetoma Goodpasture Idiopathic pulmonary hemosiderosis Wegener granulomatosis Lupus pneumonitis Lung contusion
Difference btw hemoptysis and hematemesis
History:
Hemoptysis- no nausea and vomiting,lung disease,asphyxia
Hematemesis-presence of nausea or vomiting,gastric or liver disease,no asphyxia
Sputum:
Hemoptysis- frothy,liquid or clotted appearance,bright red or pink
Hematemesis-rarely frothy,coffee ground,brown to black
Lab:
Hemoptysis- alkaline pH,mixed with macrophages and neutrophils
Hematemesis-acidic pH,mixed with food particles
Diff btw bleed from lower and upper respiratory tract
URT- cough
LRT- epistaxis,expectoration without cough
Rx of low risk pts with normal chest radiograph
Outpatient
Antibiotics
Close monitoring
Amount or frequency of bleeding and cancer
No correlation
Hemoptysis associated with Orthopnea
- CCF
- left ventricular dysfunction
- Mitral valve stenosis
Hemoptysis with fever and productive cough,causes
- Upper respiratory infection
- acute sinusitis
- acute bronchitis
- pneumonia
- lung abscess
Hemoptysis associated with HIV
- neoplasia
- TB
- kaposi
Hemoptysis associated with smoking
- acute bronchitis
- chronic bronchitis
- lung cancer
- pneumonia
Hemoptysis associated with weight loss
- emphysema
- lung cancer
- TB
- bronchiectasis
- lung abscess
- HIV
Hemoptysis associated with clubbing
- lung cancer
- bronchiectasis
- lung abscess
- severe chronic lung disease
- secondary lung metastasis
Hemoptysis
Fever
Dullness to percussion
Unilateral rales
Pneumonia
Clinical findings in wegener granulomatosis
Gingival thickening
Mulberry gingivitis
Saddle nose
Nasal septum perforation
Risk factors that increase the likelihood of finding cancer in bronchoscopy
Male
Age >40yrs
Smoking >40 pack years
Duration of hemoptysis of more than a week
Bronchoscopy indicated if tumor is suspected
Fiberoptic bronchoscopy
For visualisation of bleeding site,biopsy,brushings,bronchial lavage
Bronchoscopy indicated in massive hemoptysis
Rigid bronchoscopy
Greater suctioning and airway maintanence capacity
Cause of death in massive hemoptysis
Asphyxiation not exanguination
Hemoptysis and alveolar infiltrates
Diffuse alveolar infiltrates- Chronic heart failure,pulmonary Edema,aspiration,toxic injury
Patchy alveolar infiltrates-bleeding disorders,idiopathic pulmonary hemosiderosis,goodpasture
Hemoptysis with lobar or segmental infiltrates
- pneumonia
- thromboembolism
- obstructing carcinoma
Hemoptysis with no change in X ray
- bronchitis
- Upper respiratory tract infection
- sinusitis
- pulmonary embolism
Clinical diagnosis of diffuse alveolar hemorrhage is confirmed by
BAL
Histology associated with diffuse alveolar hemorrhage
Pulmonary capillaritis
Causes of diffuse alveolar hemorrhage in SLE
Pulmonary capillaritis
Bland pulmonary hemorrhage
Diffuse alveolar damage
MPA is always associated with
Focal segmental necrotising glomerulonephritis
Difference btw p-ANCA and c-ANCA
p-ANCA doesnt correlate with disease activity
Rx of severe DAH in MPA with unremitting respiratory failure
Recombinant factor 7
Most common underlying histology in DAH in goodpasture
Bland hemorrhage
Profile of goodpasture patient
Men in 20s who smoke
Preferred term for postnasal drip syndrome
Upper airway cough syndrome
In pts with ineffective cough,monitor for
Atelectasis
Pneumonia
Respiratory failure
Rx of UACS
Antihistaminic/decongestant therapy with first generation antihistaminics
Rx of acute cough associated with cold
First G A/D preparation (brompheniramine and sustained release pseudoephedrine)
Naproxen
Dx of cough variant asthma can be confirmed by
Resolution of cough after anti asthma therapy
Rx of asthmatic cough refractory to ICS or bronchodilators
Leukotriene antagonists
Rx of cough due to GERD
Lifestyle modifications
Acid suppression
Prokinetics
Does failure of therapy rule out GERD as a cause of cough?
No
Do pH monitoring as dose may be insufficient or medical therapy may have failed
Anti reflux diet
No >45g fat in 24hrs Soda Tea Coffee Chocholates Citrus fruits Alcohol Smoking To be avoided
In a pt with respiratory tract infection with or without sputum production lasting for less than 3 weeks,a diagnosis of acute bronchitis should not be made unless
Pneumonia
Common cold
Acute asthma
Acute exacerbation of COPD has been ruled out
Rx of adult pts with acute bronchitis with wheeze accompanying cough
Beta2 agonist inhalation
Chronic bronchitis
Pt with chronic cough and sputum expectoration daily for atleast 3months for 2 consecutive years
Rx of stable patient with chronic bronchitis
Beta agonists
Ipratropium bromide
Theophylline
Are newer antihistaminics useful in cold induced cough
No
Can theophylline used in acute exacerbation of chronic bronchitis
No
Rx of NAEB
ICS
History which is important in NAEB
Occupational history
IBD pt with cough
Bronchiolitis
Post infectious cough,duration
3-8weeks
Rx of post infectious cough
Ipratropium
