19.8.2013(cough)

Question 0

Tracheobronchial causes of hemoptysis

Answer 0

Bronchogenic Ca,bronchial carcinoid,kaposi sarcoma
Bronchitis(acute and chronic)
Bronchiectasis 
Broncholithiasis
Airway trauma
Foreign body

Question 1

Infectious causes of hemoptysis

Answer 1

Staphylococcus
Pseudomonas
Aspergillus
Influenza

Question 2

Pulmonary parenchymal sources of bleeding

Answer 2

Pneumonia
Lung abscess
Tuberculosis
Mycetoma
Goodpasture
Idiopathic pulmonary hemosiderosis
Wegener granulomatosis
Lupus pneumonitis
Lung contusion

Question 3

Difference btw hemoptysis and hematemesis

Answer 3

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

Question 4

Diff btw bleed from lower and upper respiratory tract

Answer 4

URT- cough

LRT- epistaxis,expectoration without cough

Question 5

Rx of low risk pts with normal chest radiograph

Answer 5

Outpatient
Antibiotics
Close monitoring

Question 6

Amount or frequency of bleeding and cancer

Answer 6

No correlation

Question 7

Hemoptysis associated with Orthopnea

Answer 7

1. CCF
2. left ventricular dysfunction
3. Mitral valve stenosis

Question 8

Hemoptysis with fever and productive cough,causes

Answer 8

1. Upper respiratory infection
2. acute sinusitis
3. acute bronchitis
4. pneumonia
5. lung abscess

Question 9

Hemoptysis associated with HIV

Answer 9

1. neoplasia
2. TB
3. kaposi

Question 10

Hemoptysis associated with smoking

Answer 10

1. acute bronchitis
2. chronic bronchitis
3. lung cancer
4. pneumonia

Question 11

Hemoptysis associated with weight loss

Answer 11

1. emphysema
2. lung cancer
3. TB
4. bronchiectasis
5. lung abscess
6. HIV

Question 12

Hemoptysis associated with clubbing

Answer 12

1. lung cancer
2. bronchiectasis
3. lung abscess
4. severe chronic lung disease
5. secondary lung metastasis

Question 13

Hemoptysis
Fever
Dullness to percussion
Unilateral rales

Answer 13

Pneumonia

Question 14

Clinical findings in wegener granulomatosis

Answer 14

Gingival thickening
Mulberry gingivitis
Saddle nose
Nasal septum perforation

Question 15

Risk factors that increase the likelihood of finding cancer in bronchoscopy

Answer 15

Male
Age >40yrs
Smoking >40 pack years
Duration of hemoptysis of more than a week

Question 16

Bronchoscopy indicated if tumor is suspected

Answer 16

Fiberoptic bronchoscopy

For visualisation of bleeding site,biopsy,brushings,bronchial lavage

Question 17

Bronchoscopy indicated in massive hemoptysis

Answer 17

Rigid bronchoscopy

Greater suctioning and airway maintanence capacity

Question 18

Cause of death in massive hemoptysis

Answer 18

Asphyxiation not exanguination

Question 19

Hemoptysis and alveolar infiltrates

Answer 19

Diffuse alveolar infiltrates- Chronic heart failure,pulmonary Edema,aspiration,toxic injury
Patchy alveolar infiltrates-bleeding disorders,idiopathic pulmonary hemosiderosis,goodpasture

Question 20

Hemoptysis with lobar or segmental infiltrates

Answer 20

1. pneumonia
2. thromboembolism
3. obstructing carcinoma

Question 21

Hemoptysis with no change in X ray

Answer 21

1. bronchitis
2. Upper respiratory tract infection
3. sinusitis
4. pulmonary embolism

Question 22

Clinical diagnosis of diffuse alveolar hemorrhage is confirmed by

Answer 22

BAL

Question 23

Histology associated with diffuse alveolar hemorrhage

Answer 23

Pulmonary capillaritis

Question 24

Causes of diffuse alveolar hemorrhage in SLE

Answer 24

Pulmonary capillaritis Bland pulmonary hemorrhage Diffuse alveolar damage

Question 25

MPA is always associated with

Answer 25

Focal segmental necrotising glomerulonephritis

Question 26

Difference btw p-ANCA and c-ANCA

Answer 26

p-ANCA doesnt correlate with disease activity

Question 27

Rx of severe DAH in MPA with unremitting respiratory failure

Answer 27

Recombinant factor 7

Question 28

Most common underlying histology in DAH in goodpasture

Answer 28

Bland hemorrhage

Question 29

Profile of goodpasture patient

Answer 29

Men in 20s who smoke

Question 30

Preferred term for postnasal drip syndrome

Answer 30

Upper airway cough syndrome

Question 31

In pts with ineffective cough,monitor for

Answer 31

Atelectasis Pneumonia Respiratory failure

Question 32

Rx of UACS

Answer 32

Antihistaminic/decongestant therapy with first generation antihistaminics

Question 33

Rx of acute cough associated with cold

Answer 33

First G A/D preparation (brompheniramine and sustained release pseudoephedrine) Naproxen

Question 34

Dx of cough variant asthma can be confirmed by

Answer 34

Resolution of cough after anti asthma therapy

Question 35

Rx of asthmatic cough refractory to ICS or bronchodilators

Answer 35

Leukotriene antagonists

Question 36

Rx of cough due to GERD

Answer 36

Lifestyle modifications Acid suppression Prokinetics

Question 37

Does failure of therapy rule out GERD as a cause of cough?

Answer 37

No | Do pH monitoring as dose may be insufficient or medical therapy may have failed

Question 38

Anti reflux diet

Answer 38

``` No >45g fat in 24hrs Soda Tea Coffee Chocholates Citrus fruits Alcohol Smoking To be avoided ```

Question 39

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

Answer 39

Pneumonia Common cold Acute asthma Acute exacerbation of COPD has been ruled out

Question 40

Rx of adult pts with acute bronchitis with wheeze accompanying cough

Answer 40

Beta2 agonist inhalation

Question 41

Chronic bronchitis

Answer 41

Pt with chronic cough and sputum expectoration daily for atleast 3months for 2 consecutive years

Question 42

Rx of stable patient with chronic bronchitis

Answer 42

Beta agonists Ipratropium bromide Theophylline

Question 43

Are newer antihistaminics useful in cold induced cough

Answer 43

No

Question 44

Can theophylline used in acute exacerbation of chronic bronchitis

Answer 44

No

Question 45

Rx of NAEB

Answer 45

ICS

Question 46

History which is important in NAEB

Answer 46

Occupational history

Question 47

IBD pt with cough

Answer 47

Bronchiolitis

Question 48

Post infectious cough,duration

Answer 48

3-8weeks

Question 49

Rx of post infectious cough

Answer 49

Ipratropium