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Harrison- Approach to Symptoms > 19.8.2013(cough) > Flashcards

19.8.2013(cough) Flashcards

0
Q

Tracheobronchial causes of hemoptysis

A 
Bronchogenic Ca,bronchial carcinoid,kaposi sarcoma
Bronchitis(acute and chronic)
Bronchiectasis 
Broncholithiasis
Airway trauma
Foreign body
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1
Q

Infectious causes of hemoptysis

A

Staphylococcus
Pseudomonas
Aspergillus
Influenza

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2
Q

Pulmonary parenchymal sources of bleeding

A 
Pneumonia
Lung abscess
Tuberculosis
Mycetoma
Goodpasture
Idiopathic pulmonary hemosiderosis
Wegener granulomatosis
Lupus pneumonitis
Lung contusion
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3
Q

Difference btw hemoptysis and hematemesis

A

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

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4
Q

Diff btw bleed from lower and upper respiratory tract

A

URT- cough

LRT- epistaxis,expectoration without cough

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5
Q

Rx of low risk pts with normal chest radiograph

A

Outpatient
Antibiotics
Close monitoring

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6
Q

Amount or frequency of bleeding and cancer

A

No correlation

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7
Q

Hemoptysis associated with Orthopnea

A
  1. CCF
  2. left ventricular dysfunction
  3. Mitral valve stenosis
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8
Q

Hemoptysis with fever and productive cough,causes

A
  1. Upper respiratory infection
  2. acute sinusitis
  3. acute bronchitis
  4. pneumonia
  5. lung abscess
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9
Q

Hemoptysis associated with HIV

A
  1. neoplasia
  2. TB
  3. kaposi
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10
Q

Hemoptysis associated with smoking

A
  1. acute bronchitis
  2. chronic bronchitis
  3. lung cancer
  4. pneumonia
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11
Q

Hemoptysis associated with weight loss

A
  1. emphysema
  2. lung cancer
  3. TB
  4. bronchiectasis
  5. lung abscess
  6. HIV
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12
Q

Hemoptysis associated with clubbing

A
  1. lung cancer
  2. bronchiectasis
  3. lung abscess
  4. severe chronic lung disease
  5. secondary lung metastasis
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13
Q

Hemoptysis
Fever
Dullness to percussion
Unilateral rales

A

Pneumonia

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14
Q

Clinical findings in wegener granulomatosis

A

Gingival thickening
Mulberry gingivitis
Saddle nose
Nasal septum perforation

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15
Q

Risk factors that increase the likelihood of finding cancer in bronchoscopy

A

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

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16
Q

Bronchoscopy indicated if tumor is suspected

A

Fiberoptic bronchoscopy

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

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17
Q

Bronchoscopy indicated in massive hemoptysis

A

Rigid bronchoscopy

Greater suctioning and airway maintanence capacity

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18
Q

Cause of death in massive hemoptysis

A

Asphyxiation not exanguination

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19
Q

Hemoptysis and alveolar infiltrates

A

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

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20
Q

Hemoptysis with lobar or segmental infiltrates

A
  1. pneumonia
  2. thromboembolism
  3. obstructing carcinoma
21
Q

Hemoptysis with no change in X ray

A
  1. bronchitis
  2. Upper respiratory tract infection
  3. sinusitis
  4. pulmonary embolism
22
Q

Clinical diagnosis of diffuse alveolar hemorrhage is confirmed by

A

BAL

23
Q

Histology associated with diffuse alveolar hemorrhage

A

Pulmonary capillaritis

24
Q

Causes of diffuse alveolar hemorrhage in SLE

A

Pulmonary capillaritis
Bland pulmonary hemorrhage
Diffuse alveolar damage

25
Q

MPA is always associated with

A

Focal segmental necrotising glomerulonephritis

26
Q

Difference btw p-ANCA and c-ANCA

A

p-ANCA doesnt correlate with disease activity

27
Q

Rx of severe DAH in MPA with unremitting respiratory failure

A

Recombinant factor 7

28
Q

Most common underlying histology in DAH in goodpasture

A

Bland hemorrhage

29
Q

Profile of goodpasture patient

A

Men in 20s who smoke

30
Q

Preferred term for postnasal drip syndrome

A

Upper airway cough syndrome

31
Q

In pts with ineffective cough,monitor for

A

Atelectasis
Pneumonia
Respiratory failure

32
Q

Rx of UACS

A

Antihistaminic/decongestant therapy with first generation antihistaminics

33
Q

Rx of acute cough associated with cold

A

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

34
Q

Dx of cough variant asthma can be confirmed by

A

Resolution of cough after anti asthma therapy

35
Q

Rx of asthmatic cough refractory to ICS or bronchodilators

A

Leukotriene antagonists

36
Q

Rx of cough due to GERD

A

Lifestyle modifications
Acid suppression
Prokinetics

37
Q

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

A

No

Do pH monitoring as dose may be insufficient or medical therapy may have failed

38
Q

Anti reflux diet

A 
No >45g fat in 24hrs
Soda
Tea
Coffee
Chocholates
Citrus fruits
Alcohol
Smoking
To be avoided
39
Q

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

A

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

40
Q

Rx of adult pts with acute bronchitis with wheeze accompanying cough

A

Beta2 agonist inhalation

41
Q

Chronic bronchitis

A

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

42
Q

Rx of stable patient with chronic bronchitis

A

Beta agonists
Ipratropium bromide
Theophylline

43
Q

Are newer antihistaminics useful in cold induced cough

A

No

44
Q

Can theophylline used in acute exacerbation of chronic bronchitis

A

No

45
Q

Rx of NAEB

A

ICS

46
Q

History which is important in NAEB

A

Occupational history

47
Q

IBD pt with cough

A

Bronchiolitis

48
Q

Post infectious cough,duration

A

3-8weeks

49
Q

Rx of post infectious cough

A

Ipratropium

Harrison- Approach to Symptoms (11 decks)

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