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Junior - Pulm Mod 1 > 4 - Cough > Flashcards

4 - Cough Flashcards

1
Q

What are the 3 main subtypes of cough?

A

Acute: < 3 weeks
Subacute: 3-8 weeks
Chronic: >8

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2
Q

Physiologic effects of cough?

A

Sudden, forceful and sometimes frequent -> increased intrathoracic and intrabdominal pressure

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3
Q

Symptoms that go along with coughs?

A 
Cough syncope
Dysrhythmias
Headache
Subconjunctival hemorrhage
Inguinal hernia
GRD
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4
Q

MC cause of acute cough?

A

Viral respiratory tract infection (RTI)/acute bronchitis

  • pneumonia
  • pulmonary embolism
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5
Q

Acute bronchitis causes

A 
Influenza
Parainfluenza
Coronavirus
Rhinovirus
Respiratory synchytial virus 
Pertussis
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6
Q

Clinical features of acute cough and acute bronchitis?

A 
Cough (+/-) sputum
Few/no systemic sxs
Chest wall tenderness
Wheezing possible
Rhonchi clearing after cough
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7
Q

What testing is required for acute cough?

A

Usually a good hx and pe is all that you need

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8
Q

Who gets a CXR?

A

Suspected pneumonia

Pulse > 100
R >24
T > 100.4
Crackles on PE
Consolidation
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9
Q

Do old people get fevers with pneumonia?

A

Sometimes they do not. You must focus on:

  • respiration rate
  • SpO2
  • Mental status
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10
Q

What treatments do we do for symptomatic acute cough?

A

Antitussive
Anti-inflammatory mucolytics
Antihystamine-decongestant
Bronchodilators

Dont really help

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11
Q

When do sub-acute coughs usually present?

A

Post infection

- may linger long after RTI sxs resolve

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12
Q

MC causes of chronic cough?

A

Post-nasal drainage (PND) (90%)
Asthma
GERD

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13
Q

Less common causes of chronic cough?

A 
ACEI
Bronchiectasis and cystic fibrosis
Chronic bronchitis
Bronchiolitis
Neoplasm
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14
Q

S/S of PND?

A

Rhinorrhea
Nasal congestion
Throat “tickle”
Throat clearing

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15
Q

PE for PND?

A

Nasal bogginess/congestion
Oropharyngeal mucus “cobblestoning”
“Silent” (sometimes)

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16
Q

Sinusitis s/s?

A

Copious sputum

Sinus mucosal thickening

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17
Q

What is upper airway cough syndrome (UACS)

A

New name for PND

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18
Q

Tx for PND/UACS?

A 
Avoid allergens
Intranasal corticosteroids
Oral antihistamines
Oral decongestants
Oral montelukast 
Abx: only from proven sinusitis (image)
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19
Q

How long does chronic cough usually take to get better with tx?

A

1-2 weeks

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20
Q

2nd MC cause of chronic cough?

A

Cough variant asthma

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21
Q

What is required for a Dx of asthma?

A

A response to therapy (SABA)

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22
Q

How long does the cough for cough variant asthma usually take to improve?

A

6-8 weeks of asthma therapy

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23
Q

What may cause 40% of cough?

A

GERD

It will be on the pance

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24
Q

Does sputum color matter?

A

Not at all

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25
Q

When does GERD cough get worse?

A

Night
While supine
After eating

26
Q

Tx for GERD cough?

A

Treat the GERD

Avoid fatty foods, caffeine, chocolate, ETOH
Stop smoking
Lose wt
Elevate head of bed
PPI
27
Q

How long does tx of GERD take to get rid of the cough?

A

3 months should do it

28
Q

When does the ACEI cough usually start?

A

1 week after initiation. It could be up to 1 year

29
Q

Bronchiectasis ?

A

Chronic inflammation or infection leading to progressive airway damage

Permanent abnormally dilated bronchi

Chronic inflammatory cells -> mucus pooling

30
Q

S/s of bronchiectasis?

A 
Large volume of sputum (2tbsp +)
Dyspnea
Hemoptysis
Pleuritic chest pain
Wt loss
Anemia
31
Q

CXR for bronchiectasis shows?

A

Tubular or cystic structures
“Tracks” or “rings”
Dilated mucus filled bronchi

32
Q

What about bronchiectasis pts with non diagnostic CXR?

A

CT is preferred

33
Q

What is the accuracy of CT for diagnosing bronchiectasis?

A

95%

The study of choice

34
Q

Tx for bronchiectasis?

A

Abx 10-14 days
Chest physiotherapy
Postural drainaige
Inhaled bronchodilators

35
Q

Do bronchiectasis patients get cough suppressants?

A

No

36
Q

What is a common bug that causes bronchiectasis?

A

Pseudomonas

37
Q

What is the MC cause of severe chronic lung disease in young adults?

A

Cystic fibrosis

38
Q

What is the death rate of Cystic fibrosis?

A

1:32000 it is the MC fatal hereditary dz of whites in the United States

39
Q

Carriers of cystic fibrosis?

A

1:25 people are carriers

40
Q

What is the classic presentation of Cystic fibrosis?

A

Chronic lung disease and pancreatic insufficiency resulting from thick mucus secretions

41
Q

What is a common pathology of cystic fibrosis?

A

Mucus plugging of various exocrine ducts and inflammation

- MC at lungs, pancreas and testes

42
Q

Pulmonary symptoms of cystic fibrosis?

A 
Cough
Sputum 
Decreased exercise tolerance
Recurrent hemoptysis
Clubbing
A/P diameter increased
Hyperresonance
Crackles at apex
43
Q

Non pulmonary S/S of cystic fibrosis?

A 
Sinus tenderness
Nasal polyps
Steatorrhea
Diarrhea
Abdominal pain
Congenital bilateral absence of vas deference
Gallstones
44
Q

PFTs for cystic fibrosis?

A

Mixed obstructive > restrictive

  • decreased FVC, FEV1 and TLC
  • elevated RV to TLC ration
  • reduced DLCO
45
Q

Labs for cystic fibrosis?

A

ABG’s

  • hypoxemia
  • compensated respiratory acidosis
46
Q

What do Cystic Fibrosis centers do?

A 
Clear/reduce secretions
Reverse bronchoconstriction
Treat RTI’s
Replace pancreatic enzymes
Nutritional/psychosocial support
47
Q

Cystic fibrosis treatment?

A

Postural drainage, percussion/vibration, cough
Inhaled recumbent human deoxyribonuclease (rhDNAse)
Inhaled hypertonic saline
Short/long term abx
SABA
Ivacaftor
Long transplant

48
Q

What is the goal of rhDNAse?

A

Decrease sputum viscosity which improves FEV1

49
Q

What is ivacaftor?

A

Oral medication for specific gene mutation

50
Q

Do lung transplants help with CF?

A

Yeah but the 3 yr post transplant survival is only 55%

51
Q

What usually causes death in CF patients?

A

Pulmonary complications

52
Q

What is bronchiolitis?

A

Genetic term for inflammatory processes affecting bronchioles

Airways are <2mm

53
Q

Who gets bronchiolitis?

A

MC in infants and children

54
Q

What causes bronchiolitis?

A

Usually its RSV

55
Q

Do adults get bronchiolitis?

A

Yes but its less common and they have many subtypes

56
Q

What do adults with bronchiolitis usually have?

A

A hx of exposure to something

57
Q

S/S of bronchiolitis?

A

Insidious onset of cough and dypsnea not following asthma/COPD pattern

Tachypnea, crackles and wheezing

58
Q

What about radiology for bronchiolitis?

A

CXR: nothing
CT: air trapping, similar to asthma

59
Q

How is bronchiolitis diagnosed?

A

Lung biopsy

Or clinically

60
Q

How is bronchiolitis treated?

A 
Cease the exposure
Corticosteroids
Bronchiodilators
Cough suppressaants
O2 to keep above 88

Junior - Pulm Mod 1 (4 decks)

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