Chronic Cough and Hemoptysis Flashcards
How is a chronic cough defined?
cough persisting for three weeks or longer
Describe the physiology of a couigh.
there is a complex reflex arc with both mechanical and chemical receptors - intrathoracic pressures reach 300 mmHg and expiratory velocities approach 500 mph
Where are the receptors that can trigger cough?
multiple places: nose and sinus, posterior phayrnx, pericardium, diaphragm, ear canals/eardurms, trachea, bronchi, esophagus, stomach and pleura
What are the most common etiologies of chronic cough?
postnasal drip
asthma
GERD
What percentage of smokers have chronic cough?
25%
What are some causes of post nasal drop?
allergies
vasomotor rhinitis
sinusitis
What’s the treatment for post-nasal drip?
ipratropium nasal spray
nasal corticosteroids
antibiotics if sinusitis is present
How do you confirm asthma as the cause of a chronic cough?
demonstrate improvement with one week of inhaled beta-agonist therapy
What should the workup inlude for GERD as a cause of chronic cough?
24 hr. esophageal pH monitoring
What’s the treatment for GERD as a cause of chronic cough?
dietary changes - smaller meals and no evening snacking
elevation of head of bed
PPI
What are three less likely causes of chronic cough?
lung cancer
bronchiectasis
eosinophilic bronchitis
What are two centrally-acting cough medications?
codeine and dextromethorphan
What are essentially the two varieties of hemoptysis?
either pure blood or mixed in with sputum
What are the vascular origins of hemptypisis?
bronchial arteries (which supply airways, hilar lymph nodes, visceral pleura)
What should be included in the evaluatin of hemptysis?
H&P
chest XR
CBC, UA, creatinine, coags (platelets, INR, PTT)
bronchoscopy
What are the risk factros for lung cancer found on bronchoscopy?
male sex
older than 40
smoking history over 40 pack years
hemoptysis greater than one week
How do bronchscopy and CT compare in terms of finding pathology?
CT is better than bronchscopy at finding lung cancers, but CT can’t detect bronchitis and small mucosal lesions
so they’re complementary - do bronchscopy first and then CT
Where do most thrombi come from in PE?
iliofemoral
also pelvic veins, also right heart, renal veins or upper extremity veins
What are the risk factors for PE?
immobilization surgery within 3 months stroke hx of thromboembolism malignancy women: obesity, heavy smoking, hypertension, birth control pills, pregnancy air travel over 3000 miles
What is the most common cause of PE without any risk factors present? What are some others?
Factor V Leiden mutation
Also high concentrations of factor VIII or occult malignancy like pancreatic or prostate cancer.
What are the common symptoms of pE?
dyspnea
pleuritic pain
cough
hemoptysis
What are the signs of PE?
tachypnea crackles tachycardia loud P2 Fever
A loud p2 means what?
pulmonary hypertension
What should the workup include for PE?
arterial blood gases
EKG
CXR
D-dimer
