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CRRAB 2 Week 5 and 6 > Chronic Cough and Hemoptysis > Flashcards

Chronic Cough and Hemoptysis Flashcards

1
Q

How is a chronic cough defined?

A

cough persisting for three weeks or longer

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2
Q

Describe the physiology of a couigh.

A

there is a complex reflex arc with both mechanical and chemical receptors - intrathoracic pressures reach 300 mmHg and expiratory velocities approach 500 mph

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3
Q

Where are the receptors that can trigger cough?

A

multiple places: nose and sinus, posterior phayrnx, pericardium, diaphragm, ear canals/eardurms, trachea, bronchi, esophagus, stomach and pleura

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4
Q

What are the most common etiologies of chronic cough?

A

postnasal drip
asthma
GERD

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5
Q

What percentage of smokers have chronic cough?

A

25%

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6
Q

What are some causes of post nasal drop?

A

allergies
vasomotor rhinitis
sinusitis

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7
Q

What’s the treatment for post-nasal drip?

A

ipratropium nasal spray
nasal corticosteroids
antibiotics if sinusitis is present

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8
Q

How do you confirm asthma as the cause of a chronic cough?

A

demonstrate improvement with one week of inhaled beta-agonist therapy

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9
Q

What should the workup inlude for GERD as a cause of chronic cough?

A

24 hr. esophageal pH monitoring

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10
Q

What’s the treatment for GERD as a cause of chronic cough?

A

dietary changes - smaller meals and no evening snacking

elevation of head of bed

PPI

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11
Q

What are three less likely causes of chronic cough?

A

lung cancer
bronchiectasis
eosinophilic bronchitis

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12
Q

What are two centrally-acting cough medications?

A

codeine and dextromethorphan

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13
Q

What are essentially the two varieties of hemoptysis?

A

either pure blood or mixed in with sputum

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14
Q

What are the vascular origins of hemptypisis?

A

bronchial arteries (which supply airways, hilar lymph nodes, visceral pleura)

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15
Q

What should be included in the evaluatin of hemptysis?

A

H&P
chest XR
CBC, UA, creatinine, coags (platelets, INR, PTT)
bronchoscopy

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16
Q

What are the risk factros for lung cancer found on bronchoscopy?

A

male sex
older than 40
smoking history over 40 pack years
hemoptysis greater than one week

17
Q

How do bronchscopy and CT compare in terms of finding pathology?

A

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

18
Q

Where do most thrombi come from in PE?

A

iliofemoral

also pelvic veins, also right heart, renal veins or upper extremity veins

19
Q

What are the risk factors for PE?

A 
immobilization
surgery within 3 months
stroke
hx of thromboembolism
malignancy
women: obesity, heavy smoking, hypertension, birth control pills, pregnancy
air travel over 3000 miles
20
Q

What is the most common cause of PE without any risk factors present? What are some others?

A

Factor V Leiden mutation

Also high concentrations of factor VIII or occult malignancy like pancreatic or prostate cancer.

21
Q

What are the common symptoms of pE?

A

dyspnea
pleuritic pain
cough
hemoptysis

22
Q

What are the signs of PE?

A 
tachypnea
crackles
tachycardia
loud P2
Fever
23
Q

A loud p2 means what?

A

pulmonary hypertension

24
Q

What should the workup include for PE?

A

arterial blood gases
EKG
CXR
D-dimer

25
Q

What will the arterial blood gases show in PE?

A

usually respiratory alkalosis wtih decreased pO2 and pCO2

26
Q

What might the CXR show in PE?

A

atelectasis or pleural effusion, but many are normal

27
Q

What does a positive D-dimer tell you?

A

it’s high sensitivity but low specificity, so low positive predictive value and high negative predictive value:

can rule out a PE, but can’t rule in a PE

28
Q

How does a VQ scan stack up in terms of sensitivity and specifiity?

A

normal scan can exclude PE, but high probability scan is not very sensitive, so most scans ar eintermediate or low probability, so not all that diagnostic

29
Q

How are the sensitivity/specificity of CT?

A

sensitivity of 70-87% with a specificity of 90%

30
Q

If you have high pre-test probability but the CT is normal, what additional test should you consider?

A

angiography

31
Q

What’s the treatment of PE?

A

first heparin - unfractionated or low molecular weight

then warfarin and heparin for 5 days

warfarin for 6 months

32
Q

When do we use thrombolytics for PE?

A

if the PE is massive and you hav ehypotension

33
Q

What structural treatment can you use in patients with PE and contraindiationsf or anti-coagulation?

A

inferior vena cava filter

CRRAB 2 Week 5 and 6 (6 decks)

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