Chronic Cough/Asthma

Question 0

Chronic cough in a smoker vs non smoker (Ddx)?

Answer 0

COPD or bronchogenic carcinoma versus postnasal drip, GERD, asthma

Question 1

Acute cough? Most common cause? Other causes?

Answer 1

Call for less than three weeks. Usually by upper respiratory infection. Also caused by CHF, pneumonia, PE.

Question 2

Asthma?

Answer 2

Bronchial hyperactivity and smooth muscle hypertrophy leading to chronic inflammatory condition with widespread bronchospasm

Question 3

Cobblestone appearance of the oropharynx may represent?

Answer 3

Lymphoid hyperplasia

Question 4

End expiratory wheezing versus localized wheezing?

Answer 4

Active bronchospasm versus foreign body/bronchogenic tumor

Question 5

Suspect postnasal drip, asthma, or GERD if?

Answer 5

Negative chest x-ray in immunocompetent non-smoker

Question 6

Initial treatment for nonallergic postnasal drip Versus allergic rhinitis?

Answer 6

First generation antihistamine decongestant for three weeks

Vs new generation antihistamine and nasal corticosteroid

Question 7

Patients postnasal drip does not improve with treatment, How to examine for sinusitis? Tx?

Answer 7

Sinus radiographs. Look for opacification, air-fluid levels, or mucosal thickening. Treat with antibiotics

Question 8

Cough variant asthma?

Answer 8

Presents with dry cough occurs throughout the day and night – worsened by URIs, allergies, cold or exercise

Question 9

Confirmatory test results for asthma?

Answer 9

1. Reduced FEV1 and FEV1/FVC
2. Increased FEV1 after Beta agonist inhalation
3. Methacholine challenge

Question 10

PFT changes after albuterol vs Methacholine challenge?

Answer 10

Increase in FEV1 of 12+ percent after bronchodilator treatment

Decrease in FEV1 of 20+ percent after methacholine

Question 11

Treatment for asthma?

Answer 11

Bronchodilators and inhaled/oral corticosteroids

Question 12

GERD lifestyle changes?

Answer 12

Low-fat diet
Elevation of head in bed
Avoid caffeine, alcohol, peppermint, chocolate
Weight-loss
Smoking cessation

Question 13

If GERD cough does not resolve with lifestyle changes, treatment?

Answer 13

H2 receptor antagonists (famotidine) or PPI

Question 14

If acid suppression does not resolve GERD, treatment?

Answer 14

Metoclopramide to increase gastric motility

Question 16

Types of asthma?

Answer 16

1. mild intermittent (Less than twice a week)
2. Mild persistent (More than twice a week but less than once a day)
3. Moderate persistent (Daily)
4. Severe persistent (Continual)

Question 17

Daily medications for mild intermittent asthma?

Answer 17

None

Question 18

Daily medications for mild persistent asthma?

Answer 18

Low-dose steroids (preferred) or from cromolyn, leukotriene modifiers, sustained release theophylline, nedocromil

Question 19

Daily medications for moderate persistent asthma?

Answer 19

Preferred – long-acting Beta two agonist or low to medium dose inhaled steroids

Steroids and leukotriene modifiers/theophylline

Question 20

Daily medications for severe persistent asthma?

Answer 20

High-dose inhaled steroids and long-acting inhaled beta two agonist

Question 21

Patients with GERD who remain symptomatic after maximal medical treatment should get?

Answer 21

1. 24-hour esophageal pH monitoring

2. Endoscopy to show esophagitis or reflux

Question 22

Quick relief medications for all classes of asthma?

Answer 22

Short acting inhaled beta two agonist and oral steroids

Question 23

Intrinsic vs extrinsic asthma?

Answer 23

Not atopic (cold, stress, cough-variant )

Vs

Due to environmental triggers - Produce IgE, associated with eczema and hay fever

Question 24

Dz with wheezing?

Answer 24

1. CHF - edema
2. COPD - inflamed airways
3. Cardiomyopathies - edema around bronchi
4. Lung cancer

Question 25

Montelukast - MoA? Use?

Answer 25

Leukotriene modifiers. Prophylaxis for asthma.

Question 26

Associated findings in patients with asthma?

Answer 26

``` #Symptoms worse at night #Polyps and sensitivity to aspirin #Eczema/atopic dermatitis ```

Question 27

Exploratory phase in asthma?

Answer 27

Increased

Question 28

Best initial diagnostic test in acute asthma exacerbation? Most accurate diagnostic test in pt with no symptoms?

Answer 28

Peak expiratory flow or atrial blood gas Methacholine challenge

Question 29

Role of CXRs in asthma exacerbation?

Answer 29

``` #Exclude pneumonia #Exclude pneumothorax #Exclude CHF ```

Question 30

CBC finding in asthma?

Answer 30

Increased eosinophils

Question 31

Increased IGE levels in asthmatic suggests? Treatment? Increased IGE levels in non-asthmatic pulmonary patient?

Answer 31

Allergic etiology; omalizumab Allergic bronchopulmonary aspergillosis

Question 32

Cromolyn/nedocromil MoA? Use in asthma?

Answer 32

Inhibits mast cell mediator release and eosinophil recruitment Asthma ppx

Question 33

Adverse effects of systemic corticosteroids?

Answer 33

``` #Osteoporosis #cataracts #Adrenal suppression #thinning skin, striae, easy bruising #Hyperlipidemia, hyperglycemia, acne, hirsutism ```

Question 34

Role of ipratropium in: general asthma management? Acute exacerbation?

Answer 34

Unclear (effective in COPD) Useful (But slower than albuterol)

Question 35

Gave which vaccines to asthma patients?

Answer 35

Influenza and pneumococcal vaccine

Question 36

Best indication of severity of acute asthma exacerbation?

Answer 36

Respiratory rate > accessory muscle use

Question 37

Peak expiratory flow based on? Approximation for?

Answer 37

Height and age FVC

Question 38

Drugs of last resort in acute asthma exacerbation?

Answer 38

Epinephrine and Mg (bronchodilation)