Common presentations and Resp infections

Question 1

Pathology of cough

Answer 1

Is an important defensive reflex, but can be a marker of disease

Question 2

Syndromes of cough

Answer 2

Acute cough
90 days duration
Rarely infectious in origin

Question 3

Causes of chronic cough

Answer 3

Smoking
ACEi
Upper airway cough syndrome aka post-nasal drip
Cough variant asthma
Non-asthmatic eosinophilic bronchitis (not very severe)
GERD

Question 4

Common causes of dyspnea

Answer 4

Pneumonia/aspiration
Acute exacerbation of COPD
Asthma exacerbation
Pulmonary edema
Pulmonary embolism

Question 5

When is dyspnea an emergency?

Answer 5

Hypoxic
Hypercapneic
In extremis (not doing well)

Question 6

Tx of dyspnea

Answer 6

Treat the underlying cause of their dyspnea
Supplemental O2
Establish IV access and monitor as necessary
Non-invasive mechanical ventilation (bipap)
Intubation/Ventilation
↑PEEP/ ↑FiO2
If still doing poorly after that, more intense measures

Question 7

Common causes of hemoptysis

Answer 7

Diffuse intrapulmonary hemorrhage, tracheoarterial fistula, TB, cancer, mitral stenosis
Confirm not from nosebleed or stomach

Question 8

Investigations of hemoptysis

Answer 8

CXR, Urinalysis (see if blood in urine too)
in a smoker or >50 or massive: more likely malignancy -> bronchoscopy (see if bleed is actually from airway) and CT (find malignancies); maybe ECHO

Question 9

Tx of hemoptysis

Answer 9

ABCs first
Supportive measures
Protect the non-bleeding lung if unilateral
Consider arteriographic embolization (actually block off bronchial aa. to resolve)
Surgical therapy
Once temporized, consider the underlying cause

Question 10

Common presentation of pneumothorax

Answer 10

acute onset of right sided chest pain accompanied by shortness of breath
Stable vital signs
Distended neck veins
Decreased intensity of breath sounds on right
No peripheral edema

Question 11

Tx of tension pneumothorax

Answer 11

Insert large needle b/w 2 and 3 ribs.
Will hear hiss from lung.
Pt is supine, so air will rise to top of chest.
Put in chest tube after this.

Question 12

Difference b/w tension pneumothorax and just a pneumothorax?

Answer 12

Tension has distended veins, will have mediastinum push over on CXR.

Question 13

Cause of pneumothorax

Answer 13

Young tall male smokers have risk, not sure why. Sometimes some blebs at top of lung which can rupture and release air.
Other pts: don’t know

Question 14

Presentation of pleural effusion

Answer 14

SOB, pleuritic or non chest pain, referred shoulder pain, cough

Question 15

What do you do with a pleural effusion?

Answer 15

Sample the fluid and compare to normal (low-protein (<15 g/l) filtrate containing relatively few cells)

Question 16

Physical exam for pleural effusion

Answer 16

Might not detect small vols
Dullness to percussion
Absent tactile fremitus
Absent breath sounds
Bronchial breath sounds and egophony at the upper margin of the fluid collection

Question 17

Investigations for effusion

Answer 17

PA and lat CXR can detect effusions >100-150 ml in volume
U/S Able to detect as little as 5-50 ml of fluid
CT is the ultimate to find small effusions, and gives extra information
Thoracocentesis: type of fluid

Question 18

Thoracocentesis.

Answer 18

Can diagnosis type of fluid and/or relieve symptoms

Complications: pain, pneumo-/hemothorax, reexpansion

Question 19

Is it transudate or exudate ?

Answer 19

Exudate if any of the following:
pleural fluid to serum (P:S) protein >.5
P:S Lactate Dehydrogenase (LD) > .6
LD > 200 IU/L

Question 20

Causes of transudate?

Answer 20

CHF, Cirrhosis/Ascites, Nephrotic syndrome, PE, others

Question 21

Causes of Exudate?

Answer 21

Usually pneumonia
-uncomplicated: no cells in fluid
-complicated: cells, more solid, lower pH
-empyema: pus
Others: infection, cancer, PE, GI, drugs, trauma, lupus, RA, etc.

Question 22

Tx transudate and exudate

Answer 22

Transudate: diuresis. Draining is not helpful really.
Exudate: drain fluid.
If recurrent, try pleurodesis (obliterate the space)

Question 23

Common Cold/Rhinitis

Answer 23

rhinovirus, RSV etc. Mostly Viruses
-NO ANTIBIOTICS
-Vapor, Vit C maybe?
-Zn and Honey seem a little helpful
-Symptomatic: 
—decongestant: oxymetazoline, phylephrine, Antihistamines
—Analgesics: Ibu, ASA, NSAIDS

Question 24

Pharyngitis

Answer 24

Group A Strep (others maybe C diphtheria, N gonnorhea)

• sudden, fever, tonsilitis/exudate, headache, nausea
• give amoxicillin for 10 days

Question 25

Sinusitis

Answer 25

S pneumoniae, H influezae, other bacteria

• After a cold (but rare)
• face hurts, discharge, fever
• give amoxicillin, 2nd line doxycycline
• but many people resolve within 2 weeks w/o meds…

Question 26

Bronchitis/Laryngitis

Answer 26

Viruses

give ß2 agonist if wheezing