Cough 2.0

Question 1

Egophony

Answer 1

. Patient says long eeee but it Sounds like (ah) as in hat in lungs
. Normal lung: transmits low frequency sounds
. Consolidated lung (alveoli filled w/ something): transmits higher frequencies better (AH higher frequency than EE)
. Must be auscultated bilaterally

Question 2

Bronchophony

Answer 2

. Voice louder than normal, not necessarily intelligible when Normal voice is muffled, weak, indistinct, unintelligible when you listen to lung
. Same parthogenesis as egophony, higher frequency transmitted better via diseased/consolidated lung

Question 3

Whispered pectoriloquy

Answer 3

Patient Whispered words
Louder and intelligible when Normal voice is muffled, weak, indistinct, unintelligible
. Same pathogenesis as egophony

Question 4

Tactile Fremitus

Answer 4

. Detects low frequency vibrations (men more than women)
. Place hand palm down on lung
. Patient says 99, or 1,1,1 or 1,2,3, and random German OR says ninety-nine in English
. Asymmetry present
. Inc. means consolidation
. Dec. means air fluid or tumor

Question 5

Lung Percussion

Answer 5

. Strike pleximeter finger w/ opposite fingers

. Look for resonance

Question 6

Pleural Effusion

Answer 6

. Fluid btw visceral and parietal pleura
. Dec. transmission of low frequencies and augments higher frequencies
. Decreases tactile fremitus
. Increases vocal resonance

Question 7

Tests to consider w/ cough

Answer 7

CBC w/ differential 
CXR
Pulmonary function tests (PFTs)
Chest CT scan 
Testing for viral and bacterial etiologies
Test and treat for possible GI reflux

Question 8

Deaths per year related to smoking

Answer 8

480,000 deaths

Question 9

Diseases caused by smoking

Answer 9

. Lung cancer
. Heart disease
. Lung disease 
. DM
. COPD

Question 10

Money spent on diseases related to smoking in US

Answer 10

. $170 billion

Question 11

FDA approved pharmacotherapy for smoking cessation

Answer 11

. Varenicline (Chantix)
. Bupropion SR (Zyban)
. Nicotine replacement gum

Question 12

Vocal resonance findings usually mean ___

Answer 12

Consolidated lung

Question 13

Percussion changes in lungs usually mean ___

Answer 13

. Fluid or air where its not supposed to be

Question 14

When there is hyporesonance the patient has ____

Answer 14

Pneumothorax

Question 15

Chronic cough over 8 weeks differentials

Answer 15

. Post nasal drip
. GERD
. Asthma
. ACE-I induced
. Atypical infections 
. Bronchiectasis (bronchi larger than they should, don’t’ have normal clearing mechanisms)
. Cancer
. ILD (interstitial lung disease)
. Occult heart failure
. Chronic bronchitis

Question 16

Acute cough differentials

Answer 16

. Infectious
. Aspiration
. Noxious stimulus

Question 17

Subacute cough differentials

Answer 17

. Residual from tracheobronchitis “post-tussive viral syndrome”

Question 18

Lingula

Answer 18

Remnant of what middle lobe would’ve been on the left

Question 19

PMN

Answer 19

. Type of cell prominent in bacterial infections