Cough Flashcards
_______ is the commonest manifestation of lower
respiratory tract infection
Cough
Cough is the cardinal feature of ______
chronic bronchitis
Cough may persist for many weeks following an
acute upper respiratory tract infection (URTI) as
a result of persisting ______ or ______
bronchial inflammation and
increased airway responsiveness
______ is the commonest cause of a
persistent or chronic cough, especially causing
nocturnal cough due to secretions (mainly from
chronic sinusitis) tracking down the larynx and
trachea during sleep
Postnasal drip
The commonest causes of haemoptysis are
1
2
3
URTI (24%), acute or chronic bronchitis (17%),
bronchiectasis (13%), TB (10%).
A _______ is suggestive of cancer: the explosive
nature of a normal cough is lost when laryngeal paralysis
is present, usually resulting from bronchial carcinoma
infiltrating the left recurrent laryngeal nerve.
bovine cough
Chronic cough may be the first presentation of
_____pneumonia in an HIV-infected pt
Pneumocystis jiroveci
Red flags for cough
- Age >50 years
- Smoking history
- Asbestos history exposure
- Persistent cough
- Overseas travel
- TB exposure
- Haemoptysis
- Unexplained weight loss
- Dyspnoea
Pulmonary infiltration
with fibrosis may result from some cytotoxic drugs,
especially_______
bleomycin
Cough can be a feature of some of the ACE inhibitors
and _____,______,______
beta blockers, inhaled steroids and sulfasalazine
A typical
‘psychogenic’ cough is barking in quality—the ‘__________. It does not occur during sleep
Cape
Barren goose’ cough
Occupational list for causes of cough
mining ______
aircraft manufacturing________
farming (‘farmer’s lung’—allergic pneumonitis from mouldy hay)
and bird handling (‘bird fancier’s lung’—allergic alveolitis or psittacosis from pigeons or budgerigars
(pneumoconiosis),
(asbestosis and mesothelioma),
PE of pt with cough
_______ on auscultation indicate pulmonary oedema
of heart failure, interstitial pulmonary fibrosis and
early lobar pneumonia,
while coarse crackles indicate
_______, _______, ______
Fine crackles
resolving pneumonia, bronchiectasis and TB
Important radiologic procedures for pts with cough
— plain chest X-ray (shows many problems)
— ____________helps more precise localisation
of lesion, may show cavitation
— ________: shows bronchiectasis (a very
unpleasant procedure)
— CT scanning (more sensitive than plain X-ray)
— CT pulmonary angiogram
— ___________: for
pulmonary infarction
— echocardiogram (pulmonary hypertension)
tomography:
bronchography
ventilation/perfusion isotope scan
Character of the cough
• _________→ tracheitis and bronchitis (major
bronchi); extrinsic pressure on trachea
• __________ → laryngeal disorders (e.g. laryngitis)
Brassy
Barking
Character of the cough
• _________ → laryngeal disorders (e.g.
laryngitis, croup)
• _________ → vocal cord paralysis (leftrecurrent
laryngeal nerve)
• Weak cough → indicates bronchial carcinoma
• _______ → whooping cough
• _______→ tracheitis; left ventricular failure
Croupy (with stridor)
Bovine (no power)
Paroxysmal with whoops
Painful
Causes of nocturnal cough
— asthma — left ventricular failure — postnasal drip — chronic bronchitis — whooping cough
Causes of waking cough
— bronchiectasis
— chronic bronchitis
— GORD
cough associated with changing posture
— bronchiectasis
— lung abscess
Cough with meals
— hiatus hernia (possible)
— oesophageal diverticulum
— tracheo-oesophageal fistula
A healthy, non-smoking individual produces
approximately ______ of mucus a day
100–150 mL
This
normal bronchial secretion is swept up the airways
towards the trachea by the________
mechanism and is usually swallowed.
mucociliary clearance
The commonest cause of excess mucus production is
_______
cigarette smoking.
Character of sputum
_________ → due to cellular
material (neutrophils or eosinophil granulocytes)
_______ → lobar pneumonia ( S. pneumoniae ): due
to blood
Yellow or green (purulent)
Rusty
Character of sputum
- Profuse, watery → ______
- Thin, clear mucoid → ______
- Redcurrant jelly → ______
- Profuse and offensive →_____
alveolar cell carcinoma
viral infection
bronchial carcinoma
bronchiectasis; lung abscess
Character of sputum
Thick plugs (cast-like) → \_\_\_\_\_ • Pink frothy sputum → pulmonary oedema
allergic bronchopulmonary Aspergillus;
bronchial carcinoma
Rare causes of hemoptysis
Idiopathic pulmonary haemosiderosis
Goodpasture syndrome
Blood disorders including anticoagulants
Several clinicians describe the _______as the commonest cause of cough
catarrhal child
syndrome
This refers to children who develop a postnasal drip
following acute respiratory infection and allergic
rhinitis
catarrhal child
syndrome
Habit cough can occur in children, especially those
with a history of ______
school phobia
One study found the causes of chronic cough in the elderly to be 1 2 3
postnasal drip syndrome 48%,
gastro-oesophageal reflux 20%
and asthma 17%.
Combined URTI and LRTI include
1
2
3
influ enza, measles, whooping cough and laryngotracheobronchitis
This highly infectious URTI, which is often mistakenly
referred to as ‘the flu’, produces a mild systemic upset
and prominent nasal symptoms
The common cold (acute coryza
The
incubation period is usually 1–3 days and the illness
commences abruptly with a fever, headache, shivering
and generalised muscle aching
Influenza
Causes of common cold
Rhinoviruses Parainfluenza Influenza B, C Coronavirus RSV
Common cause of influenza
Influenza A Influenza B Novel strains influenza A e.g. H5N1
Where is sorethroat more common, common cold or influenza?
common cold
Antiviral agents for influenza
Neuraminidase inhibitors (cover influenza A and B):
zanamivir (Relenza) 10 mg by inhalation bd
oseltamivir (Tamiflu) 75 mg (o) bd
How to give antiviral in influenza
commenced within 36 hours of
onset and given for 5 days.
Influenza vaccination offers some protection for up
to ____ of the population for about 12 months
70%
This strain presents with typical influenza
symptoms commonly accompanied by gastrointestinal
symptoms (especially diarrhoea)
(The swine variety of H1N1 influenza A)
Tx of (The swine variety of H1N1 influenza A)
The treatment is the same as for influenza in
general with neuraminidase inhibitors. A vaccine is
now available
This is acute inflammation of the tracheobronchial
tree that usually follows an upper respiratory
infection. Although generally mild and self-limiting,
it may be serious in debilitated patients
Acute bronchitis
etiology of complicated acute bronchitis
often due to
Haemophilus influenzae and Streptococcus pneumoniae
Abx for acute bronchitis
amoxycillin 500 mg (o) 8 hourly for 5 days
or
doxycycline 200 mg (o) statim, 100 mg
This is a chronic productive cough for at least 3
successive months in 2 successive years
Chronic bronchitis
CAP is usually caused by a single
organism, especially______
Streptococcus pneumoniae
Tx duration for pneumonia
Treatment is usually for __days for most bacterial causes,
2 weeks for_______nfection and
2–3 weeks for Legionella
5–10
Mycoplasma or Chlamydia i
Xray of atypical Pnx
Chest X-ray (diffuse infiltration) incompatible
with chest signs
MC cause of atypical Pnx
Mycoplasma pneumoniae
Tx of Mycoplasma pneumoniae
roxithromycin 300 mg (o) daily
or
doxycycline 100 mg bd for 14 days
What atypical Pnx
— related to cooling systems in large buildings
— incubation 2–10 days
Legionella pneumophila (legionnaire disease
Dx criteria for Legionnaires disease
1 2 3 4 5
- prodromal influenza-like illness
- a dry cough, confusion or diarrhoea
- very high fever (may be relative bradycardia)
- lymphopaenia with moderate leucocytosis
- hyponatraemia
Tx of Legionella
azithromycin IV (first-line) or erythromycin
(IV or oral)
plus (if very severe)
ciprofloxacin or rifampicin
Tx of Chlamydia psittaci (psittacosis):
treat with roxithromycin or erythromycin or
doxycycline
Tx of Coxiella burnetti (Q fever)
treat with doxycycline 200 mg (o) statim then
100 mg daily for 14 days
Mx of mild Pnx
amoxycillin/clavulanate 875/125 mg (o)
12 hourly for 7 days especially if S. pneumoniae
isolated or suspected
plus (especially if atypical pneumonia suspected)
roxithromycin 300 mg (o) daily for 7 days
Guidelines for severe pneumonia
and hospital admission
• Altered mental state/acute onset confusion
• Rapidly deteriorating course
• Respiratory rate >30 per minute
• Pulse rate >125 per minute
• BP <90/60 mmHg
• Hypoxia P a O 2 <60 mm Hg or O 2 saturation
<92%
• Leucocytes <4 × 10 8 L or >20 × 10 9 /L
Pnx in children
- _______ are the most common cause in infants.
- _______ are common in children over 5 years.
- ________ is a cause in all age groups
Viruses
Mycoplasma
S. pneumoniae
When to admit infants with severe pnx
Infants:
1
2
3
Older children
1
2
3
- RR>70 •
- Intermittent apnoea
- Not feeding
RR>50
• Grunting
• Signs of dehydration
A cough lasting 2 months or more
is defined as a ______
chronic cough
Organisms for chronic persistent cough
Haemophilus influenzae (the most common), S. pneumoniae and Moraxella
Haemophilus influenzae (the most common), S. pneumoniae and Moraxella
How to Tx?
most susceptible to amoxycillin or
amoxycillin/clavulanate or parenteral cephalosporins
Indications for 24-hour ambulatory oesophageal
pH monitoring in chronic cough include
• unexplained chronic cough after clinical assessment • symptomatic gastro-oesophageal reflux • chronic cough with known aetiology unresponsive to therapy
_______accounts for 25% of cancer deaths in
men and 24% of cancer deaths in women (rapidly
rising),
Lung cancer
MC cause of lung CA
cigarette smoking
________accounts for over
95% of primary lung malignancies
Bronchial carcinoma
Sx of lung CA
- Cough (42%)
- Chest pain (22%)
- Wheezing (15%)
- Haemoptysis (7%)
- Dyspnoea (5%)
Causes of a solitary pulmonary nodule
(on X-ray
Bronchial carcinoma
Solitary metastasis
Granuloma (e.g. TB)
Hamartoma
______ is not an
option for SCLC since it metastasises so rapidly (80% have
metastasised at the time of diagnosis).
Surgery
________
is suitable for the deadly SCLC but currently only extends
life expectancy from 3 to 20 months (at best).
Chemotherapy
________ is a malignant tumour of mesothelial
cells usually at the pleura. It is associated with prior
asbestos exposure, possibly decades earlier (90%
report exposure
Mesothelioma
Prognosis of mesothelioma
Prognosis is poor and treatment is palliative
support.
________ is dilatation of the bronchi when their
walls become inflamed, thickened and irreversibly
damaged, usually following obstruction followed
by infection
Bronchiectasis
The_______ and ______ are the
commonest sites for localised disease in Bronchiectasis
left lower lobe and lingula
Main pathogens for bronchiectasis
Streptococcus pneumoniae,
Pseudomonas aeruginosa, Haemophilus influenzae
(commonest)
CT of for bronchiectasis
can show bronchial wall thickening
Gold standard for bronchiectasis dx
high resolution CT scan is the new gold standard
for diagnosis
______ or ______ is
recommended for first presentation of bronchiectasis
Amoxycillin 500 mg
(o) tds for 2–3 weeks or roxithromycin
Examples of opiod cough supressants
Opioid: Codeine Dihydrocodeine Hydrocodone Pholcodine Ethylmorphine Normethadone
Examples of expectorants/mucolytics
Senega
Ammonia
Guaiphenesin
Bromhexine
Unexplained cough over the age of 50 is ________until proved otherwise (especially if
there is a history of smoking
bronchial
carcinoma
______ is essential to exclude adequately a
suspicion of bronchial carcinoma when the chest
Bronchoscopy
Bright red haemoptysis in a young person may be
the initial symptom of_____
pulmonary TB.
The presence of _____ in the sputum renders it
yellow or green (purulent) but does not necessarily
imply infection
white cells
