Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3 Oxford Cases > Cough > Flashcards

Cough Flashcards

1
Q

What questions should be asked when a patient presents with cough

A 
Acute or chronic?
Consistent or intermittent?
Productive or dry
Any blood
Timing 
Character
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is classified as an acute or chronic cough

A

Acute <3 weeks
Chronic >8 weeks
3-8 weeks = recovering acute illness or developing chronic illkness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does blood in the sputum suggest (different appearances)

A

Blood-streaked - Infection or bronchiectasis
Pink and frothy - pulmonary oedema
Frank blood - TB, lung cancer, pulmonary embolus, bronchectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does character of the cough suggest

A

Wheezy - obstruction e.g. asthma, COPD
Bovine (breathy) - characteristic of vocal cord paralysis
Dry cough - bronchitis (usually viral) or interstitial lung disease
Gurgling/wet - bronchiectasis
Whooping cough - pertussis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What questions should be asked about what triggers the cough

A

Environmental irritants- smoking. occupation, pets
Past medical history - asthma, GORD, rhinitis, HF, RTI
Drug history - ACEi
Travel - Asian subcontinent, central Asia and sub-saharan Africa
Close contacts - same as travel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What questions should be asked about factors that are associated with cough

A 
Fever, night sweat, rigors, weight loss
Breathlessness
Chest pains, pleuritic
Wheeze
Frequent throat cleaning/and or rhinorrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the differentials for an acute dry cough

A 
Asthma
Rhinitis/sinusitis + post-nasal drip
URTI - pharyg,laryng, tracheitis
Drug induced e.g. ACEi
Smoke.toxin inhalation
Inhaled foreign body 
Lung cancer
Pulmonary oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the differentials for a chronic dry cough

A 
Asthma
GORD
Post-nasal drip
Smoking 
Lung cancer
Drug induced
COPD
Pulmonary oedema 
Recurrent aspiration
Psychogenic 
Non-asthmatic eosinophillic bronchitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the differentials for an acute productive cough

A

LRTI (pneumonia, bronchitis)
COPD
TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the differentials for a chronic productive cough

A 
Bronchiectasis 
TB 
Lung cancer
Recurrent aspiration
CF/priamry ciliary dyskinesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What signs on physical examination for a cough would suggest an infective cause

A 
Temperature
Sweating
Tachycardic
Respiratory distress 
Tender cervical lymphadenopathy 
Reduced chest expansion
Reduced breath sounds 
Increased vocal resonance in consolidation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What signs on physical examination would suggest COPD

A

Hyperexpanded/barrel chest
Intercostal recession
Signs of right heart failure (ascites, organomegaly, oedema, raised JVP, parasternal heave, tricusp regurg) - due to cor pulmonale
Asterixis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What signs would suggest someone is in respiratory distress

A 
RR raised
Dyspnoea
Difficulty completing sentences
Use of accessory muscles
Peripheral cyanosis 
Confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What blood investigations should be called for coughs with suspected infective cause

A

ABG - monitor gas exchange, ensure no resp failure
FBC - infection
CRP - infection
U&Es - check for dehydration (sign of severe pneumonia)
Blood cultures - before antibiotics given, check for infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What imaging would be done for a cough with suspected infective cause

A

CXR

ECG - rule out ischaemia or AF secondary, may see RHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What microbiology investigations would be done for a cough with suspected infective cause

A

Urinary antigens - pneumococcal and legionella antigens

Sputum culture - induced sputum or non-bronchoscopic bronchoalveolar lavage (NBAL)

17
Q

What is the CURB-65 score and how is it calculated

A

Used to calculate severity of pneumonia and determine need for hospitalisation
Presence of any 1 scores 1 point, max 5. Patients with 2 or more should be admitted
Confusion - AMTS <8/10
Urea high >6mM
RR > 30 minutes
BP <90 S, <60 D
>65

18
Q

What are the considerations for which broad-spectrum antibiotic you should give for patients who have an exacerbation of COPD due to pneumonia

A

Severity (CURB65)
Comorbidity with COPD
HAP vs CAP
Suspicion of unusual organisms
Any pneumonia treated by antibiotics in the past few weeks
Whether the antibiotic is deemed to predispose to C. difficile colitis

19
Q

What organisms are more likely to be causative in a)HIV patients and b)CF patients

A

a) Pneumocystis jirovecii

b) pseudomonas

20
Q

What are the complications of pneumonia

A

Spread of infection - pleural effusion, empyema, abscess, septicaemia
Damage to local structure - bronchiectasis, pneumothorax

21
Q

How will a pneumothorax present on examination

A

Breathless, RR high
Apyrexial
tachycardic, BP slightly elevated
Unilateral decreased expansion, hyperresonant percussion, reduced breath sounds

22
Q

What are the 3 most common causes of a chronic cough in a non-smoker

A

Asthma
GORD
post-nasal drip

23
Q

What investigations should be done for suspected asthma

A

Peak flow
Spirometry (FEV1/FVC ratio <0.7 shows obstructive disease)
Asthma is a clinical diagnosis

24
Q

Which features are suggestive of asthma

A

Breathlessness, chest tightness, cough (particularly worse at night/early morning or triggered by exercise, allergen exposure, cold air or after aspirin/beta blocker admin)
History or family of atopic disorders
Wheeze on auscultation
Otherwise unexplained low FEV, PEF or serum eosinophilia

25
Q

How is postnasal drip diagnosed

A

Largely on exclusion and confirmed by trial of treatment

Try antihistamines and/or nasal decongestants

26
Q

How is GORD diagnosed

A

Therapeutic trial with PPI and arrange follow up to see if it has worked

27
Q

Where will a squamous cell carcinoma of the lung most likely present

A

Hilar regions

28
Q

What are the treatments for a acute-chronic cough due to recovery from infection

A

Inhaled corticosteroids or oral antihistamines
Inhale ipratropium bromide
Antitussives e.g. codeine (opiates), dextromorphan, benzocaine (LA) - little evidence

29
Q

What class of drug is ipratropium bromide

A

Anticholinergic

Blocks the efferent limb of the cough reflex

30
Q

What factors / history are suggestive of TB

A

Cough, producing blood-streaked sputum
Weight loss and night sweats
Travel to high risk country e.g. Pakistan

31
Q

How should oxygen be administered to COPD patients

A

Venturi masks
Smaller fixed ratios (24-40%)

Acute resuscitation, high flow should be given regardless

32
Q

What is a bovine cough

A

Due to recurrent laryngeal nerve palsy, more common in left than right (as left branch loops around the aorta )
Most commonly due to malignancy e.g. Pancoast’s tumour or surgery e.g. neck

33
Q

What is required for interpretation of the PaO2 onABG

A

FiO2 - inspired oxygen

A patient who has a normal O2 may have severely impaired ventilation if they are getting 15 L/min of oxygen

34
Q

How does Streptococcus pneumoniae present on CXR

A

Lobar pneumonia - localised rather than patchy infiltrates

35
Q

How does adenovirus infection present on CXR

A

Interstitial pneumonia, shadowing is interstitial rather than alveolar
Bronchograms would not be visible

36
Q

How does mycoplasma pneumoniae present on CXR

A

Bronchopneumonia with rare abscess

37
Q

What are the existing treatments for GORD

A 
PPIs
H2 receptor antagonists e.g. ranitidine 
Magnesium carbonate
Aluminium hydroxide 
Alginates

Y3 Oxford Cases (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions