Cough Flashcards
Acute Dry cough differentials?
URTIs e.g. laryngitis or pharyngitis
Drugs e.g. ACEi
Chronic Dry cough differentials?
Lung cancer
GORD
Mesothelioma
Mixed Dry and Productive cough differentials?
Mixed Dry = HF and asthma
Mixed productive = HF and COPD
Productive acute cough differentials?
Pneumonia (LRTI) or TB
Productive Chronic cough differentials?
Lung cancer, bronchiectasis or CF
Most common cause of CAP?
Strep pneumoniae
Scoring system for CAP severity?
CURB-65
Pneumonia CAP causes?
Strep pneumoniae (gram +ve diplococci), haemophilus influenzae B (gram -ve rod) and Moraxella catarrhalis
Atypical Pneumonia causes?
Mycoplasma pneumonia (associated with transverse myelitis) Legionella pneumophila (Air conditioning, associated with Hyponatraemia and abnormal LFTS)
Chlarmydia psittaci (pet birds) Chlamydia pneumoniae
Hospital acquired pneumonia causes?
Staph aureus (Cavitating lesions) Pseudomonas aeruginosa Klebsiella (alcoholic rf, cavitating legions association)
Cause of aspiration pneumonia?
Anaerobes from gut flora
Symptoms of typical pneumonia?
Typical = fever, SOB, cough (green), pleuritic chest pain and confusion
Atypical = dry cough, headache, diarrhoea, myalgia and hepatitis.
Signs of pneumonia?
Inspection = resp distress, cyanosis and increased HR and RR, decreased O2 and BP if septic
Reduced chest expansion an dull percussion over consolidation
Auscultation of pneumonia?
Basal crepitation (coarse) Bronchial breathing and increased vocal resonance
Investigations for pneumonia?
Obvs, sputum MCS, bloods, pleural fluid mcs via thoracocentesis ad CXR
Bloods = high wcc, high crp and T1RF on ABG
Atypical pneumonia symptoms and organism investigations?
Symptoms = Atypical = dry cough, headache, diarrhoea, myalgia and hepatitis.
Serology, urinary antigens for legionella, blood film of cold agglutins for mycoplasms and LFTs for legionella
Types of pneumonia on the XRAY?
Lobar and bronchopneumonia (patchy)
Can see consolidation of air bronchograms
Management for pneumonia?
CURB 65 = confusion <8 AMTS, urea >7mmol/L, RR>30, BP<90/60mmHg and Age >65
1 = GP 2= A&E 4+ = admission +-ICU
Acute pneumonia management?
Oxygen (sit up)m IV fluid, analgesics and ABx
CPAP if required
Causative organism Abx?
CAP = amoxicillin (co-amox) Atypical = clarithromycin
Staph = flucloxacillin MRSA = vancomycin Pseudomonas = tazocin + gentamicin
Aspiration pneumonia = metronidazole
Pneumonia complications?
Plural effusion
Empyema
Sepsis
Lung abscess (staph aureus) = swinging fever, persistent pneumonia and foul smelling sputum
RFs and Signs/symptoms for TB?
Travel, south asians, immunocompromised
FLAWS, SOB, COugh _ green sputum, HAEMOPTYSIS and lymphadenopathy
List of TB complications?
TB pneumonia, pleural effusion, meningitis, erytherma nodosum, clubbing, peritonitis, ascites,
Potts disease and addisions disease
TB investigations?
Obvs, sputum MC&S and microscopy with Ziehl-neelsen stain
Bloods and CXR
Lymph node biopsy for caseating granuloma
Mantoux ad IGRA
TB CXR features?
Consolidation, bi hilar lymhadenopathy, upper lobe scarring, cavitating lesions and pleural effusions.
Miliary TB = nodular shadowing
Congenital causes of bronchiectasis?
CF
Primary Ciliary dyskinesia (kartageners) = triad of bronchiectasis, sinusitis, situs inversus
Youngs syndrome = bronchoectasis, sinusitis, infertility
Acquired bronchiectasis causes?
Infection e.g. pneumonia, TB, measles and percussis
Lung cancer
Symptoms of bronchiectasis?
Chronic cough + green sptum, haemoptysis, SOB, fever and weight loss
Signs = clubbing and auscultation (basal crepitations)
Resp clubbing causes?
Bronciectasis, IPF, lung cancer and TB
Causes of basal crepitations?
HF, pneumonia, bronchiectasis and IPF
Bronchiectasis investigations?
Usual bvs, sputum MCS, sweat test for CF and genetic testing
Gold standard is High resolution CT . Maybe CXR
Classical sign is signet ring sign
Bronchiectasis management?
Conservative: exercise, vaccinations (influenza), airway clearance: chest physiotherapy, high frequency oscillation devices, nebulised hypertonic saline
Pharmacological: IV ABx (acute infection) or oral Abx (prophylactic e.g. azithromycin)
Surgical: localised resection
Bronchiectasis complications?
Recurrent infectios, cor pulmonale (RHF) or respiratory failure
Lung cancer breakdown and RFs?
Primary = Small cell (15%)?endocrine cells e.g. SIADH, ectopic ACTH
Non-small cell cancer: Adenocarcinoma (goblet cells in peripheral). SqCC (Squamous epithelial, PTHrp), Large cell carcinoma (epithelial cells)
RFs: Smoking or asbestos (sqcc)
Primary tumour symptoms?
Cough dry or productive, Haemoptysis, SOB, weight loss, loss of appetite and night sweats.
Local invasion and met symptoms?
Local: nervous (Horners syndrome)(left recurrent laryngeal nerve = bovine cough)
Superior Vena Cava (SVC obstruction)
Bone = pain/fratures
Brain = headaches, blurry vision
Liver = hepatomegaly
Lymphadenopthy
Signs of lung cancer?
Clubbing and lymphadenopathy.
Dull percussion
Creps and increased vocal resonance
Lung Cancer investigations?
Obvs, Bloods e.g. FBC, calcium, ALP or LFTs, Imaging = CXR, CT, CAP, PET
Caclium and ALP possibly high. LFTs possible deranged
Biospy = bronchoscopy or transthoracic needle
CXR for lung cancer?
Primary = consolidatn, bi-hilar lyphadenopathy, pleural effusions, cavitating lesions usually Sqcc
Secondary = con shaped lesions e.g. cannonball mets
Atelectasis = Sails sign
Mesothelioma specifics?
Asbestos exposure
Pleural friction rub on auscultation
Thoracoscopy and histology are definitive diagnosis
Mesothelioma CXR features/
pleural thickening, pleural plaques and pleural effusions
