Cough and Hemiptysis ICR

Question 1

chronic cough

Answer 1

longer than 8 weeks

not an acute infection

Question 2

acute/subacute cough

Answer 2

less than 8 weeks

acute infection or post infectious cause

often self limited

Question 3

paroxysm

Answer 3

sudden “spell”

rapid coughing with increasingly less lung volue

can lead to emesis (vomiting) due to intensity

Question 4

post-tussive emesis

Answer 4

severe cough that causes vomiting

associtated with pertussis infection

Question 5

PND

Answer 5

post nasal drip

secretions ooze down nasopharynx due to nasal or sinus inflammation from allergies or infection

Question 6

another term for post nasal drip

Answer 6

UACS upper airways cough syndrome

Question 7

GERD

Answer 7

gastric contents can reflux into esophagus and cause cough with or without aspiration into lungs

Question 8

vocal cord erythema may suggest…

Answer 8

GERD

Question 9

eosinophilic bronchitis

Answer 9

eosinophils infiltrate airways and cause cough

can detect in sputum

treat with inhaled steroids

Question 10

how is eosinophilic bronchitis UNLIKE asthma…

Answer 10

no airway hypersensitivity with EB and no abnormal breathing tests

Question 11

medullary cough center

Answer 11

nucleus tractus solitarius

connects afferent impulses to efferent nerves

Question 12

cough reflex starting in larynx, trachea, bronchi, ear canal, pleura, stomach

Answer 12

vagus nerve –> cough center medulla–>vagus nerve –> larynx and tracheobronchial tree muscles

Question 13

cough reflex starting in nose and paranasal sinus

Answer 13

trigeminal nerve –> medullary cough center –> phrenic/intercostal/lumbar nerves –> diaphragm, intercostal, abdominal, and lumbar muscles

Question 14

cough reflex starting in pharynx

Answer 14

glossopharyngeal nerve –> medullary cough center –> trigeminal, facial, hypoglossal, accessory nerves –> upper airways and accessory muscles

Question 15

cough reflex starting in pericardium, diaphragm

Answer 15

phrenic nerve –> medullary cough center –> trigeminal, facial, hypoglossal, and accessory nerves –> upper airways and accessory muscles

Question 17

in expiration the glottis______

Answer 17

opens

Question 18

equal pressure point theory

Answer 18

pressure is equal inside and outside the airway (high lung volume)–> compression occurs and mucus can be moved

Question 19

irritation of external auditory canal

Answer 19

hurts arnolds nerve - the auricular branch of the vagus nerve

Question 20

what type of drugs can cause cough?

Answer 20

ACE inhibitors

Question 21

treat chronic rhinitis…

Answer 21

nasal steroids and antihistimine-decongestent combo

use first generation antihis. because its more effective than 2nd

Question 22

if patients dont respond to steroids/antihis/decongestant, next?

Answer 22

look for asthma using methacholine challene

Question 23

if it didnt respond to steroids/antihis, and negative methacholine challenge (isnt asthma, ), thennn?

Answer 23

check for gerd with 24 hr pH probe

treat gerd with proton pump inhibitors (omeprazole or prevacid) at least 8 weeks

Question 24

order of impiric treatment when cough has no appaarent etiology

Answer 24

1) upper airway cough syndrom - treat w nasal steroids and antihistimine/decongestant
2) asthma - using methacholine challenge
3) gerd - proton pump inhibiotors (omeprazole or prevacid)
4) bronchoscopy - –> reevaluate and repeat a previor approach

Question 25

alarm symptoms to check for

Answer 25

hemoptysis

chest pain

short of breath

fevers, night sweats or weightloss

Question 26

what could feversm night sweats, weightloss indicate?

Answer 26

chronic infection (TB) cancer, or chronic inflammatory disease like vasculitis

Question 27

when the xray is normal, a cough is most likely due to

Answer 27

UACs, PND, asthma, or GERD

Question 28

for kids, acute vs chronic times?

Answer 28

less or greater than 2-3 weeks

Question 29

hemoptysis

Answer 29

coughing blood from lower respiratory tract (below vocal cords)

Question 30

hematemesis

Answer 30

vomit blood from GI tract

Question 31

epistaxis

Answer 31

nosebleed (upper airway bleed)

Question 32

alkaline vs acidic blood

Answer 32

alk = hemoptysis or epistaxis

ac = hematemesis

Question 33

bright red and frothy blood

Answer 33

hemoptysis or epistaxis

Question 34

dark/coffee ground blood

Answer 34

hematemesis

Question 35

blood tinged sputum present vs absent

Answer 35

hemoptysis has it

hematemesis and epistaxis does not have blood tinged sputum