Cough and hemoptysis

Question 1

performs an essential protective function for human airways and lungs

Answer 1

cough

Question 2

often a clue to the presence of respiratory disease

Answer 2

cough

Question 3

cough center location?

Answer 3

medulla(brainstem-tractus nucleus solitarius)

Question 4

Each cough occurs through the stimulation of a complex reflex arc. This is initiated by the irritation of ?

Answer 4

cough receptors

Question 5

cough receptors are found in?

Answer 5

trachea, main carina, branching points of large airways, and more distal smaller airways,pharynx

Question 6

Laryngeal and tracheobronchial receptors respond to both mechanical and chemical stimuli.? yes or no?

Answer 6

yes

Question 7

Chemical receptors sensitive to acid, heat, and capsaicin-like compounds trigger the cough reflex via activation of the

Answer 7

type 1 vanilloid (capsaicin) receptor

Question 8

Sensory nerve fibers (branches of the vagus nerve) located in the ciliated epithelium of the upper airways (pulmonary, auricular, pharyngeal, superior laryngeal, gastric) and cardiac and esophageal branches from the diaphragm

Answer 8

Afferent pathway

Question 9

Impulses from the cough center travel via the vagus, phrenic, and spinal motor nerves to diaphragm, abdominal wall and muscles. The nucleus retroambigualis, by phrenic and other spinal motor nerves, sends impulses to the inspiratory and expiratory muscles; and the nucleus ambiguus, by the laryngeal branches of the vagus to the larynx.

Answer 9

Efferent pathway

Question 10

causes of impaired cough

Answer 10

decreased respiratory muscle strength

• chest wall or abdominal pain
• chest wall deformity
• impaired glottic closure/trache
• abnormal airway secretions
• central respiratory depression/anethesia/sedation/coma

Question 11

less than 3 week cought

commonly due to RTI or inhalation of noxious chemicals or smoke

Answer 11

acute cough

Question 12

3-8 weeks cough, common residuum of tracheobronchitis as in pertussis or in post-viral syndrome

Answer 12

subacute cough

Question 13

cough more than 8 weeks, caused by a variety of CP diseases including inflammatory, infections neoplastic and cardiovascular etiologies

Answer 13

Chronic cough

Question 14

what are the most common identifiable causes of chronic cough when CXR are normal?

Answer 14

cough-variant asthma
GERD
nasopharyngeal drainage
medications(ACEI)

Question 15

indicated in the evaluation of virtually all instances presenting with chronic cough

Answer 15

Chest X-ray

Question 16

if cough is productive and or purulent this is ordered

cytologic examination to determine malignancy and to distinguish between neutrophilic from eosinophilic bronchitis

Answer 16

sputum analysis

Question 17

occur ins 5-30% of patients and is not dose dependent
mechanism is due to sensitization of nerve endings due to accumulation of bradykinin
e.g Captopril, Imidapril

Answer 17

ACEI induced cough

Question 18

post nasal drip, frequent clearing, sneezing and rhinorhea
PE: excess mucoid or purulent secretions, inflamed and edematous nasal mucosa, cobblestone appearance of mucosa of posterior pharyngeal wall

Answer 18

Postnasal drainage of any etiology

Question 19

reflux of gastric contents into the lower esophagus

Answer 19

GERD

Question 20

common among children,due to asthma in the absence of wheezing, SOB and chest tightness

Answer 20

cough variant asthma

Question 21

sputum eosinophilia in excess of 3% without airflow obstruction or bronchial hyperresponsiveness, treated with glucocorticoids

Answer 21

Chronic eosinophilic bronchitis

Question 22

expectoration of blood from respiratory tract

Answer 22

hemoptysis

Question 23

what is the 1st step in evaluation of hemoptysis?

Answer 23

proper evaluation to ascertain the bleeding is coming from respi treee or instead originating from the nasal cavities

Question 24

next step in evaluating hemoptysis?

Answer 24

determine the nature of expectoration(blood tinged/pink/frothy/frank blood)

Question 25

hemoptysis commonly arises from?

Answer 25

bronchi or medium sized airways

Question 26

unique feature that predisposes to hemoptysis?

Answer 26

dual blood supply which is the pulmonary and bronchial circulations

Question 27

systemic pressure is greater than bronchial pressure? yes or no?

Answer 27

yes

Question 28

in highly industrialized countries the most common cause of hemoptysis?

Answer 28

bronchitis, bronchiectasis

Question 29

• mostly due to viral bronchitis
• those with chronic bronchitis are predisposed to bacterial superinfection such as S. Pneumoniae, H. influenzae or M. cattarhalis

Answer 29

blood-tinged or small volume hemoptysis

Question 30

-caused by bronchiectasis

Answer 30

-massive hemoptysis

Question 31

commonly results from pulmonary edema due to elevated left ventricular end- diastolic pressure
-presentation can be a spectrum from pink and frothy to frank blood

Answer 31

vascular etiology(hemoptysis)

Question 32

• bronchogenic carcinoma of any histology

- often indicates airways involvement of the tumor

Answer 32

malignant etiology(hemotysis)

Question 33

400 ml of blood hemoptysis in 24 hrs?

100-150 ml of blood expectoration in one time

Answer 33

massive hemoptysis

Question 34

usually obtained first but does not localize bleeding and may appear normal

Answer 34

chest x-ray

Question 35

additional testing for patients with risk factors for malignancy such as 40 years old and above with smoking history

Answer 35

CT Chest and flexible bronchoscopy

Question 36

what are the interventions done during hemoptysis?

Answer 36

-protect the non-bleeding lung
-locate the site of bleeding
control the bleeding

Question 37

paramount in the management of massive hemoptysis

Answer 37

protect the non-bleeding lung

Question 38

patient should be positioned with the bleeding ___ to use the gravitational advantage to keep blood out of the non-bleeding lung

Answer 38

side down

Question 39

imaging studies to locate the site of the bleeding

Answer 39

CXR(initial only, not specific)

CT angiography

Question 40

control of bleeding may be accomplished in 3 ways

Answer 40

• from airway lumen
• from the involved blood vessels
• surgical resection of both airway and vessel involved

Question 41

used to suction clot and insert a balloon catheter that occludes the involved airway

Answer 41

flexible bronchoscopy

Question 42

done by IP or thoracic surgeon: may allow interventions such as photocoagulation and cautery

Answer 42

Rigid bronchoscopy

Question 43

procedure of choice for control massive hemoptysis

Answer 43

bronchial artery embolization

Question 44

80% success rate at controlling bleeding immediately

risk: ermbolization of anterior spinal artery

Answer 44

bronchial artery embolization