Cough DSA Flashcards
Acute cough lasts ______ and is usually _______.
Less than 3 weeks
Self-limited.
Sub-acute cough lasts _________ and indicated what?
- 3-8 weeks
- Prolonged acute cough or early presentation of chronic cough.
Chronic cough lasts ______.
More than 8 weeks.
What are the most common causes of acute cough?
Which is the MOST common?
- 1. Viral URI (common cold)
- Lower respiratory infection (bronchitis and pneumonia)
- Bacterial sinusitis
- Rhinitis d/t allergens or environmental irritants
- Asthma or COPD
- Cardiogenic pulmonary edema
- Aspiration or foreign body
- ACE inhibitor
- PE
Which viruses are associated with cough and URI?
1. Coronavirus
2. Adenovirus
3. Rhinovirus
Which viruses are associated with cough and LRI?
- 1. Influenza A/B
- 2. Parainfluenza
- 3. Respiratory syncytial virus (RSV)
How are most viral causes of cough treated?
Symptomatically
Influenza is characterized by:
Clinical Dx requires:
Dx:
- -Sudden onset of fever and weakness, followed by cough, HA, muscle aches and nasal/pulmonary sx during the app season.
- -T: >100 (3.7 C) and one of the following sx: [cough, pharyngitis or rhinorrhea]
- Viral culture of secretions or rapid diagnostic tests (PCR, immunoflurouesce. enzyme immunoassay).
- Rapid tests help in confirming +, but sensitivity is limited and (-) results do not exclude dx.
- Viral culture of secretions or rapid diagnostic tests (PCR, immunoflurouesce. enzyme immunoassay).
When is anti-viral therapy indicated for patients with influenza?
- Hospitalized patients
- Those with severe, complicated or progressive illness.
________ are given to treat Influenza A and B.
When should it be administered and what effect do they have?
Neuraminidase inhibitors.
Give within first 2 days of sx and can reduce duration and complications.
What are the preventative treatments for Influenza A and B?
- Vaccination
- Antiviral chemoprophylaxis (NA inhibitors); only for:
- patients living in an assissted living facility when there is an influenza outbreak,
- ppl who have higher risk of influenza related complications and have had recent contact with confirmed case,
- unvaccinated health care workers who had a recent contact with confirmed case.
H1N1 is a emerging _________ virus
- Symtoms:
- Treat:
- Influenza A
- Cough, fever and rinorrhea
- Chemoprophylaxis (NA inhibitors)
What are the non-viral causes of uncomplicated
[acute bronchitis** and **cough] in adults?
- B. pertussis
- Mycoplasma pneumonia
- Chlamdophila pneurmoniae
How do we detect cause of acute bronchitis?
How do we treat acute bronchitis?
-
Diagnostic tests are not recommended: gram stain and culture of sputum does not reliably detect
- GOLD STANDARD: + bacterial culture or PCP
- Abx is not recommended, unless you think adult pertussis. However, nothing can tell us if its pertussis unless there is a HIGH probability (cough that last more than 2 weeks without an apparent cause + [paroxysms of coughing, inspiratory whoop or posttussive emesis or cough >2 weeks when there is a documented outbreak].
If acute bronchitis is d/t pertussis, how do ABX help?
Decrease the spread of the disease because does not stop sx if given after 7-10 days of onset.
What is the PRIMARY diagnostic goal when evaluating a patient for acute cough?
Rule out pneumonia: it is the 3 MCC and the most severe.
How do we rule out pneumonia as the cause of acute cough?
Pneumonia would have abnormal vital signs:
- HR: over 100/min
- RR: over 28/min
- T: over 100 F (37.7)
- Crackles
- Decrease breath sounds
If patient does not have these, end diagnosing for pneumonia.
How do we dx asthma as a cause of acute cough?
Hard to diagnose unless there is a reliable hx of asthma and episodes of wheezing + SOB in addition to the cough.
Why is asthma so hard to dx with [transient bronchial hyperresponsiveness] and [abnormal spirometry]?
Occur in all causes of acute bronchitis
When should inhaled- short acting B agonists be used as a treatment?
Patients with [cough + wheezing];
no benefit in cough without wheezing.
Acute worsening of chronic bronchitis and bronchiectasis presents how?
-abrupt increase from baseline in cough, sputum production and purulence and SOB
How do we treat acute cough?
What is their effectiveness?
Main indications: cant sleep, painful cough and debilitating cough
-
Self-limited but: antitussive agents, expectorants, mucolytic agents, antihistamines and nasal anticholinergic agents
- Little evidence supports OTC and prescription antitussive meds; placebo
- Guaifenesin has some benefit
What are the most common causes of chronic cough?
In most patients, chronic cough is caused by more than 1 thing.
- 1. Upper airway cough sydrome (UACS)
- 2. Asthma
- 3. GERD
- Non-asthmatic eosinophillic bronchitis
- Medication reaction (ACE-i)
- Chronic bronchitis d/t smoking
ALL patients that we suspect with chronic cough should be given what?
- 1. Chest radiography
- 2. Careful history and physical exam findings for ALL common causes.
All patients with chronic cough should do what, before workup?
Stop smoking and ACE inhibitors 4 weeks before.
How do we determine the cause of chronic cough?
Look at which therapy eliminates symptoms associated with cough.
What is UACS?
- Upper airway cough syndrome: recurrent cough that occurs when mucus from the nose drains down the oropharynx => triggers cough receptors.
Symptoms of UACS?
- 1. Post nasal drainage
- 2. Clears throat alot
- 3. Nasal discharge
- 4. Cobblestone stone appearane on oropharyngeal mucosa
- 5. Mucus dripping from oral mucosa
Treatment of UACS?
Dx:
- Tx: non-sedating antihistamines + decongestant
- Dx: If drugs treat discharge and cough
How do we treat an unknown chronic cough?
Nonsedating antihistamines + decongestant to see if it is UACS
What is cough-varient asthma and how is it dx?
- Asthma (airway hypersensitivity) where cough is the main symptom.
- Dx when asthma meds treat cough; takes 6-8 weeks.
Which test result can exclude cough-variant asthma as a diagnosis?
-Bronchoprovacation test: (-) test is 100% sensitive to rule out, but a positive test does not indicate, because test is not specific.
How does GERD cause chronic cough?
-
Most common: vagal mediated distal esophageal tracheobronchial reflex.
- Aspiration
How do we treat chronic cough caused by GERD
- First, give PPI because noninvasive
- Then: 24 hour- esophageal pH monitoring (most sensitive and specific)
- Sx decrease 3 months after.
When do we diagnose chronic cough due to NAEB (nonasthmatic eosinophillic bronchitis)?
- NL CXR
- NL spirometry
- (-) methacholine challenge test
What is NAEB?
Chronic cough with eosinophils in airway, obtained by sputum or bronchial lavage during bronchoscopy.
If a patient has NAEB, what should we ask on exam?
How do we treat?
- Occupational exposure to sensitizer
- Inhaled glucocorticoids and avoid allergens.
What is a hallmark symptom of chronic bronchitis caused by smoking?
Treatment?
- Cough + sputum.
- Tx: Stop smoking to decrease sputum production and airway inflammation.
- Inhaled anticholinergic agents (tiotropium and ipratropium): decrease sputum production
- Systemic glucocorticoids and ABX: decrease cough when bad exacerbations
What is bronchiectasis?
Dx?
Tx?
- Chronic bronchitis that causes chronic/recurrent cough with voluminous (>30 mL/day) of sputum and purulent exacerbations.
- Dx: CXR and CT show thick bronchial walls and tram-line pattern
- Tx: ABX, based of sputum culture and chest radio
Is stopping smoking good at stopping chronic cough?
Yes: decrease in almost 100% of patients.
Cough d/t ACE inhibitors is related to ________ and occurs when?
Dx:
Tx:
- Class, not dose.
- Hours - weeks/months after 1st dose of ACE inhibitor.
- Dx: cough stops around 26 days after stopping ACE inhibitors
- Tx: switch ACE inhibitor with angiotensin receptor blocker.
Does hemoptysis occur in acute or chronic cough?
What is the most common causes?
- Either
- Infection (bronchitis or pneumonia) followed by malignancy.
What can cause hemoptysis?
- -High pulmonary pressure d/t left sided HF
- -PE
- -Lower respiratory causes
- -Upper airway souces of bleeding (nose) and and GI bleeding
All patients with hemoptysis need ______.
What increase risk of malignancy?
- Chest radiography
- M, over 40YO, smoking >40-pack years, sx last longer than 1 week.
Pts with increase risk of malignancy who have hemoptysis need to be reffered where, if cause of hemoptysis on chest radiography is not IDd?
- Chest CT
- Fiberoptic bronchopy
- NECESSARY bc CT doesnt always show lesions
Hemoptysis patient with history of LRT infection and NL chest radiograph should be treated with ________
- Oral ABX to see if treats..
- If recurs or persists, get a broncoscopy.
Patient with massive hemoptysis (over 200mL/day) requires what?
- 1. Urgent impatient eval
- 2. Early consultation with pulomonologist
- ICU
- -Airway management to prevent ASPHYXIATION, not exsanguition/
