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CPR Exam 2 > Cough DSA > Flashcards

Cough DSA Flashcards

1
Q

Acute cough lasts ______ and is usually _______.

A

Less than 3 weeks

Self-limited.

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2
Q

Sub-acute cough lasts _________ and indicated what?

A
  • 3-8 weeks
  • Prolonged acute cough or early presentation of chronic cough.
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3
Q

Chronic cough lasts ______.

A

More than 8 weeks.

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4
Q

What are the most common causes of acute cough?

Which is the MOST common?

A
  • 1. Viral URI (common cold)
    1. Lower respiratory infection (bronchitis and pneumonia)
    1. Bacterial sinusitis
    1. Rhinitis d/t allergens or environmental irritants
    1. Asthma or COPD
    1. Cardiogenic pulmonary edema
    1. Aspiration or foreign body
    1. ACE inhibitor
    1. PE
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5
Q

Which viruses are associated with cough and URI?

A

1. Coronavirus

2. Adenovirus

3. Rhinovirus

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6
Q

Which viruses are associated with cough and LRI?

A
  • 1. Influenza A/B
  • 2. Parainfluenza
  • 3. Respiratory syncytial virus (RSV)
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7
Q

How are most viral causes of cough treated?

A

Symptomatically

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8
Q

Influenza is characterized by:

Clinical Dx requires:

Dx:

A
  • -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.
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9
Q

When is anti-viral therapy indicated for patients with influenza?

A
  • Hospitalized patients
  • Those with severe, complicated or progressive illness.
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10
Q

________ are given to treat Influenza A and B.

When should it be administered and what effect do they have?

A

Neuraminidase inhibitors.

Give within first 2 days of sx and can reduce duration and complications.

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11
Q

What are the preventative treatments for Influenza A and B?

A
  1. Vaccination
  2. 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.
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12
Q

H1N1 is a emerging _________ virus

  • Symtoms:
  • Treat:
A
  • Influenza A
  • Cough, fever and rinorrhea
  • Chemoprophylaxis (NA inhibitors)
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13
Q

What are the non-viral causes of uncomplicated

[acute bronchitis** and **cough] in adults?

A
  1. B. pertussis
  2. Mycoplasma pneumonia
  3. Chlamdophila pneurmoniae
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14
Q

How do we detect cause of acute bronchitis?

How do we treat acute bronchitis?

A
  • 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].
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15
Q

If acute bronchitis is d/t pertussis, how do ABX help?

A

Decrease the spread of the disease because does not stop sx if given after 7-10 days of onset.

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16
Q

What is the PRIMARY diagnostic goal when evaluating a patient for acute cough?

A

Rule out pneumonia: it is the 3 MCC and the most severe.

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17
Q

How do we rule out pneumonia as the cause of acute cough?

A

Pneumonia would have abnormal vital signs:

    1. HR: over 100/min
    1. RR: over 28/min
    1. T: over 100 F (37.7)
    1. Crackles
    1. Decrease breath sounds

If patient does not have these, end diagnosing for pneumonia.

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18
Q

How do we dx asthma as a cause of acute cough?

A

Hard to diagnose unless there is a reliable hx of asthma and episodes of wheezing + SOB in addition to the cough.

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19
Q

Why is asthma so hard to dx with [transient bronchial hyperresponsiveness] and [abnormal spirometry]?

A

Occur in all causes of acute bronchitis

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20
Q

When should inhaled- short acting B agonists be used as a treatment?

A

Patients with [cough + wheezing];

no benefit in cough without wheezing.

21
Q

Acute worsening of chronic bronchitis and bronchiectasis presents how?

A

-abrupt increase from baseline in cough, sputum production and purulence and SOB

22
Q

How do we treat acute cough?

What is their effectiveness?

A

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
23
Q
A
24
Q

What are the most common causes of chronic cough?

A

In most patients, chronic cough is caused by more than 1 thing.

  • 1. Upper airway cough sydrome (UACS)
  • 2. Asthma
  • 3. GERD
    1. Non-asthmatic eosinophillic bronchitis
    1. Medication reaction (ACE-i)
    1. Chronic bronchitis d/t smoking
25
Q

ALL patients that we suspect with chronic cough should be given what?

A
  • 1. Chest radiography
  • 2. Careful history and physical exam findings for ALL common causes.
26
Q

All patients with chronic cough should do what, before workup?

A

Stop smoking and ACE inhibitors 4 weeks before.

27
Q

How do we determine the cause of chronic cough?

A

Look at which therapy eliminates symptoms associated with cough.

28
Q

What is UACS?

A
  • Upper airway cough syndrome: recurrent cough that occurs when mucus from the nose drains down the oropharynx => triggers cough receptors.
29
Q

Symptoms of UACS?

A
  • 1. Post nasal drainage
  • 2. Clears throat alot
  • 3. Nasal discharge
  • 4. Cobblestone stone appearane on oropharyngeal mucosa
  • 5. Mucus dripping from oral mucosa
30
Q

Treatment of UACS?

Dx:

A
  • Tx: non-sedating antihistamines + decongestant
  • Dx: If drugs treat discharge and cough
31
Q

How do we treat an unknown chronic cough?

A

Nonsedating antihistamines + decongestant to see if it is UACS

32
Q

What is cough-varient asthma and how is it dx?

A
  • Asthma (airway hypersensitivity) where cough is the main symptom.
  • Dx when asthma meds treat cough; takes 6-8 weeks.
33
Q

Which test result can exclude cough-variant asthma as a diagnosis?

A

-Bronchoprovacation test: (-) test is 100% sensitive to rule out, but a positive test does not indicate, because test is not specific.

34
Q

How does GERD cause chronic cough?

A
  • Most common: vagal mediated distal esophageal tracheobronchial reflex.
    • Aspiration
35
Q

How do we treat chronic cough caused by GERD

A
  • First, give PPI because noninvasive
  • Then: 24 hour- esophageal pH monitoring (most sensitive and specific)
  • Sx decrease 3 months after.
36
Q

When do we diagnose chronic cough due to NAEB (nonasthmatic eosinophillic bronchitis)?

A
  • NL CXR
  • NL spirometry
  • (-) methacholine challenge test
37
Q

What is NAEB?

A

Chronic cough with eosinophils in airway, obtained by sputum or bronchial lavage during bronchoscopy.

38
Q

If a patient has NAEB, what should we ask on exam?

How do we treat?

A
    • Occupational exposure to sensitizer
    • Inhaled glucocorticoids and avoid allergens.
39
Q

What is a hallmark symptom of chronic bronchitis caused by smoking?

Treatment?

A
  • 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
40
Q

What is bronchiectasis?

Dx?

Tx?

A
  • 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
41
Q

Is stopping smoking good at stopping chronic cough?

A

Yes: decrease in almost 100% of patients.

42
Q

Cough d/t ACE inhibitors is related to ________ and occurs when?

Dx:

Tx:

A
  • 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.
43
Q

Does hemoptysis occur in acute or chronic cough?

What is the most common causes?

A
  • Either
  • Infection (bronchitis or pneumonia) followed by malignancy.
44
Q

What can cause hemoptysis?

A
  1. -High pulmonary pressure d/t left sided HF
  2. -PE
  3. -Lower respiratory causes
  4. -Upper airway souces of bleeding (nose) and and GI bleeding
45
Q

All patients with hemoptysis need ______.

What increase risk of malignancy?

A
  • Chest radiography
  • M, over 40YO, smoking >40-pack years, sx last longer than 1 week.
46
Q

Pts with increase risk of malignancy who have hemoptysis need to be reffered where, if cause of hemoptysis on chest radiography is not IDd?

A
  • Chest CT
  • Fiberoptic bronchopy
    • NECESSARY bc CT doesnt always show lesions
47
Q

Hemoptysis patient with history of LRT infection and NL chest radiograph should be treated with ________

A
  • Oral ABX to see if treats..
  • If recurs or persists, get a broncoscopy.
48
Q

Patient with massive hemoptysis (over 200mL/day) requires what?

A
  • 1. Urgent impatient eval
  • 2. Early consultation with pulomonologist
    1. ICU
  • -Airway management to prevent ASPHYXIATION, not exsanguition/
49
Q
A

CPR Exam 2 (29 decks)

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