exam 2 case study resp

Question 1

cough worse at night is associated with what

Answer 1

asthma

Question 2

differential dx for cough over past year

Answer 2

1. cough variant asthma
2. upper airway cough syndrome
3. GERD
4. chronic cough

Question 3

acute cough - up to 3 wks causes

Answer 3

URI, exacerbation of established lung disease, exposure to irritant, acute sinusitis, bronchitis, influenza: self limiting

Question 4

sub acute cough 3-8 wks causes

Answer 4

** a cough present more than 2 weeks consider pertussis

post viral cough, recurrent aspiration, post infectious cough

Question 5

chronic cough causes- beyond 8 wks

Answer 5

UACS
	Asthma
	GERD
	Always consider: smoking could there be a component of COPD
	Look at medications: ACEI

Question 6

life threatening causes of cough

Answer 6

Pneumonia
PE
Lung cancer
Exac of or acute CHF, afib

Question 7

classic triad of asthma symptoms

Answer 7

wheezing, cough (nighttime) episodic SOB. With or without a classic feeling of a heavy weight or tightness in the chest.

Question 8

what is asthma

Answer 8

reactive airway disease that results in chronic inflammation of the airways that involves mast cells, eosinophils, T-lymphocytes, macrophages, neutrophils ad epithelial cells

Question 9

asthma PE

Answer 9

ENT: assessing nasal turbinates
Viral: mucosa is reddened and swollen
Allergic: pale, bluish or red
Post Pharynx
Assessing for post nasal drip, erythema, oral ulcers, thrush
Neck
Assessing for thyroid enlargement/nodules/goiter
Chest
Percuss: resonant/hyper-resonant/dull
Auscultate: clear, crackles, wheezing, rhonchi, absence of lungs/ptx or pleural effusion
Diaphragmatic excursion: paralyzed diaphragm
Apical: atrial fib? Irregular/regular

Question 10

asthma severity

Answer 10

mild >70, moderate 50-69%, and severe < 50 with very severe below 40.

actual FEV1 %

Question 11

what disease to think about with past MI

Answer 11

Ischemic heart disease

Question 12

appearance of cobble stoning correlated with what disease

Answer 12

GERD

Question 13

diagnostic criteria for asthma

Answer 13

Clinically based meeting requirements of
Episodic symptoms of airway hyper-reactivity or airway obstruction that is at least partially reversible
Based on: history, PE, spirometry and other testing as needed such as methacholine challenge
Based on response to first line treatment: ICS resolution of cough

Question 14

common findings with asthma= PE nose

Answer 14

atopic findings
edematous nasal mucosa
nasal poylps

Question 15

COPD- factors for dx

Answer 15

Age over 40 years
Significant smoking history 15-20 years
Ongoing exposure to occupational chemicals
Slow gradual onset of progressive DOE, persistent, minor variability
Productive cough: morning
PE is similar, more likely hyperinflation

Question 16

CXR with asthma

Answer 16

often normal, but can have hyperinflation w/ flares

Question 17

CXR with emphysema or hyperinflation, think of what disease

Answer 17

COPD

although COPD may not have emphysema always

Question 18

COPD PFT test results consistent with what

Answer 18

Partially reversible with greater hyperinflation

DLCO usually lower

Question 19

Asthma PFT results consistent with what

Answer 19

Reversibility of > 200ml/baseline and 10-12% from baseline post IBD (inhaled bronchodilator)
DLCO normal

Question 20

overlaps with COPD and asthma

Answer 20

Longstanding asthmatics can develop fixed airway without reversibility
Especially when not treated appropriately and scar tissue develops
Moderate to severe COPD: may have hyper-reactive airways