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Clinical Year Exams > MYE SPE (Cough) > Flashcards

MYE SPE (Cough) Flashcards

1
Q

What is the MC etiology and pathogen associated with Common Cold/URI?

A

Viral

- Rhinovirus

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2
Q

What four sxs are often seen with Common Cold/URI? When is it most contagious?

A
  • NON-productive cough
  • Clear/watery rhinorrhea
  • Nasal congestion
  • Sore throat (dry/scratchy)

First 2-3 days

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3
Q

What three PE findings are often seen with Common Cold/URI? What PE finding is NOT seen?

A
  • Swelling and discharge of nasal mucosa
  • Pharyngeal erythema (mild)
  • Conjunctival injection

NO LAD

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4
Q

What are two possible complications of Common Cold/URI?

A
  • Acute rhinosinusitis

- AOM

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5
Q

What is the typical course of Common Cold/URI, and what is the treatment (2)?

A

SELF-LIMITING (1-2 weeks)

  • NSAIDs/Acetaminophen
  • Antihistamines (Sudafed)
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6
Q

What four sxs/group of sxs are seen with COVID-19?

A
  • Fever
  • Cough +/- SOB
  • URI sxs (myalgias, diarrhea, HA, sore throat, N/V, abd. pain)
  • Loss of sense of smell and/or taste
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7
Q

What is the dx test of choice for COVID-19?

A

NAAT nasal swab

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8
Q

What is the recommended tx for COVID-19 (outpatient (2) vs. inpatient (2))?

A
  • OP: ISOLATE, supportive care

- IP: steroids (Dexamethasone), Remdesivir

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9
Q

What is the most common etiology associated with Acute Rhinosinusitis? What age group is most often affected?

A

VIRAL

- Age 45-64 years (mostly female)

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10
Q

How is Acute VIRAL Rhinosinusitis typically diagnosed?

A

Clinically

- <10 days of sxs, NOT worsening

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11
Q

What is the most common cause of Acute BACTERIAL Rhinosinusitis?

A

VIRAL

- Mucosal edema/sinus inflammation causes obstruction with bacteria, leading to secondary bacterial infection

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12
Q

When are abx indicated in the treatment of Acute BACTERIAL Rhinosinusitis (3)?

A
  • Persistent sxs for 10+ days, no improvement
  • Onset of severe sxs
  • Viral URI that initially improved THEN worsened (“double worsening”)
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13
Q

What is the first line treatment for Acute BACTERIAL Rhinosinusitis? What if the patient is high risk?

A

Augmentin for 5-7 days

- High risk = inc. Augmentin dose for 7-10 days

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14
Q

What is the gold standard diagnostic test for Acute BACTERIAL Rhinosinusitis?

A

Sinus Aspirate culture (by ENT)

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15
Q

What are the four cardinal symptoms associated with Chronic Rhinosinusitis? How does this differ for children?

A
  • Mucopurulent drainage
  • Nasal obstruction/congestion
  • Facial pain/pressure/fullness
  • Reduced/loss sense of smell

In children, cough rather than smell

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16
Q

What is the diagnostic criteria for Chronic Rhinosinusitis (3)?

A 
- 2/4 cardinal sxs present
AND
- Sxs for 12+ weeks
AND
- Disease on CT or Nasal Endoscopy
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17
Q

What three symptoms are often seen with Influenza? What is the typical onset, and when is it most contagious?

A

ABRUPT onset of…

  • Fever
  • Myalgias
  • Malaise
  • HA

First 2 days

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18
Q

If outpatient, when is testing recommended for Influenza (3)? If inpatient, when is it recommended?

What additional test is also often ordered as the gold standard?

A

OP: NOT recommended unless high risk = 65+, children <5 years or IC

IP: ANY patient with sxs upon admission or during admission

Gold standard = viral culture (3-10 days for results)

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19
Q

What is the preferred test for Influenza?

A

NAAT (Rapid Molecular Assay)

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20
Q

What is the recommended treatment for Influenza if severe or high-risk, and what is the window for giving it? How does this affect prognosis (2)?

A

Tamiflu (Oseltamivir) within 48 hours

- Reduces complications and shortens course by 1-2 days

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21
Q

How does Influenza vaccination differ for children 6 months to 8 years vs. 18-64 years vs. 65+ years?

A
  • 6 months-8 years = for first dose, TWO standard dose trivalent IM that are 4+ weeks apart
  • 18-64 years = standard dose trivalent IM
  • 65+ years = HIGH dose trivalent IM
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22
Q

What is the major complication associated with Influenza, and in what population is this a leading cause of mortality?

A

PNA

- Native Americans

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23
Q

What is the most common etiology of Pharyngitis?

A

VIRAL

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24
Q

What is the most common bacterial pathogen associated with Pharyngitis?

A

GAS (Strep pyogenes)

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25
Q

How does viral pharyngitis differ from bacterial pharyngitis on PE? What two viral pathogens are the exception to this?

A

Viral = NO pharyngeal exudate

- Exceptions: Adenovirus, Mononucleosis

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26
Q

What four symptoms are often seen with GAS Pharyngitis? What three other non-specific sxs may be seen?

A
  • Fever
  • Sore throat
  • Malaise
  • Odynophagia (painful swallowing)

Also, non-productive cough, N/V, myalgias

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27
Q

What cardiac condition is primarily associated with cough? How does this cough often present?

A

CHF

- Typically CHRONIC cough

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28
Q

What are the two types of CHF? Describe each.

A
  • Systolic = HFrEF

- Diastolic = HFpEF

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29
Q

What four symptoms are seen with LEFT-sided CHF?

A

LEFT:

  • DOE
  • PND
  • Orthopnea
  • Fatigue
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30
Q

What four symptoms are seen with RIGHT-sided CHF?

A

RIGHT:

  • JVD
  • Hepatic congestion
  • Ascites
  • Edema
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31
Q

What condition can present with pulsus altercans?

A

LEFT-sided (ventricular) CHF

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32
Q

What heart sounds may be presents with CHF (2)?

A
  • S3

- S4

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33
Q

What three findings may be seen with CHF on x-ray?

A
  • Kerley B lines
  • Effusion
  • Cardiomegaly
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34
Q

What is the GOLD standard dx test used for CHF?

A

Echo

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35
Q

What is the recommended treatment for ACUTE exacerbation of CHF (5)?

A

LMNOP

  • Lasix
  • Morphine
  • Nitrates
  • O2
  • Position (sit up)
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36
Q

What four drugs/groups of meds can be used to treat CHF?

What other patient education should be provided to CHF patients (4)?

A
  • Loop diuretics
  • ACE-I
  • BBs
  • Entresto (Sacubitril/Valsartan)

Can consider…

  • Aldosterone Antagonists
  • Hydralazine/Nitrates

Education: weight loss, low sodium, lower fluids, daily weight monitoring

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37
Q

Compare high-output CHF to low-output CHF.

A
  • HIGH = high CO; demand > supply

- LOW = low EF, low CO

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38
Q

What group of medications is associated with an SE of dry cough? When will this typically present?

What group of medications can be used as an alternative?

A

ACE-Is can cause dry cough within 1 week of starting the med

- Alternative = ARBs (Losartan); be sure to D/C ACE-I

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39
Q

What are three major RF associated with COPD, and which is most common?

A
  • SMOKING = MC
  • Secondhand smoke
  • Alpha-1 Antitrypsin Deficiency
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40
Q

What three sxs are often seen with COPD?

A
  • Excess sputum production
  • Cough
  • DOE
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41
Q

What is the recommended screening test for Lung CA? In what population would screening be recommended (hint: __ AND __ or __)?

A

CT

- Annually if 55-80 years old with 30+ year pack history AND currently smoking or smoked within past 15 years

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42
Q

How do you define Chronic Bronchitis?

A

Productive cough for 3 months for 2 consecutive years

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43
Q

What are two subtypes of COPD?

A
  • Chronic Bronchitis

- Emphysema

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44
Q

How can you differentiate sxs of Chronic Bronchitis from Emphysema (2 sxs for each)?

A
  • Chronic Bronchitis: productive cough, respiratory acidosis

- Emphysema = SOB, respiratory alkalosis

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45
Q

What spirometry results are indicative of COPD (2)?

A
  • FEV1/FVC = <70%

- FEV1 = <80%

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46
Q

What value are the four grades of COPD based on (GOLD), and what are the four grades?

A

Based on FEV1…

  • GOLD 1 = FEV1 of 80%+
  • GOLD 2 = FEV1 of 50-70%
  • GOLD 3 = FEV1 of 30-49%
  • GOLD 4 = FEV1 of <30%
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47
Q

What is the #1 recommended tx for COPD?

A

STOP SMOKING

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48
Q

What three classes of drugs are used to treat COPD, and what is an example of each?

A
  • SABA = Albuterol
  • LABA/ICS = Salmeterol
  • LAMA = Tiotropium
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49
Q

What are the four categories of treatment of COPD (1, 12 or 2, 2 or 3, 1)

A
  • Category A = SABA
  • Category B = SABA + LABA, SABA + LAMA
  • Category C = SABA + LAMA
  • Category D = SABA + LAMA, SABA+ LABA + LAMA
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50
Q

What is the most common etiology and pathogen associated with Acute Bronchitis?

A

VIRAL

- Adenovirus

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51
Q

What is the primary sxs associated with Acute Bronchitis? What other three sxs may present?

A

Non-productive cough

  • Wheezing
  • Rhonchi
  • Pharyngitis
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52
Q

How do you dx Acute Bronchitis?

A

CLINICAL

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53
Q

What is the recommended tx for Acute Bronchitis (3)?

A

Supportive care

  • Rest
  • Hydration
  • NSAIDs
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54
Q

Compare mild intermittent, mild persistent, moderate persistent and severe persistent Asthma (3 components each)?

A
  • Mild intermittent = <2 days/week, night awake <2 x/month, FEV1 80%+
  • Mild persistent = 2+ days/week, night awake 3-4 x/month, FEV1 80%+
  • Moderate persistent = daily, night awake 1 x/week, FEV1 60-80%
  • Severe persistent = throughout day, awake nightly, FEV1 <60%
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55
Q

What three sxs are associated with Asthma?

A
  • SOB
  • Wheezing
  • Cough (worse at night)
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56
Q

When is the cough in Asthma worst?

A

AT NIGHT

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57
Q

What two physical exam findings are seen with Asthma?

A
  • Prolonged expiration

- Hyperresonance to percussion

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58
Q

What are the three components of Samter’s Triad?

A
  • Asthma
  • Sinus disease with nasal polyps
  • ASA/NSAID allergy
59
Q

What is the GOLD standard dx test for Asthma?

A

Spirometry

60
Q

What two findings may be seen on sputum culture with Asthma?

A
  • Curschmann’s spirals

- Charcot-Leyden crystals

61
Q

What is the bronchodilator test and what does it indicate in Asthma?

A

Asthma = reversible

- Reversible if FEV1 increases by 12%

62
Q

What are the three components of Atopic Triad?

A
  • Asthma
  • Allergic rhinitis
  • Atopic dermatitis
63
Q

What are the six steps of Asthma treatment, and how do they relate to the Asthma classifications (1, 2, 3, 3, 2, 3)?

A
  • Step 1 = Mild Intermittent: SABA PRN
  • Step 2 = Mild Persistent: low-dose ICS daily OR LTRA (Montelukast)
  • Step 3 = Moderate Persistent: medium-dose ICS daily OR low-dose ICS + LABA; consider referral
  • Step 4 = Severe Persistent: medium-dose ICS + LABA OR medium-dose ICS + LTRA; REFER
  • Step 5 = been referred: high-dose ICS + LABA
  • Step 6 = been referred: high-dose ICS + LABA + oral steroids
64
Q

What is the MC type of Interstitial Lung Disease?

A

Idiopathic Pulmonary Fibrosis

65
Q

What two sxs are associated with Idiopathic Pulmonary Fibrosis?

A
  • Gradual SOB

- NON-productive cough

66
Q

What is the recommended dx test for Idiopathic Pulmonary Fibrosis, and what two findings may be seen?

A

HRCT

  • Ground glass opacities
  • Honeycomb
67
Q

What is the recommended tx for Idiopathic Pulmonary Fibrosis?

A

EARLY REFERRAL for lung transplant

68
Q

What are the three types of Pneumoconiosis, and what causes each type (hint: think occupation)?

A
  • Silicosis = miners, males
  • Coal Worker’s (Black Lung) = coal miners, males
  • Asbestosis = construction, males
69
Q

What condition presents with “crazy paving” pattern on HRCT?

A

Silicosis

- Type of Pneumoconiosis

70
Q

What is the primary sxs and PE finding seen with Silicosis?

A
  • Sxs = NON-productive cough

- PE = crackles

71
Q

What finding will be seen with chronic SIMPLE Silicosis and Coal Worker’s (Black Lung) on CXR/HRCT? What about chronic COMPLICATED?

What part of the lung do these typically show?

A
  • Chronic simple = eggshell
  • Chronic complicated = angel wings

UPPER LOBES

72
Q

Which type of Pneumoconiosis is associated with increased risk of TB?

A

Silicosis

- Type of Pneumoconiosis

73
Q

What condition involves black masses, occasionally with liquified center?

A

Coal Worker’s (Black Lung)

- Type of Pneumoconiosis

74
Q

What specific finding is seen on CXR/HRCT with Asbestosis?

What part of the lung do these typically show?

A
  • Pleural plaques

LOWER LOBES

75
Q

Which type of Pneumoconiosis is associated with increased risk of Bronchogenic Carcinoma and Malignant Mesothelioma?

A

Asbestosis

76
Q

What two condition are you at increased risk for with Asbestosis?

A
  • Bronchogenic Carcinoma

- Malignant Mesothelioma

77
Q

What is the most common body system affected with Sarcoidosis? What other two body systems are affecteD?

A

LUNGS

- Also skin and eyes

78
Q

What are two common sxs associated with Sarcoidosis?

What are three common skin sxs and one ocular sxs associated with Sarcoidosis?

A
  • SOB
  • Dry, non-productive cough
  • SKIN = erythema nodosum, lupus pernio
  • EYES = anterior uveitis
79
Q

What is the pathognomonic sxs associated with Sarcoidosis?

A

Lupus pernio (violaceous, raised discoloration of face)

80
Q

What does the “typical” Sarcoidosis patient look like (3, think RF)?

A

African American female that does NOT smoke

81
Q

What lab finding is seen with Sarcoidosis?

A

Elevated serum ACE

82
Q

What is the 1st line tx for Sarcoidosis? What is the 2nd line tx?

A
  • 1st line = observation +/- steroids

- 2nd line = immunomodulators

83
Q

What is the primary RF associated with Solitary Pulmonary Nodules (SPNs)?

A

Thymomas

84
Q

How can you differentiate a nodule from a mass with Solitary Pulmonary Nodules (SPNs)? What is there increased chance of with a mass?

What are the MC type of SPN?

A
  • Nodule = <3 cm
  • Mass = 3+ cm; greater change of CA

MC = infectious granulomas (TB, Cocci, abscess)

85
Q

What three findings are indicative of a BENIGN Solitary Pulmonary Nodule (SPN)?

A
  • SLOW growth
  • Round/smooth
  • Calcifications
86
Q

What three findings are indicative of a MALIGNANT Solitary Pulmonary Nodule (SPN)?

A
  • RAPID growth
  • Irregular/speculated
  • Cavitation with thick walls
87
Q

What is a Carcinoid Tumor? What is the MC site affected?

A

Neuroendocrine tumors

- GI tract (or lungs)

88
Q

What is the greatest RF associated with Bronchogenic Carcinoma?

A

SMOKING

89
Q

What are the two types of Bronchogenic Carcinoma, and what are the subtypes of each (1, 3)?

A

SCLC
- Oat Cell

NSCLC

  • Adenocarcinoma
  • SCC (Squamous Cell)
  • LCC (Large Cell)
90
Q

Which subtype of Bronchogenic Carcinoma typically presents with cough, and WHY? What other subtype also presents with cough

A

SCLC (Oat Cell CA)
- Arises in central airway

Also Squamous Cell CA (type of NSCLC)

91
Q

Which subtype of Bronchogenic Carcinoma typically presents with peripheral nodules/masses?

A

Adenocarcinoma (type of NSCLC)

92
Q

Which subtype of Bronchogenic Carcinoma typically occurs centrally/in main bronchus?

A

Squamous Cell CA (type of NSCLC)

93
Q

Which subtype of Bronchogenic Carcinoma typically presents with central nodules/masses?

A

Large Cell CA (type of NSCLC)

94
Q

Which two subtypes of Bronchogenic Carcinoma typically metastasize to DISTANT organs?

A
  • Adenocarcinoma (type of NSCLC)

- Large Cell CA (type of NSCLC)

95
Q

Which subtype of Bronchogenic Carcinoma typically presents with hemoptysis?

A

Squamous Cell CA (type of NSCLC)

96
Q

Which two subtypes of Bronchogenic Carcinoma present most often with cough?

A
  • SCLC (Oat Cell CA)

- Squamous Cell CA (type of NSCLC)

97
Q

What are the preferred tx for each type of Bronchogenic Carcinoma?

A
  • SCLC = chemo

- NSCLC = surgery

98
Q

What is the MC pathogen associated with bacterial PNA, and what color sputum does it present with?

A

S. pneumoniae

- Rust-colored sputum

99
Q

When does CAP present, and what pathogen is MC?

A

Within 48 hours of hospital or OP

- S. pneumoniae

100
Q

What four sxs present with bacterial PNA?

A
  • Productive cough
  • Fever
  • SOB
  • Pleuritic CP
101
Q

What is the gold standard dx test for bacterial PNA?

A

CXR (PA and lateral)

102
Q

What is CURB-65 and what condition is it associated with? What is it used to determine?

A

If 2+ present = admit for PNA

  • Confusion
  • Urea of 7+
  • RR of 30+
  • BP <90/60
  • 65+ years old
103
Q

What is the recommended OUTPATIENT tx for bacterial PNA if uncomplicated (1, 1) vs complicated (2, 1)?

A
  • OP uncomplicated = Azithro OR Doxy

- OP complicated = Augmentin + Azithro OR Levofloxacin

104
Q

What is the recommended INPATIENT tx for bacterial PNA (2, 2)?

A
  • Augmentin + Azithro

- Augmentin + Levofloxacin

105
Q

What two vaccinations are recommended for bacterial PNA?

A
  • Influenza

- Pneumococcal

106
Q

What is the MC VIRAL pathogen associated with PNA?

A

Influenza

107
Q

What four sxs present with viral PNA?

A
  • NON-productive cough
  • Fever/chills
  • Rhinorrhea
  • HA, sore throat
108
Q

What type of PNA is MC associated with HIV, and what specific pathogen?

A

Unicellular/Fungal PNA

- Pneumocystis jirovecii

109
Q

What is the tx for Unicellular/Fungal PNA?

A

Bactrim

110
Q

What is Bronchiectasis? What is the MC pathogen?

A

Permanent and abnormal dilation of major bronchi (airways)

- H. flu

111
Q

What are four sxs associated with Bronchiectasis?

A
  • Copious/thick/foul-smelling sputum
  • Chronic daily cough
  • Hemoptysis
  • Recurrent lung infections
112
Q

What is the recommended tx for Bronchiectasis (2)?

A

Abx (Ampicillin) + Bronchodilator

113
Q

What is Virchow’s Triad, and what condition is it associated with?

A

PE

  • Venous stasis
  • Injury to vessel wall
  • Hypercoagulation
114
Q

What four sxs are commonly associated with PE?

A
  • SOB (sudden onset)
  • Pleuritic CP
  • Hemoptysis
  • Cough/wheezing
115
Q

What two EKG findings are seen with PE?

A
  • Sinus tachy

- S1Q3T3

116
Q

What is the gold standard dx test for PE? What is the BEST dx test for PE?

A
  • Gold = CTPA (pulmonary angiography)

- BEST = spiral CT

117
Q

What are the general recommended tx for PE (3)?

A
  1. O2
  2. IV fluids
  3. Anticoagulation
118
Q

For tx of PE, what are the four classes of anticoagulation, and what is an example of each (2, 2, 1, 1)?

A
  • Antithrombin III = Heparin or LMWH
  • Facto Xa Inhibitor = Xarelto, Eliquis
  • Direct thrombin inhibitor = Pradaxa
  • Vitamin K inhibitor = Warfarin
119
Q

What are two PE findings seen with PE?

A
  • JVD

- S3 and S4 sounds

120
Q

What finding is seen on CXR with Unicellular/Fungal PNA aka P. jirovecii?

A

“Batwing” appearance

121
Q

What is the pathogen associated with Pertussis? What three sxs (triad) are associated with this condition?

A

Bordetella pertussis

  • Coughing spells (paroxysms of cough)
  • Inspiratory whoop
  • Posttussive emesis
122
Q

What are the three phases of Pertussis (describe each), and how long does each last?

A
  1. Catarrhal = URI sxs, fever for 1-2 weeks
  2. Paroxysmal = triad of sxs for 2-6 weeks
  3. Convalescent = cough gradually improves for weeks/months
123
Q

What dx test is the GOLD standard for Pertussis?

A

Culture (bacterial)

124
Q

What is the recommended tx for Pertussis? What is an alternative option?

A

Macrolides = Azithromycin

- Bactrim

125
Q

How do you contract Cryptococcosis? What is the primary pathogen?

A

Inhalation of spores from FRICKIN PIGEON SHIT

- Cryptococcus neoformans

126
Q

What is the recommended tx for Cryptococcosis (1+1)?

A

Amphotericin B + Flucytosine

127
Q

What five sxs are often associated with Tuberculosis?

A
  • Fever
  • Cough (dry)
  • Hemoptysis
  • CP (often pleuritic)
  • Weight loss
128
Q

What is the classic finding seen with TB?

A

Posttussive crackles

129
Q

What is the primary dx test used for TB, and how do you interpret it?

A

TST (Mantoux Tuberculin Skin Test)

- Measure INDURATION, not erythema

130
Q

How can you differentiate ACTIVE vs. LATENT TB (3, hint: think sxs, contagious, dx test)?

A

Active:

  • Sxs of cough for 3+ weeks, CP, hemoptysis
  • Contagious
  • Abnormal CXR AND +sputum smear/culture

Latent:

  • Asxs
  • NOT contagious
  • Normal CXR and -sputum smear/culture
131
Q

What is the recommended tx for ACTIVE TB (4), and for how long?

A

RIPE for 6-12 months

  • Rifampin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
132
Q

What is the recommended tx for LATENT TB, and for how long (2)?

A

Isoniazid + Rifapentine

133
Q

What is the primary transmission of Histoplasmosis?

A

Bird or bat poop (ex. spelunking)

134
Q

What is the tx for mild/moderate Histoplasmosis (2) vs. severe Histoplasmosis (1)?

A
  • Mild/moderate = Itraconazole

- Severe = Amphotericin B

135
Q

What are the two MC types of Esophageal CA?

A
  • SCC (MC worldwide)

- Adenocarcinoma (MC in U.S.)

136
Q

What is the primary sxs associated with Esophageal CA?

A

Solid food dysphagia (then fluid dysphagia)

137
Q

What is the recommended dx test for Esophageal CA?

A

Endoscopy with biopsy

138
Q

What is the primary sxs associated with GERD?

A

Heartburn (30-60 min post-prandial)

- Can have CHRONIC cough

139
Q

What is the recommended dx test for GERD?

A

Upper endoscopy

140
Q

What is the recommended tx for GERD (2)?

A
  1. Lifestyle modifications

2. H2 Blockers (Ranitidine) vs. PPIs (Omeprazole)

141
Q

What four sxs may present with Non-Hodgkins Lymphoma?

A
  • Cough
  • SOB
  • Edema
  • Mediastinal mass
142
Q

What is the MC TYPICAL pathogen associated with CAP? What about ATYPICAL CAP?

A
  • Typical: Streptococcus pneumoniae

- Atypical: Mycoplasma pneumoniae

143
Q

What is the MC etiology of CAP (and what pathogen? What is the 2nd MC etiology (and what pathogen)?

A
  • MC = BACTERIAL: Streptococcus pneumoniae

- 2nd MC = VIRAL: Influenza

Clinical Year Exams (3 decks)

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