Respiratory Flashcards
What are the 3 major types of cough?
- Productive (chesty)
- Non-productive (tickly, dry)
- Congested (tight, hard cough)
What are the most common causes of coughs?
- Bacteria
- Viruses
- Allergies
- Post nasal drip
What are the differential diagnosis and referral points to consider when a patient presents with a cough?
- Wheezing, shortness of breath
- Dry, night-time cough - especially children (barking cough)
- Coloured sputum - yellow/green
- Blood in sputum
- Cough lasting longer than 3 weeks RED FLAG
- Pain on inspiration
- Chest pain
- Generally unwell, fever
- Drug induced cough/wheeze (ACE-inhibitors, NSAIDs, beta-blockers)
How do expectorants work? Give examples
They aim to remove mucus from chest/airways (e.g Guaifenesin - benylin chesty)
How do cough suppressants (anti-tussives) work? Give examples
Suppresses cough (e.g codiene, pholcodeine, dextromethorphan)
How do demulcents work?
Coats the pharynx so prevents coughing (e.g simple linctus, honey and lemon)
What ages should codeine containing products be recommended in?
Over 18s only
What are the most common cause of sore throats?
Viruses. (only 10% are caused by bacteria)
How do you know if a sore throat is caused by bacteria?
- Marked tonsillar exudate
- Tender glands
- Fever over 39.4C
- No cough and duration > 7 days
What are the referral symptoms for a sore throat?
- Adverse drug reaction (e.g. carbimazole) - associated skin rash
- Duration >7
- Dysphagia
- Symptoms suggestive of bacterial infection
What treatment is available OTC for a sore throat?
Generally symptomatic relief is all that is needed
- Lidocaine, Benzocaine (local anaesthetics)
- Chlorohexidine, Tyrothricin (anti-bacterials)
- Benzydamine (anti-inflammatories)
- Paracetamol, Aspirin, Ibuprofen, Flurbiprofen (Analgesics)
What should you no longer recommend for sore throats?
Codeine and Dihydrocodiene products
How do you differentiate between the common cold and influenza?
A cold is usually accompanied by sore throat, sneezing, nasal discharge, congestion, cough, fever, headache, malaise and will last for up to 14 days
A fever will usually present with shivers, chills, malaise, aching of limbs, insomnia, non-productive cough and a loss of appetite
What are the referral symptoms for a cold?
- Facial pain/severe frontal headache
- Ear pain originating from the middle ear
- Patients with symptoms that indicate flu
- Persistent fever
- Chest pain (RED FLAG)
How do you treat the common cold OTC?
- Analgesics
- Decongestants
- Anti-histamines
- Cough syrups
- Vitamin C and zinc?
- Echinacea
How can anti-histamines help the common cold?
They can lesson the symptoms of sneezing and a runny nose/post nasal drip. (occurs due to anti-cholinergic actions)
What differential diagnosis points do you need to consider for allergic rhinitis?
- Family history of atopic conditions maybe present
- Present with symptoms of nasal itching, sneezing, nasal congestion, ocular irritation
- Symptoms peak in the morning and evening, and when hot and humid
- Ensure that it isn’t cold or flu
What are the referral symptoms for allergic rhinitis?
- Wheezing/shortness of breath
- Treatment failure
- Unilateral discharge (especially in children)
What OTC treatment is available for allergic rhinitis?
- Allergen avoidance (first line)
- Antihistamines
- Corticosteroids (intranasal)
- Mast cell stabilisers (intranasal and ocular)
- Decongestants (intranasal and systemic)
Which antihistamines are sedating?
Chlorphenamine
Which antihistamines are non-sedating?
- Loratadine
- Cetirizine
- Acrivastine (over 12s)
- Benadryl plus (contrains pseudoephedrine)
Which antihistamines are available as eye drops?
Levocabastine and Antazoline
What ages are corticosteroids for allergic rhinitis allowed to be used in?
over 18s
What is an example of a mast cell stabiliser?
Sodium cromoglycate (requires frequent administration e.g. 4 times a day)
