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MedEd GKP/AB/VP > Respiratory - Cough > Flashcards

Respiratory - Cough Flashcards

1
Q

A 21 year old man has a productive cough, wheeze and steatorrhea. On examination he is clubbed and cyanosed, and has bilateral coarse crackles. His blood glucose level is measure at 11mmol/l.

a) Lung cancer
b) Cystic fibrosis
c) Goodpasture’s disease
d) Pneumonia
e) Tuberculosis

A

b) Cystic fibrosis

Cough, wheeze
Digital clubbing and cyanosis
Bilateral coarse crackles
Pancreatic insufficiency

(Not cancer- yes he’s clubbed but other features don’t fit
Pneumonia – may currently have but overarching picture is something bigger)

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2
Q

A middle aged man comes into A+E with cough, haemoptysis and a fever. He says he doesn’t have a permanent home and you notice that his clothes look very loose on him.

a) Sarcoidosis
b) COPD
c) Lung cancer
d) Pneumonia
e) Tuberculosis

A

e) Tuberculosis

Productive cough +/- haemoptysis
Weight loss, Fevers
Contact with infected e.g. high risk groups

People without permanent residence at increased risk

(Fever – infection, systemic features less likely pneumonia
Haemoptysis and weight loss – could be cancer but again, homelessness (RF) and fever point towards infectious cause)

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3
Q

3) A 16 year old girl comes to the GP with an irritating cough. She says it bothers her at night and when she wakes up in the morning.

a) Asthma
b) Cystic fibrosis
c) Goodpasture’s disease
d) Pneumonia
e) Post-nasal drip

A

a) Asthma

Often young onset
Recurrent, intermittent episodes of: 
Cough
Wheeze
SOB - Often worse at night

(No features CF
No infectious features)

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4
Q

What is CF?

A

autosomal recessive disease - mutation in CF transmembrane conductance regulator gene (CFTR) -> results in inability to secrete Cl and hydrate secretions.

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5
Q

Which organs/systems and how does CF affect most?

A 
Lungs - recurrent infections -> bronchiectasis
Pancreas- malabsorption, diabetes
Liver - cirrhosis
Biliary system - gallstones
GI tract - obstruction
Vas deferens - sterility
\+ children - failure to thrive

(mucus blocks airways and pancreatic duct/ biliary tree)

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6
Q

What resp condition can commonly be a long-term complication of CF?

A

Bronchiectasis

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7
Q

What is bronchiectasis?

A

Bronchiectasis: abnormal and permanently dilated airways due to chronic infection of the bronchi and bronchioles -> permanent dilation of the airways. Related to CF ‘mucopurulent cough’

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8
Q

What are the features of CF?

A

Cough, wheeze
Cyanosis
Digital clubbing
Bilateral coarse crackles

+ children - failure to thrive

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9
Q

Diagnosis of CF?

A

NEONATAL SCREENING
Sweat test
Sputum culture, CXR, spirometry

Bloods:
Genetic screening
FBC/U&E/LFT/vitamins

Faecal elastase for pancreatic dysfunction

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10
Q

At what stage in life do patients with CF usually present?

A

Usually present very early in life – as most have pancreatic insufficiency -> malabsorption (steatorrhea)
Can present later if initially pancreatic sufficient -> then become insufficient

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11
Q

CF MGMT

A 
MDT approach:
Chest physio 
Mucolytics, Bronchodilators, Antibiotics
Gene therapy 
Correction of vitamin deficiencies/pancreatic insufficiency  (Creon) 
LUNG/LIVER TRANSPLANT
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12
Q

Aetiology of TB?

A

MYCOBACTERIUM TB
Contact with infected e.g. high risk groups, travel
Immune deficiency

NB: infection often latent (Latent: immune system contains infection/bacilli present in ‘ghon focus’ – calcified nodule, asymptomatic, not infectious – potential for reactivation )

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13
Q

Patophysiology of TB?

A

Immune response -> caseating granulomas

  • Granuloma = Focal collection of inflammatory cells at sites of tissue infection
  • Caseation = necrotic regions, ‘cheeselike’

(Can be extra-pulmonary:
LN, GI, bone and spine (pott’s disease), military, CNS, pericardial, skin and skeletal muscles, renal, thyroid, adrenals)

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14
Q

What groups are in high risk of getting TB?

A

High risk: migrated from high risk areas, homeless, overcrowding
Immune deficiency: HIV, steroids, immunosuppressant, etc

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15
Q

What are the clinical features of respiratory TB?

A

Productive cough +/- haemoptysis

Weight loss, Fevers, Night sweats

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16
Q

TB investigations:

A

Chest X ray: consolidation +/- cavitation (usually upper zones), lymphadenopathy

Sputum: MC&S
Stain: Ziehl-Neelsen: Acid-fast bacilli
Culture: Lowenstein-jenson

LATENT TB: Tuberculin skin test, IFNY-y assays, elispot

HIV screening

(mc&s - microscopy, culture and sensitivities

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17
Q

CXR findings of TB:

A

consolidation +/- cavitation (usually upper zones), lymphadenopathy

Upper zones most oxygenated hence reside there

18
Q

How would you manage a patient with TB?

A

6 month antibiotic course:

Rifampicyn 8+16 weeks
Isoniazid 8+16 weeks
Pyraminazide 8 weeks
Ethambutol 8 weeks
\+ Pyridoxine throughout: vit B6, prevents Isoniazid SEs.
19
Q

What are the side effects of Isoniazid? What do you give to prevent them?

A

Increased blood levels of liver enzymes, peripheral neuropathy,
liver inflammation,
unclear if use during pregnancy is safe for the baby.

Pyridoxine, which is vitamin B6, may be given to reduce the risk of side effects (peripheral neuropathy in particular).

20
Q

Side effects of Rifampicin?

Extra question, not sure if in Sofia

A

Liver toxicity — hepatitis, liver failure in severe cases
Respiratory — breathlessness
Cutaneous — flushing, pruritus, rash, hyperpigmentation, redness and watering of eyes
Abdominal — nausea, vomiting, abdominal cramps, diarrhea
Flu-like symptoms — chills, fever, headache, arthralgia, and malaise.
Rifampicin has good penetration into the brain, and this may directly explain some malaise and dysphoria in a minority of users.
Allergic reaction — rashes, itching, swelling of the tongue or throat, severe dizziness, and trouble breathing

21
Q

What is asthma?

A

Chronic inflammatory condition of lung airways

22
Q

Is asthma reversible?

A

Yes, it is (unlike COPD)

23
Q

Asthma epidemiology?

A

Often young onset

24
Q

Asthma classification?

A

Mild, moderate, acute severe, life threatening (to be covered in future session)

25
Q

Causes of asthma?

A

Genetic: Atopy: asthma, eczema and hayfever (IgE mediated)
Environmental: Allergens: house dust-mite, pets, fungal spores…etc

26
Q

Patophysiology of asthma?

A

Bronchial muscle contraction, mucosal inflammation, increased mucus -> airway narrowing

Characteristics:
Airflow limitation
Airway hyper-responsiveness
Inflammation of bronchi

27
Q

Symptoms of asthma?

A

Recurrent, intermittent episodes of:
Cough
Wheeze
SOB
Often worse at night (or day if occupational)
Precipitated by: cold air, exercise, pollution, anxiety, drugs

(Occupational: flour, allergens from animals, wood dust, pharmaceutical
+ NSAIDS and Beta blockers)

28
Q

Asthma signs on resp exam?

A 
Tachypnoea
Audible wheeze
Hyperinflation
Percussion: hyper-resonant
Auscultation: polyphonic wheeze, diminished air entry
29
Q

COPD vs Asthma: smoking?

A

COPD: nearly all
Asthma: possibly

30
Q

COPD vs Asthma: symptoms <35yo?

A

COPD: Rare
Asthma: Often

31
Q

COPD vs Asthma: chronic productive cough?

A

COPD: Common
Asthma: Uncommon

32
Q

COPD vs Asthma: SOB?

A

COPD: Persistent and progressive
Asthma: Variable

33
Q

COPD vs Asthma: night time waking with SOB or wheeze?

A

COPD: uncommon
Asthma: common

34
Q

COPD vs Asthma: significant diurnal or day-to-day variability of symptoms?

A

COPD: uncommon
Asthma: common

35
Q

Old patient with chronic cough + red flag features: weight loss, night sweats, fevers, heamoptysis?

A

Lung cancer

36
Q

What is Goodpasture’s disease?

A

diffuse pulmonary haemorrhage and rapidly progressive glomerulonephritis.

Anti-GBM positive.

37
Q

Signs of Goodpasture’s disease?

A

SOB, cough, haemoptysis, haematuria, oedema, HTN, systemically unwell

38
Q

Three most common causes of chronic cough in a non-smoker?

A
  1. Asthma
  2. Post-nasal drip
  3. GORD
39
Q

What is a post-nasal drip?

A

Occurs when excessive mucus is produced by the nasal mucosa. The excess mucus accumulates in the throat or back of the nose. It is caused by rhinitis, sinusitis, GORD, or by a disorder of swallowing (such as an esophageal motility disorder). It is frequently caused by an allergy, which may be seasonal or persistent throughout the year.

40
Q

How does a post-nasal drip cause a cough?

A

excess mucus irritates cough receptors. Associated URT infection

41
Q

Can GORD cause a cough?

A

Yes

42
Q

How does GORD cause a cough?

A

Reflux irritates cough receptors. Especially at night

MedEd GKP/AB/VP (28 decks)

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