T4 - Cough and SOB

Question 1

what is the tussive reflex and what does it cause?

Answer 1

stimulation of sensory nerves in epithelia of pharynx, larynx, trachea and bronchi that stimulate cough centres in the medulla
- causes contraction of respiratory muscles

Question 2

what are the respiratory muscles that contract due to the tussive reflex?

Answer 2

internal intercostals, rectus abdominis, ext and int obliques and transversus abdominis

Question 3

what are the key features of cough duration?

Answer 3

• acute <2 weeks
• persistent 2-8 weeks
• chronic >8 weeks

Question 4

what does
i) bright red blood 
ii) rusty coloured
iii) pink and frothy 
in sputum indicate?

Answer 4

i) pulmonary infarction or local capillary rupture in pharynx
ii) pneumonia
iii) HF or pulmonary oedema

Question 5

what are four common causes of haemoptysis?

Answer 5

acute infection, bronchial carcinoma, TB or a pulmonary infarct

Question 6

what are three occasional causes of haemoptysis?

Answer 6

trauma, vascular abnormalities, bleeding disorders

Question 7

what are three rare causes of haemoptysis?

Answer 7

lupus, aspergillosis, autoimmune diseases

Question 8

what are four symptoms of rhinosinusitis?

Answer 8

cough, tickle, nasal congestion, hoarseness

Question 9

how is rhinosinusitis treated?

Answer 9

with anti-histamines, intranasal corticosteroids or decongestants

Question 10

what is the most common cause of chronic cough in childhood?

Answer 10

asthma

Question 11

what is the atopic triad?

Answer 11

eczema, allergies and asthma

Question 12

what mutation can cause COPD in non smokers?

Answer 12

alpha anti trypsin deficiency

Question 13

what is bronchiectasis and what causes it?

Answer 13

caused by scarring from previous infections or secondary to other conditions such as CF
- dilation of smaller airways which makes space for mucus pooling and infection

Question 14

what organism may colonise in bronchiectasis?

Answer 14

pseudomonas

Question 15

what two cancers are associated with cough?

Answer 15

bronchogenic carcinoma and small cell lung cancer

Question 16

how is GORD characterised and what is it triggered by?

Answer 16

cough with no respiratory symptoms

- triggered by cough receptors in the oesophagus

Question 17

what two drugs cause cough (iatrogenic)

Answer 17

ACE inhibitors and beta blockers

Question 18

is ACE cough dose related?

Answer 18

no

Question 19

when does an ACE cough typically start?

Answer 19

a few months after taking them

Question 20

what three things can shortness of breath be associated with?

Answer 20

sputum, cough, chest pain

Question 21

what is a sudden cause of SOB?

Answer 21

inhaled foreign body, pneumothorax, PE

Question 22

what may cause SOB over hours?

Answer 22

asthma, HF, pneumonia, diabetic ketoacidosis

Question 23

what may cause SOB over days?

Answer 23

pneumonia and HF

Question 24

what may cause SOB over weeks?

Answer 24

pleural effusion and anaemia

Question 25

what is a common cause of SOB in the community?

Answer 25

hyperventilation

Question 26

what kind of crackles are heard in SOB related to asthma?

Answer 26

fine crackles and reduced air entry

Question 27

what is observed in pneumonia related to SOB?

Answer 27

purulent phlegm, coarse crackles, reduced air entry (NO wheeze or fine crackles)

Question 28

what is observed in HF and SOB?

Answer 28

bilateral fine crackles, no phlegm, no coarseness

Question 29

what is observed in an acute COPD exacerbation?

Answer 29

phlegm, coarse crackles, bilateral wheeze but no reduced air entry

Question 30

what four things are associated with chronic SOB?

Answer 30

postural (worse when lying down), oedema (HF), cough (COPD and HF), sputum (COPD/HF)