Unit 3 - Approach to the Coughing Patient Flashcards

1
Q

The coughing mechanism is a _____ mechanism that works with the mucociliary apparatus.

A

protective

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2
Q

What medical history must you obtain when determining the cause of coughing?

A

Duration, progression, associations (time of day), triggers, character of cough, and other systemic signs

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3
Q

What are potential triggers for a cough?

A

the owner is a smoker, perfume/air fresheners, household cleaners, dusty kitty litter, and house construction

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4
Q

What environmental exposure can cause a cough?

A

boarding/grooming, obtained from a shelter, outdoors/travel history, walks, dog parks, show/agility competitor, heartworm prevention, other sick animals in the house

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5
Q

When determining the cause of a cough, what should you look for/do on the PE?

A

tracheal and cervical palpation, nasal discharge, changes in weight, fundic examination, skin lesions, cardiac abnormalities, lymphadenopathy, and rectal examination

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6
Q

What does a non-productive cough sound like?

A

usually loud, harsh, and paroxysmal

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7
Q

What is a goose-honk most commonly associated with?

A

upper airway disease - trachea and mainstem bronchi

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8
Q

What is a productive cough?

A

when sputum is expectorated from the lower airways

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9
Q

What is productive cough most commonly associated with?

A

lower airway disease or pulmonary parenchymal disease

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10
Q

How does a productive cough sound like?

A

it is typically softer in volume - a huff - can be confused with vomiting

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11
Q

Coughing is _____ in cats, so it should be persued ______.

A

uncommon, aggressively

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12
Q

What is coughing most commonly associated with in cats?

A

lower airway disease (asthma is the most common)

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13
Q

How do you know if a cough is cardiogenic in nature?

A

It is classically worse at night, there is exercise intolerance and tachypnea at rest, and there is perihilar edema on radiographs that is responsive to furosemide

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14
Q

What are the locations where non-cardiogenic coughs come from?

A

upper (large) airway, lower (small) airway, parenchymal, and less commonly pleural space

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15
Q

What are the infectious causes of upper airway coughs?

A

infectious tracheobronchitis, parasitic (filaroides), or hilar lymph node enlargement

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16
Q

Are upper airway coughs typically productive or non-productive?

A

non-productive

17
Q

What are the non-infectious causes of upper airway coughs?

A

tracheal collapse, compressive masses, or foreign bodies

18
Q

What can cause lower airway cough?

A

inflammatory airway disease or smoke/chemical irritant inhalation

19
Q

What are the causes of inflammatory airway disease?

A

canine chronic bronchitis, feline lower airway disease, eosinophilic bronchopneumopathy

20
Q

What are the infectious causes of parenchymal disease cough?

A

bacterial pneumonia, fungal disease, heartworm infection, parasitic, or Toxoplasma

21
Q

What are the non-infectious causes of parenchymal disease cough?

A

neoplasia, lung lobe torsion, and non-cardiogenic pulmonary edema

22
Q

What are the common ‘first tier’ tests for diagnosing underlying causes of cough?

A

CBC, throacic rads, fecal examination, heartworm testing, and cytology (skin lesions, nasal discharge, and lymph nodes)

23
Q

What are common ‘second tier’ tests for diagnosing underlying causes of cough?

A

Cardiac evaluation, chemistry panel, urinalysis, airway sampling (for type of pneumonia), advanced imaging, lung aspirate/biopsy, bronchoscopy, and thoracotomy

24
Q

What does TTW stand for?

A

transtracheal wash

25
What does ETW stand for?
endotracheal wash
26
When is TTW or ETW indicated?
for diffuse disease
27
How do you perform TTW or ETW?
Place a catheter to the level of the carina, insert saline (patient must be able to cough), recover the saline for cytology and culture
28
What is BAL and when is it indicated?
Bronchoalveolar lavage - indicated for localized disease - scope is used to perform this
29
If you decide to do empiric antibiotic therapy, what guidelines should you follow?
limit to one course, discontinue 1-2 weeks prior to sampling airways, informed client consent (may complicate future diagnosis/tx if unsuccessful)
30
What is an antitussive?
a drug used to prevent or relieve a cough
31
What are the most effective antitussives (general)?
opioids
32
What opoids can be used for antitussives?
butorphanol, hydrocodone, loperamide, diphenoxylate
33
What is combined with hydrocodone to prevent human abuse?
anti-cholinergics
34
When wouldn't you use an antitussive?
the vast majority of lower airway coughs - contraindicated in causes of pneumonia
35
What condition do we use antitussives in?
collapsing trachea cases
36
What abnormal breath sound will you hear with a cardiogenic cough?
crackles
37
What other disease process, aside from CHF, can cause a cardiogenic cough?
advanced mitral valve disease, specifically causing cardiomegaly, that causes the left atrium to push on the mainstem bronchi