Age >50 years Smoking history Asbestos history exposure Persistent cough Overseas travel TB exposure Haemoptysis Unexplained weight loss Dyspnoea

Cough Flashcards by MA CARMELA CONCEPCION SALES

_______ is the commonest manifestation of lower

respiratory tract infection

Cough

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Cough is the cardinal feature of ______

chronic bronchitis

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Cough may persist for many weeks following an
acute upper respiratory tract infection (URTI) as
a result of persisting ______ or ______

bronchial inflammation and

increased airway responsiveness

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______ is the commonest cause of a
persistent or chronic cough, especially causing
nocturnal cough due to secretions (mainly from
chronic sinusitis) tracking down the larynx and
trachea during sleep

Postnasal drip

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The commonest causes of haemoptysis are
1
2
3

URTI (24%), acute or chronic bronchitis (17%),

bronchiectasis (13%), TB (10%).

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A _______ is suggestive of cancer: the explosive
nature of a normal cough is lost when laryngeal paralysis
is present, usually resulting from bronchial carcinoma
infiltrating the left recurrent laryngeal nerve.

bovine cough

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Chronic cough may be the first presentation of

_____pneumonia in an HIV-infected pt

Pneumocystis jiroveci

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Red flags for cough

Age >50 years
Smoking history
Asbestos history exposure
Persistent cough
Overseas travel
TB exposure
Haemoptysis
Unexplained weight loss
Dyspnoea

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Pulmonary infiltration
with fibrosis may result from some cytotoxic drugs,
especially_______

bleomycin

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Cough can be a feature of some of the ACE inhibitors

and _____,______,______

beta blockers, inhaled steroids and sulfasalazine

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A typical

‘psychogenic’ cough is barking in quality—the ‘__________. It does not occur during sleep

Cape

Barren goose’ cough

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Occupational list for causes of cough

mining ______

aircraft manufacturing________

farming (‘farmer’s lung’—allergic pneumonitis from mouldy hay)

and bird handling (‘bird fancier’s lung’—allergic alveolitis or psittacosis from pigeons or budgerigars

(pneumoconiosis),

(asbestosis and mesothelioma),

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PE of pt with cough

_______ on auscultation indicate pulmonary oedema
of heart failure, interstitial pulmonary fibrosis and
early lobar pneumonia,

while coarse crackles indicate
_______, _______, ______

Fine crackles

resolving pneumonia, bronchiectasis and TB

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Important radiologic procedures for pts with cough

— plain chest X-ray (shows many problems)
— ____________helps more precise localisation
of lesion, may show cavitation
— ________: shows bronchiectasis (a very
unpleasant procedure)
— CT scanning (more sensitive than plain X-ray)
— CT pulmonary angiogram
— ___________: for
pulmonary infarction
— echocardiogram (pulmonary hypertension)

tomography:

bronchography

ventilation/perfusion isotope scan

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Character of the cough
• _________→ tracheitis and bronchitis (major
bronchi); extrinsic pressure on trachea
• __________ → laryngeal disorders (e.g. laryngitis)

Brassy

Barking

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Character of the cough

• _________ → laryngeal disorders (e.g.
laryngitis, croup)
• _________ → vocal cord paralysis (leftrecurrent
laryngeal nerve)
• Weak cough → indicates bronchial carcinoma
• _______ → whooping cough
• _______→ tracheitis; left ventricular failure

Croupy (with stridor)

Bovine (no power)

Paroxysmal with whoops

Painful

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Causes of nocturnal cough

— asthma
— left ventricular failure
— postnasal drip
— chronic bronchitis
— whooping cough

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Causes of waking cough

— bronchiectasis
— chronic bronchitis
— GORD

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cough associated with changing posture

— bronchiectasis

— lung abscess

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Cough with meals

— hiatus hernia (possible)
— oesophageal diverticulum
— tracheo-oesophageal fistula

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A healthy, non-smoking individual produces

approximately ______ of mucus a day

100–150 mL

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This
normal bronchial secretion is swept up the airways
towards the trachea by the________
mechanism and is usually swallowed.

mucociliary clearance

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The commonest cause of excess mucus production is

_______

cigarette smoking.

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Character of sputum

_________ → due to cellular
material (neutrophils or eosinophil granulocytes)

_______ → lobar pneumonia ( S. pneumoniae ): due
to blood

Yellow or green (purulent)

Rusty

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Character of sputum * Profuse, watery → ______ * Thin, clear mucoid → ______ * Redcurrant jelly → ______ * Profuse and offensive →_____

alveolar cell carcinoma viral infection bronchial carcinoma bronchiectasis; lung abscess

Character of sputum ``` Thick plugs (cast-like) → _____ • Pink frothy sputum → pulmonary oedema ```

allergic bronchopulmonary Aspergillus; | bronchial carcinoma

Rare causes of hemoptysis

Idiopathic pulmonary haemosiderosis Goodpasture syndrome Blood disorders including anticoagulants

Several clinicians describe the _______as the commonest cause of cough

catarrhal child | syndrome

This refers to children who develop a postnasal drip following acute respiratory infection and allergic rhinitis

catarrhal child | syndrome

Habit cough can occur in children, especially those | with a history of ______

school phobia

``` One study found the causes of chronic cough in the elderly to be 1 2 3 ```

postnasal drip syndrome 48%, gastro-oesophageal reflux 20% and asthma 17%.

Combined URTI and LRTI include 1 2 3

influ enza, measles, whooping cough and laryngotracheobronchitis

This highly infectious URTI, which is often mistakenly referred to as ‘the flu’, produces a mild systemic upset and prominent nasal symptoms

The common cold (acute coryza

The incubation period is usually 1–3 days and the illness commences abruptly with a fever, headache, shivering and generalised muscle aching

Influenza

Causes of common cold

``` Rhinoviruses Parainfluenza Influenza B, C Coronavirus RSV ```

Common cause of influenza

``` Influenza A Influenza B Novel strains influenza A e.g. H5N1 ```

Where is sorethroat more common, common cold or influenza?

common cold

Antiviral agents for influenza

Neuraminidase inhibitors (cover influenza A and B): zanamivir (Relenza) 10 mg by inhalation bd oseltamivir (Tamiflu) 75 mg (o) bd

How to give antiviral in influenza

commenced within 36 hours of | onset and given for 5 days.

Influenza vaccination offers some protection for up | to ____ of the population for about 12 months

70%

This strain presents with typical influenza symptoms commonly accompanied by gastrointestinal symptoms (especially diarrhoea)

(The swine variety of H1N1 influenza A)

Tx of (The swine variety of H1N1 influenza A)

The treatment is the same as for influenza in general with neuraminidase inhibitors. A vaccine is now available

This is acute inflammation of the tracheobronchial tree that usually follows an upper respiratory infection. Although generally mild and self-limiting, it may be serious in debilitated patients

Acute bronchitis

etiology of complicated acute bronchitis

often due to | Haemophilus influenzae and Streptococcus pneumoniae

Abx for acute bronchitis

amoxycillin 500 mg (o) 8 hourly for 5 days or doxycycline 200 mg (o) statim, 100 mg

This is a chronic productive cough for at least 3 | successive months in 2 successive years

Chronic bronchitis

CAP is usually caused by a single | organism, especially______

Streptococcus pneumoniae

Tx duration for pneumonia Treatment is usually for __days for most bacterial causes, 2 weeks for_______nfection and 2–3 weeks for Legionella

5–10 Mycoplasma or Chlamydia i

Xray of atypical Pnx

Chest X-ray (diffuse infiltration) incompatible | with chest signs

MC cause of atypical Pnx

Mycoplasma pneumoniae

Tx of Mycoplasma pneumoniae

roxithromycin 300 mg (o) daily or doxycycline 100 mg bd for 14 days

What atypical Pnx — related to cooling systems in large buildings — incubation 2–10 days

Legionella pneumophila (legionnaire disease

Dx criteria for Legionnaires disease ``` 1 2 3 4 5 ```

* prodromal influenza-like illness * a dry cough, confusion or diarrhoea * very high fever (may be relative bradycardia) * lymphopaenia with moderate leucocytosis * hyponatraemia

Tx of Legionella

azithromycin IV (first-line) or erythromycin (IV or oral) plus (if very severe) ciprofloxacin or rifampicin

Tx of Chlamydia psittaci (psittacosis):

treat with roxithromycin or erythromycin or | doxycycline

Tx of Coxiella burnetti (Q fever)

treat with doxycycline 200 mg (o) statim then | 100 mg daily for 14 days

Mx of mild Pnx

amoxycillin/clavulanate 875/125 mg (o) 12 hourly for 7 days especially if S. pneumoniae isolated or suspected plus (especially if atypical pneumonia suspected) roxithromycin 300 mg (o) daily for 7 days

Guidelines for severe pneumonia | and hospital admission

• Altered mental state/acute onset confusion • Rapidly deteriorating course • Respiratory rate >30 per minute • Pulse rate >125 per minute • BP <90/60 mmHg • Hypoxia P a O 2 <60 mm Hg or O 2 saturation <92% • Leucocytes <4 × 10 8 L or >20 × 10 9 /L

Pnx in children * _______ are the most common cause in infants. * _______ are common in children over 5 years. * ________ is a cause in all age groups

Viruses Mycoplasma S. pneumoniae

When to admit infants with severe pnx Infants: 1 2 3 Older children 1 2 3

* RR>70 • * Intermittent apnoea * Not feeding RR>50 • Grunting • Signs of dehydration

A cough lasting 2 months or more | is defined as a ______

chronic cough

Organisms for chronic persistent cough

``` Haemophilus influenzae (the most common), S. pneumoniae and Moraxella ```

Haemophilus influenzae (the most common), S. pneumoniae and Moraxella How to Tx?

most susceptible to amoxycillin or | amoxycillin/clavulanate or parenteral cephalosporins

Indications for 24-hour ambulatory oesophageal | pH monitoring in chronic cough include

``` • unexplained chronic cough after clinical assessment • symptomatic gastro-oesophageal reflux • chronic cough with known aetiology unresponsive to therapy ```

_______accounts for 25% of cancer deaths in men and 24% of cancer deaths in women (rapidly rising),

Lung cancer

MC cause of lung CA

cigarette smoking

________accounts for over | 95% of primary lung malignancies

Bronchial carcinoma

Sx of lung CA

* Cough (42%) * Chest pain (22%) * Wheezing (15%) * Haemoptysis (7%) * Dyspnoea (5%)

Causes of a solitary pulmonary nodule | (on X-ray

Bronchial carcinoma Solitary metastasis Granuloma (e.g. TB) Hamartoma

______ is not an option for SCLC since it metastasises so rapidly (80% have metastasised at the time of diagnosis).

Surgery

________ is suitable for the deadly SCLC but currently only extends life expectancy from 3 to 20 months (at best).

Chemotherapy

________ is a malignant tumour of mesothelial cells usually at the pleura. It is associated with prior asbestos exposure, possibly decades earlier (90% report exposure

Mesothelioma

Prognosis of mesothelioma

Prognosis is poor and treatment is palliative | support.

________ is dilatation of the bronchi when their walls become inflamed, thickened and irreversibly damaged, usually following obstruction followed by infection

Bronchiectasis

The_______ and ______ are the | commonest sites for localised disease in Bronchiectasis

left lower lobe and lingula

Main pathogens for bronchiectasis

Streptococcus pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae (commonest)

CT of for bronchiectasis

can show bronchial wall thickening

Gold standard for bronchiectasis dx

high resolution CT scan is the new gold standard | for diagnosis

______ or ______ is | recommended for first presentation of bronchiectasis

Amoxycillin 500 mg | (o) tds for 2–3 weeks or roxithromycin

Examples of opiod cough supressants

``` Opioid: Codeine Dihydrocodeine Hydrocodone Pholcodine Ethylmorphine Normethadone ```

Examples of expectorants/mucolytics

Senega Ammonia Guaiphenesin Bromhexine

Unexplained cough over the age of 50 is ________until proved otherwise (especially if there is a history of smoking

bronchial | carcinoma

______ is essential to exclude adequately a | suspicion of bronchial carcinoma when the chest

Bronchoscopy

Bright red haemoptysis in a young person may be | the initial symptom of_____

pulmonary TB.

The presence of _____ in the sputum renders it yellow or green (purulent) but does not necessarily imply infection

white cells

Cough Flashcards

(85 cards)