Cough H&P (green/cyan)
Most common cause of acute cough (less than 3 weeks)
Viral respiratory tract infection
This initial imaging study should be ordered for pts with acute cough and abnormal vital signs (fever, tachypnea, or tachycardia)
Chest X Ray
Diagnosis to suspect in a patient with dyspnea who reports recent Hx of prolonged immobilization, surgery, estrogen therapy, etc.
Pulmonary embolism
Blood levels of this peptide can assist in the diagnosis of heart failure
NT-proBNP (N-terminal pro B-type natriuretic peptide)
Originally isolated in the brain of a pig, this peptide used to be and still sometimes is referred to as "brain natriuretic peptide", although it originates from the heart
You might suspect this condition in a patient with persistent or severe cough lasting longer than 3 weeks who has not been adequately boosted with Tdap
Pertussis
Time period when oseltamivir (tamiflu) or zanamirvir are recommended
within 30-48hrs of symptom onset; or regardless of onset if symptoms are severe, complicated, or progressive in pts requiring hospitalization (reduce symptom course by 1 day; may cause GI upset)
Dx to suspect in thin, young man with chest pain, dyspnea, and absent breath sounds
spontaneous pneumothorax
Name some clinical decision rules/scores for ruling out acute PE (at least 2 of 4)
PERC (pulmonary Embolism Rule-out Criteria)
Wells score
Revised Geneva scores
YEARS algorithm
A negative match test (testing the lack of ability to blow out a match at 25cm) and laryngeal height greater than 4cm substantially decrease the likelihood of this disease.
COPD
What treatment to give for pertussis
Macrolide antibiotic; reduces organism shedding and transmission
If given later than 7-10 days in the course of symptoms, antibiotic treatment does not affect duration of cough, which may last up to 6 months
Most common causes of dyspnea associated with wheezing (4)
acute bronchitis (most common), asthma, foreign body, vocal fold dysfunction
What oxygen saturation would you expect in a patient with carbon monoxide toxicity?
Normal. Oxyhemoglobin and carboxyhemoglobin produce similar wavelengths of light.
This clinical symptom is specific but not sensitive for COVID-19
Loss of smell/taste
You should order this kind of test when you suspect pertussis
PCR testing on a nasopharyngeal swab or nasal wash; note that the ability to detect pertussis decreases as the duration of the cough increases
UTD : Clinical diagnosis is cough >= 2 weeks plus 1 other characteristic symptom or an exposure to pertussis
Dx to suspect in pt with jugular venous distention, bibasilar crackles, third heart sound, lower extremity edema
Heart failure
Diagnosis to suspect in pt with profound lactic acidosis following exposure to burning vinyl
Cyanide poisoning
Most common causes of chronic cough in absence of ACE inhibitor use, acute respiratory tract infection, or chest radiographic abnormalities (3 of them)
Post nasal drip, (cough variant) asthma, GERD
Most effective treatment for chronic cough secondary to gastroesophageal reflux
lifestyle modifications and weight reduction
PPIs are not effectigve when used in isolation for treating chronic cough secondary to GERD
How do you measure maximum laryngeal height; and what does a small height signify
distance between the top of the thyroid carilage and suprasternal notch during end of expiration
a small height signifies hyperinflation
Diagnosis to suspect in pt with O2 sat of about 85% that does not increase with supplemental oxygen
Methemoglobinemia
Through the computus paschalis (latin for Easter Computation)
The first Sunday after the Paschal full moon, a mathimatical approximation of the first full moon on or after March 21st
March 21st is an approximation of the March equinox