Clinical pearls that you must know. Rust.
What does this mean to you? Good, blood-tinged.
So, when you say blood-tinge, it means that
with enough cough, then you might be causing
damage to the respiratory tree. You’re thinking
about, well, even to this day, we have streptococcus
pneumonia being very common in two ends of
spectrum of age. We have elderly, they’re
susceptible and the young, they’re susceptible
to streptococcus pneumonia. Hence, Pneumovax
and it’s a vaccine, is therefore,
given priority to these two populations. We’ll
talk more about this later as well.
If your patient is in a state of splenic compromise,
because you know the streptococcus pneumonia
is an encapsulated organism that you have
to make sure that you vaccinate yourself against
Foul smelling, aspiration pneumonia; daily
morning cough, chronic bronchitis. Remember
our definition once again, how long would
you have this cough consecutively, 3 months
of what kind of cough? Productive. And for
how many years? 2 years. Now, the definition
over and over again, at some point, you will
be presented, and that the way the presentation
of it would be maybe perhaps your patient
comes in and says, “I’ve been coughing,
doc”. “Okay for how long?” “Maybe
perhaps about a couple months.” You
know what I mean? They’re not going to say
exactly 3. “And how long has it been going
on?” “I don’t know, it seems like a
long time”. So, from
the patient’s point of view, it would be
rather vague, but you have to put all these
together in terms of a pattern. Move on.
Cough with exertion, exercise induced asthma.
So, this would be the intrinsic type of asthma.
So, let’s kind of branch these into two
divisions. Asthma-atopic, what does that
mean to you? You’ve heard of atopic type
of dermatitis, haven’t you? What happened?
Patient got exposed to allergens. This is
atopic asthma and often times eczema and
atopic asthma will go together. If it’s
exercise induced, this is more of your
intrinsic adult. Interesting.
If it is exercising, what kind of branch?
You tell me this, what kind of branch? Your
autonomic nervous system is then responsible
for bronchoconstriction? Bronchoconstriction.
You dare not say sympathetic, right? So, you’re
telling me parasympathetic.
Is it possible that doing exercise that you
might be releasing parasympathetic? Sure,
you are. It’s all about balance. So, if
there’s something in there in terms of theories,
then the theory that you want to keep in mind
is maybe there is excess parasympathetic activity
in these populations on the bronchi. Cough
with exertions, CHF.
Hacking, high-pitched cough, this is bordetella.
In other words, this is your whooping cough.
So, this your hacking, high-pitched cough.
Bordetella pertussis, seen after the acute
Then you have mycobacterium avium intracellulare,
MAI. Who’s your patient here? Immunocompromised.
Your CD4 count in an HIV patient. Oh boy,
might be as low as 50, quite low. So, mycobacterium
avium intracellulare, this is more of your
suppressed type of cough. Descriptions that
are important: associations, diseases, infections.