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Cough: Pearls

by Carlo Raj, MD
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    00:00 time is right.

    00:02 Clinical pearls that you must know. Rust. What does this mean to you? Good, blood-tinged.

    00:08 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.

    00:35 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 such bacteria.

    00:50 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.

    01:32 Cough with exertion, exercise induced asthma. So, this would be the intrinsic type of asthma.

    01:37 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.

    02:00 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.

    02:11 You dare not say sympathetic, right? So, you’re telling me parasympathetic.

    02:17 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.

    02:33 Hacking, high-pitched cough, this is bordetella. In other words, this is your whooping cough.

    02:40 Whooop…cough, alright? So, this your hacking, high-pitched cough.

    02:44 Bordetella pertussis, seen after the acute infection.

    02:50 Then you have mycobacterium avium intracellulare, MAI. Who’s your patient here? Immunocompromised.

    02:57 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.


    About the Lecture

    The lecture Cough: Pearls by Carlo Raj, MD is from the course Introduction to Pulmonary Pathology.


    Included Quiz Questions

    1. S. pneumoniae
    2. S. aureus
    3. M. pneumoniae
    4. B. pertusis
    5. S. aeruginosa
    1. Aspiration pneumonia
    2. Poor dental hygiene
    3. S. pneumoniae
    4. Smoking
    5. B. pertusis
    1. B. pertusis infection
    2. Aspiration
    3. COPD
    4. Infection induced asthma
    5. MAI infection

    Author of lecture Cough: Pearls

     Carlo Raj, MD

    Carlo Raj, MD


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