Cough: Pearls

by Carlo Raj, MD

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    00:01 Clinical pearls that you must know.

    00:03 Rust. What does this mean to you? Good. Blood tinged.

    00:09 So when you say blood tinged it means that with enough cough, then you might be causing damage to the respiratory tree.

    00:13 You're thinking about, well, even to this day, we have Streptococcus pneumoniae being very common, and two ends of the spectrum of age.

    00:21 We have elderly, they're susceptible; and young, they're susceptible to streptococcus pneumonia.

    00:26 Hence, Pneumovax, and it's a vaccine is therefore, given priority to these two populations.

    00:33 We'll talk more about this later as well.

    00:36 If your patient is in a state of splenic compromise, because you know, the Streptococcus pneumoniae is an encapsulated organism, that you have to make sure that you vaccinate yourself against such bacteria.

    00:50 Foul smelling, aspiration pneumonia.

    00:53 Daily morning cough, chronic bronchitis.

    00:57 Remember our definition, once again, how long would you have this cough consecutively? Three months, of what kind of cough? Productive.

    01:04 And for how many years? Two years.

    01:06 Now, the definition over and over again, at some point you will be presented.

    01:10 And 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 gonna say exactly three.

    01:22 And how long has it been going on? I don't know. It seems like a long time.

    01:25 So, from the patient's point of view, it'd be rather vague, but you have to put all this together in terms of a pattern.

    01:31 Move on. Cough with exertion, exercise induced asthma.

    01:35 So this would be the intrinsic type of asthma.

    01:37 So let's go ahead and branch this into two divisions.

    01:40 Asthma, atopic. What does that mean? You've heard of atopic topic dermatitis, haven't you? What happened? Patient got exposed to allergens.

    01:49 This is atopic asthma.

    01:51 And oftentimes, eczema and atopic asthma will go together.

    01:54 If it's exercise induced, this is more of your intrinsic adult, interesting.

    02:00 If it is exercise, and what kind of branch? You tell me this, what kind of branch your autonomic nervous system is then responsible for bronchoconstriction.

    02:10 Bronchoconstriction.

    02:12 You dare not say sympathetic, right? So you're telling me parasympathetic.

    02:16 Is it possible that doing exercise that you might be releasing parasympathetic? Sure, you are.

    02:20 Talk all about balance.

    02:22 So, if there's something in there in terms of theories, and the theory that you want to keep in mind is maybe there's excess parasympathetic activity in these populations on the bronchi.

    02:32 Cough with exertion, CHF.

    02:33 Hacking, high pitched cough.

    02:36 This is Bordetella. Another word, this is your whooping cough.

    02:40 (whooping cough) Alright.

    02:43 So does he hacking, high pitched cough? Bordetella pertussis. See enough for the acute infection.

    02:49 And then you have mycobacterium avium, intracellular, MAI.

    02:56 Who is your patient here? Immunocompromised, your CD4 count, and an HIV patient.

    03:00 Oh boy, might be as low as 50. Quite low.

    03:04 So mycobacterium avium intercellular, this is more of your suppressed type of cough.

    03:10 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. Streptococcus pneumoniae
    2. Staphylococcus aureus
    3. Mycoplasma pneumoniae
    4. Bordetella pertussis
    5. Streptococcus pyogenes
    1. Foul-smelling sputum
    2. Daily morning cough
    3. Whooping cough
    4. Cough with exertion
    5. Suppressed cough
    1. Bordetella pertussis, after acute infection
    2. Bordetella pertussis, after chronic infection
    3. Bordetella pertussis, on day 1
    4. Bordetella pertussis, on day 2

    Author of lecture Cough: Pearls

     Carlo Raj, MD

    Carlo Raj, MD

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    very concise and valuable pearls for the exams and beyond
    By Joseph Sanal P. on 06. February 2020 for Cough: Pearls

    very concise and valuable pearls for the exams and beyond