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.