3.7.2. Clinical Reasoning Cough Flashcards
3 most common causes of chronic cough
Post nasal drip = 60% of the time
Asthma
GERD
What should your pathway be for a patient with a post nasal drip causing cough?
post nasal drip (this 60% of the time): attempt to identify allergies. 1st generation antihistamines (such as brompheniramine and pseudoephedrine) help as well as nasal steroids.
If patient does not respond to antihistamine, consider sinus imaging
What should your pathway be for a patient with asthma causing cough?
Asthma? This should always be considered as a potential etiology.
Initially treat with bronchodilators and corticosteroids.
B2 agonists - Albuterol, salmeterol, formoterol
Corticosteroids - Beclomethasone, fluticasone
What should your pathway be for a patient with GERD causing cough?
GERD: proton pump inhibitor, antireflux treatment, and address lifestyle such as certain foods.
Always include GERD in differential if GI complaints and aspiration syndromes are present.
Barium esophagography is the test of choice to reveal GERD as the culprit
Analyze the classifications of cough
Cough classified as either acute or chronic. Acute is further classified as infectious and post-infectious. Infectious is usually the only one you have to treat. Chronic lasts for more than 6-8 weeks and can require more evaluation.
Discuss the “empiric” approach to diagnosis and treatment.
Identify history. Are they a smoker? help them quit. What meds are they on? ACE inhibitors “prils”? If so, try ARB’s or another substitute.
Get a chest x-ray
pulmonary function test esp. asthma or COPD
patient can have more than one reason for a cough. The diagnosis can take months
What causes hemoptysis typically?
hemoptysis is usually an infectious etiology like bronchitis
Empiric approach for a severe hemoptysis
severe hemoptysis will get admitted to ICU. Bad lung is down to avoid filling good lung.
Thoracotomy (chest surgery) to take out bad part of lung.
Embolize bronchial artery with a catheter.
Empiric approach for normal hemoptysis
many times it goes away on its own. antibiotics can cure
Get chest x-ray.
If not bronchitis by history, get CT. 5% there is a lesion if CT is normal.
over 40 y.o., smoker, or wheezing over one part of lung, do bronchoscopy
Someone with a non productive cough but is on an ACE inhibitor after a mini stroke. What is something you should be thinking about?
ACE inhibitor is the culprit. Switch to ARB. If FVC low, restrictive lung disease.
Family history of a “big vesel” and presenting with hemoptysis, not hematemesis.
What could this be?
pulmonary arterial-venous malformation (abnormal connection between pulmonary artery and vein)
What is associated with pulmonary arterial-venous malformation (abnormal connection between pulmonary artery and vein)?
90% associated with HHT (hereditary hemorrhagic telangiectasia (lesions on lips))
What would a sarcoidosis CXR reveal? What also has similar findings and how do you distinguish them?
sarcoidosis. chest x ray would show bilateral hilar adenopathy. Could be lymphoma so confirm with bronchoscopy or biopsy.
