7. Cough Flashcards
Describe the timescales of acute and chronic coughs.
Acute - < 3 weeks
Chronic - > 8 weeks
List some other key features of the history of presenting complaint.
Acute or chronic Constant or intermittent Productive or dry Blood Timing Character
Why is it important to ascertain whether the cough is constant or intermittent?
Constant – suggests intrinsic pathology
Intermittent – suggests that there may be an exogenous trigger
Describe the typical appearance of the sputum in:
COPD, infection and bronchiectasis/lung abscess
COPD - White or clear
Infection - Yellow or green
Bronchiectasis/Lung Abscess - Large volumes of purulent sputum that is green or rusty
List diseases that can cause blood-streaked sputum
Infection (e.g. atypical pneumonia – Klebsiella pneumonia)
Bronchiectasis
Name a disease that can cause pink, frothy sputum
Pulmonary oedema
Name a disease that can cause frank blood
TB
Lung cancer
PE
Rare disease (e.g. Wegner’s granulomatosis, Goodpasture’s syndrome)
List some diseases that cause cough that is worse at night
Asthma
GORD
Pulmonary oedema
What does a wheezy cough indicate
Airway obstruction due to asthma or COPD
What does a bovine cough indicate
Due to vocal cord paralysis (left recurrent laryngeal nerve) usually due to a Pancoast lung tumour
What does a dry cough indicate
Bronchitis
Interstitial lung disease
What does a gurgling/wet cough indicate
Bronchiectasis
What does a whooping cough indicate
Infection caused by Bordatella pertussis
List some common environmental triggers of cough that you should ask the patient about.
Smoking
Occupation
Pets
Change in house/office
List some significant features of the past medical history in a patient presenting with cough.
Asthma GORD Rhinitis/sinusitis Heart failure Recent chest infection
Which drug is commonly associated with causing cough?
ACE inhibitors
Why is it important to ask about the patient’s travel history?
Consider TB-endemic regions (e.g. South-East asia)
What important detail in the history may increase the likelihood of an infectious cause to the cough?
Close contact with others with cough
List some key symptoms that are associated with diseases that cause cough. Include the diseases that they are associated with in your answer.
Fevers, night sweats, weight loss -> Malignancy, TB
Breathlessness -> Asthma, COPD, pneumonia, pulmonary oedema
Chest pain (pleuritic) -> Pneumonia, pneumothorax, PE, pleurisy
Wheeze - COPD, asthma, other airway obstruction
List some causes of an acute dry cough
Asthma
Rhinitis/sinusitis with post-nasal drip
Upper respiratory tract infection
Drug-induced
List some causes of an acute productive cough
Lower respiratory tract infection
COPD
TB
List some causes of a chronic dry cough
Asthma GORD Post-nasal drip Smoking Lung cancer
List some causes of a chronic productive cough
Bronchiectasis
TB
Lung cancer
List some signs of respiratory distress on physical examination.
High rest rate
Use of accessory muscles
Peripheral cyanosis
Confusion
What might tender cervical lymphadenopathy suggest?
Upper respiratory tract infection
List some features of COPD that can be found on examination.
Chest wall deformity (e.g. barrel chest)
Intercostal recession
Signs of right heart failure (peripheral oedema, raised JVP, parasternal heave, tricuspid regurgitation)
Asterixis
List some blood tests that may be useful in a patient with cough.
ABG – assess progression towards respiratory falure
FBC – signs of infection (high WCC)
CRP
U&Es – check dehydration, urea is a useful way of gaging severity of pneumonia
Blood cultures
Why might you perform an ECG in a patient with a cough?
AF can occur secondary to pneumonia
Check for signs of right heart strain
Which pathogens that cause pneumonia produce antigens that can be detected in the urine?
Streptococcus pneumoniae
Legionella pneumophila
Why are sputum cultures rarely useful?
They are often contaminated by commensal bacteria
Which scoring system is used to assess the severity of pneumonia?
CURB-65
What are the different components of CURB-65?
Confusion Urea Respiratory rate Blood pressure 65+ yrs old
List some complications of pneumonia.
Pleural effusion
Empyema
Abscess
Septicaemia
What are the three most common causes of a chronic cough in non-smokers?
Asthma
GORD
Post-nasal drip
Why shouldn’t you give 100% oxygen to patients with COPD?
It diminishes the hypoxic drive to breathe – this results in the patient becoming very hypercapnic
It also diminishes hypoxic vasoconstriction leading to VQ mismatch
