7. Cough

Question 1

What 5 questions should you ask about history of cough?

Answer 1

Constant or intermittent? Triggers?
Onset: Acute (<3 weeks) or chronic (>8 weeks)
Productive? Blood?
Time of day?
Character? Wheezy/ Bovine/ Wet

Question 2

What factors may trigger a cough?

Answer 2

Environment: smoking, occupation, pets
PMH: Asthma, GORD, HF
DHx: ACEi
Travel: TB prevalence 
Close contacts: contagious?

Question 3

What 5 associated symptoms should you ask a person with a cough?

Answer 3

FLAWS: malignancy, TB
Breathlessness
Chest pain/ pleuritic chest pain
Wheeze
Frequent throat clearing

Question 4

How can you classify causes of cough?

Answer 4

Acute/ Chronic

Productive/ Dry

Question 5

What are 4 main causes of an acute dry cough?

Answer 5

Asthma
Rhinitis
URTI
Drug induced: ACE inhibitors

Question 6

What are 3 main causes of a chronic dry cough?

Answer 6

Asthma
GORD
Post-nasal drip

Question 7

What are 3 main causes of an acute productive cough?

Answer 7

LRTI
COPD
TB

Question 8

What are 3 main causes of a chronic productive cough?

Answer 8

Bronchiectasis
TB
Lung cancer

Question 9

What signs are consistent with an infective cause of a cough?

Answer 9

Systemic features: fever, tachycardia
Resp distress
Tender cervical lymphadenopathy
Lungs: reduced chest expansion, abnormal breath sounds

Question 10

What does the CURB 65 score determine? What does it consist of?

Answer 10

Severity of pneumonia
Confusion: AMTS ,<8
Urea: >7mM
Resp rate: >30/ min
BP: <90 systolic +/or <60 diastolic
>65 years old

Question 11

What 4 signs should be checked for in a patient with known COPD and cough?

Answer 11

Barrel chest
Intercostal recession
Signs of RHF: raised JVP, peripheral oedema, parasternal heave, tricuspid regurg.
Asterixis: in some