7. Cough

Question 1

What specific questions should you ask about a cough?

Answer 1

• Onset- is it acute or chronic
• constant? suggests intrinsic cause
• intermittent? suggests extrinsic cause
• Productive?
• Blood?
• Timing?
• character
• environmental triggers
• PMH
• DH
• travel
• close contacts

Question 2

what counts as chronic and what is acute?

Answer 2

• acute as <3 weeks
• chronic as >8 weeks

Question 3

What triggers may cause a cough?

Answer 3

PATSO Pets, allergies, travel (areas where TB is prevalent), smoking, occupation

Question 4

What associated symptoms should you ask a person with a wough?

Answer 4

FLAWS- malignancy, TB Breathlessness Chest pain Wheeze

Question 5

How can you classify causes of cough?

Answer 5

Acute/ Chronic Productive/ Dry

Question 6

What are the main causes of an acute dry cough?

Answer 6

Asthma, rhinit, URTI, drug induced- ACE inhibitors

Question 7

What are the main causes of a chronic dry cough?

Answer 7

Asthma, GORD, post-nasal drip

Question 8

What are the main causes of an acute productive cough?

Answer 8

LRTI, COPD and TB

Question 9

What are the main causes of a chronic productive cough?

Answer 9

Bronchiectasis, TB, Lung cancer

Question 10

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

Answer 10

Systemic features- fever, tachycardic Resp distress Tender cervical lymphadenopathy Lungs- reduced chest expansion, abnormal breath sounds Signs of RHF- due to COPD Asterixis- CO2 retention in some COPD patients

Question 11

What is the CURB 65 score?

Answer 11

Score used to calculate the severity of pneumonia Confusion- AMTS= 8 Urea- >7mM Resp rate >30 Blood pressure <90 systolic and <60 diastolic >65 years old