Cough

Question 1

Cough is

Answer 1

an important defense
mechanism that allows the clearance of
secretions and foreign particles.

Question 2

three phases to a cough:

Answer 2

1. Deep inspiration. 2. Glottic closure and buildup of intrathoracic pressure. 3. Opening of the glottis with rapid release of pressure.

Question 3

a wide variety of stimuli can trigger the cough reflex, including:

Answer 3

• Upper respiratory tract infection • Lower respiratory tract infection • Environmental pollutants Mechanical irritation • Chemical irritation
• Chronic inflammatory states
• Drugs

Question 4

Upper Respiratory Tract Infection (generally viral)

Answer 4

• Pharyngitis • Sinusitis (via persistent nasal secretions into the pharynx—“postnasal drip”) -
• Tracheitis

Question 5

Lower Respiratory Tract Infection

Answer 5

• Bronchitis • Pneumonia • Tu b e r c u l o s i s

Question 6

Environmental Pollutants :

Answer 6

• Dust • Pollen, animal dander, and other allergens • Cigarette smoke

Question 7

Mechanical Irritation (of upper or lower respiratory tract)

Answer 7

• Tumor
• Aortic aneurysm
• Cerumen
• Pulmonary edema

Question 8

Chronic Inflammatory States

Answer 8

• Asthma
• Chronic bronchitis (chronic obstructive
pulmonary
disease [COPD])
• Chronic aspiration
• Gastroesophageal reflux disease
• Sarcoidosis

Question 9

Acute cough

Answer 9

duration <21 days, is usually related to
respiratory infection, aspiration, or inhalation of respiratory irritants.

Question 10

Subacute cough

Answer 10

(present for 3–8 weeks) is often related to persistent
inflammation from a tracheobronchitis episode.

Question 11

Chronic cough

Answer 11

(>8 weeks in duration) can be caused by many pulmonary and
cardiac diseases.

Question 12

Pharynx

Answer 12

Post-nasal drip
History of chronic rhinitis

Question 13

Larynx

Answer 13

Laryngitis, tumour, whooping cough, croup
Voice or swallowing altered,
harsh or painful cough
Paroxysms of cough,
often associated with stridor

Question 14

Trachea

Answer 14

Tracheitis
Raw retrosternal pain with cough

Question 15

Bronchi

Answer 15

-Bronchitis (acute) and chronic obstructive pulmonary
disease (COPD)
Dry or productive, worse in mornings
-Asthma
Usually dry, worse at night
-Eosinophilic bronchitis
Features similar to asthma but airway hyper-reactivity
absent
-Lung cancer
Persistent (often with haemoptysis)

Question 16

Lung parenchyma

Answer 16

-Tuberculosis
Productive (often with haemoptysis)
-Pneumonia
Dry initially, productive later
-Bronchiectasis
Productive, changes in posture induce sputum
production
-Pulmonary oedema
Often at night (may be productive of pink, frothy sputum)
-Interstitial fibrosis
Dry and distressing

Question 17

important historical features

Answer 17

• Is the cough acute (less than 3 weeks in duration) or chronic?
• Does the patient smoke, and if so, is there any history of obstructive airway
disease?
• Is there sputum production? (If so, what color is it? Is there any blood?)
• Are there any environmental exposures (e.g., dust, fumes, animal dander)?
• Are there any associated constitutional symptoms (e.g., fever, weight loss)?

Question 18

“red-flag” symptoms

Answer 18

hemoptysis
weight loss

Question 19

physical examination

Answer 19

• Sinus tenderness (sinusitis)
• Conjunctival injection, rhinitis (upper respiratory infection [URI])
• Tympanic membrane erythema (otitis)
• Oropharyngeal “cobblestoning” (chronic sinusitis)
• Loose rhonchi (infection, i.e., bronchitis or pneumonia)
• Consolidation (pneumonia)
• Fine crackles (pulmonary edema)
• Focal wheezing (local obstructing lesion, i.e., tumor or foreign body)
• End-expiratory wheezing (obstructive airways disease, i.e., asthma/COPD)

Question 20

dry, irritant, nonproductive cough

Answer 20

secondary to ACE inhibitors

Question 21

productive early morning cough

Answer 21

chronic bronchitis

Question 22

radiography can reveal

Answer 22

infiltrate, mass, or pulmonary edema

Question 23

A clear chest radiograph

Answer 23

tracheobronchitis,
asthma, or environmental exposure

Question 24

Purulent sputum

Answer 24

many white blood cells suggests bronchitis or
pneumonia

Question 25

Pulmonary function testing

Answer 25

may reveal chronic obstruction or reactive
airways disease.

Question 26

Computed tomography

Answer 26

may reveal anatomic lesions such
as extrinsic compression, bronchiectasis, or parenchymal masses

Question 27

Purified protein derivative testing

Answer 27

is indicated if tuberculosis is
suspected

Question 28

Antitussives suppress the cough reflex

Answer 28

either by anesthetizing
the peripheral irritant receptors or increasing the threshold of
the central cough center

Question 29

Peripheral anesthetics include

Answer 29

• Benzonatate
• Phenol preparations
• Menthol preparations