Cough

Question 1

List 3 conditions that can cause chronic cough

Answer 1

1. URTI
2. LRTI
3. Bronchi - COPD/Asthma/Brochiectasis
4. Foreign body and irritants
5. Tuberculosis
6. Pulmonary oedema
7. Interstitial lung disease
8. Pneumonia
9. ACE inhibitors induced cough
10. GORD - acid reflux

Question 2

Describe at least 3 clinical features of cough

Answer 2

1. Duration
2. Quality of cough (productive or non productive)
3. Frequency
4. Associated symptoms
5. Aggravating and alleviating symptoms
6. Change in frequency over time

Question 3

List 3 red flags when evaluating a patient presenting with cough

Answer 3

1. Haemoptysis
2. Shortness of breath (dyspnea)
3. Chest Pain
4. Fever
5. Wheezing
6. Unintentional weight loss
7. Heartburn
8. Acid/bitter taste in mouth

Question 4

Differentiate between acute and chronic cough

Answer 4

Duration:
Acute - < 3 wks
Chronic - > 8 wks

Acute: URTI/LRTI, acute pulmonary oedema (sudden onset), foreign body inspiration

Chronic: COPD, asthma, lung cancer, TB, GORD, ACEI

Question 5

Describe the physiology of cough

Answer 5

Cough reflex arc
1. Stimuli activate sensory neuronal receptors in the lungs and airways
- Afferent pathway via vagus nerve
2. Signals processed at the cough centre of the medulla to trigger the cough reflex
- Efferent pathway via vagus, phrenic and motor nerves
3. Effector muscles => cough

Question 6

What are the conditions that result in clubbing of fingers? Explain what is clubbing.

Answer 6

Clubbing: enlarged and swelled finger tips. nails become curved and rounded.

Pulmonary conditions: COPD and lung cancer

Cardiovascular: Congenital heart defects, infective endocarditis

Gastro: IBD, cirrhosis (liver disease)