Cough Flashcards
Differences between the common cold and influenza
Incubation period - cold = 12hrs to 5 days, influenza is 1-3days
Fever- +/- in cold but >38 in influenza
Cough - develops later in common cold compared with influenza
Sore throat - more so in cold than influenza
Rhinitis/sneezing/rhinorrhoea - in cold not influenza
Muscle aches - influenza not colds
Toxaemia - only may develop in influenza
Causes - COmmon cold (rhinovirus common, parainfluenza, influenza B,C, Coronavirus, RSV.) Influenza A and B.
population susceptible to influenza
Aged, young, pregnant, immunosupsed, diabetes, chronic disease
Incubation and contagious periods for influenza
incubation 1-3 days
Contagious = 24hr prior to symptoms and 7 days after
Progression of influenza
acute onset of fever, headache, shivering, generalised muscle aching
Clinical criteria for influenza in an epidemic
High fever >38 + 1 respiratory symptom and 1 systemic symptoms dry cough sore throat coryza prostration or weakness myalgia headache rigors or chills
Presentation of influenza in children
abdominal pain and diarrhoea or rash
Complication of influenza
Secondary bacterial infection
Pneumonia due to staphylococcus aureus
Encephalomyelitis - rare
Depression - common
Mx of influenza
Advice
bed rest until fever gone
analgesics - paracetamol adn aspirin
Fluids - maintain high intake
House arrest/isolation - from before start of symptoms to symptoms finish. Contacts as well
Anti viral agents if inidicated eg severe
Neuraminidase inhibitors within 36 hours of onset and given for 5 days
Prevention - Flu shot.
Causes of Haemoptysis
Red flags and requires investigation Common Causes Acute infection - URTI 24%, Acute or chronic bronchitis 17% - commonest Bronchiectasis 13% TB Uncommon - cancer Lobar pneumia pulmonary infarction, PE FB Cardiac - LVHR, Mitral stenosis anticoagulant therapy Rare causes goodpasture syndrome blood disorders trauma
Causes of productive cough
bronchiectasis - massive pus, chronic, hx of pneumonia
COPD - FEV/FCV
pneumonia
FB
Lung cancer - haemoptysis, slow progressive cough
TB - haemoptysis
Lung abscess
Chronic bronchitis - Chronic cough for 3 month out of 12 over 2 years
Asthma - especially at night
Causes of non productive cough
ACE inhbitor non Asthmas? post infectious cough Lung cancer intersitial fibrosis Sarcoidiosis hyper sensitive pneumonitis bronchiolitis: inspiratory wheeze and consolidation, really young kids Psycogenetic cough Morning cough - Smokers
Cause of cough + wheeze in children
URTI - most common Croup Pneumonia Bronchiolitis Heart failure acute asthma tuberculosis viral induced wheeze whooping cough Inhaled Foreign body
Presentation of URTI
Coryza, breathlessness, cough, wheeze, or noisy breathing
Presentation of croup
barking cough and stridor
Presention of pneumonia in child
Fever, cough, respiratory distress, chest or abdominal pain, Intercostal recession, crackles and signs of consolidation
Presentation of bronchiolitis
Yellow flag -
Presentation of acute asthma in child
Yellow flag - Known asthmatic, Hx of atopy, wheeze, cough
Presentation of tuberculosis in child
Red flag - Contact with TB, not immunised with BCG, haemoptysis, night sweats.
Presentation of viral induced wheeze in child
wheeze with URTI, some progress to asthma, may respond to bronchodilators
Presentation of inhaled foreign body
toddlers, Hx of choking, unilateral wheeze, sudden onset
Cause of cough in child without breathlessness
Gastro-oesophogeal reflux Post nasal drip - commonest causes of persistent cough Trachea-Oesophageal fistula Passive smoking Cystic fibrosis
Cause of chronic cough in first few months of life
Milk inhalation/reflux
Asthma
Causes of chronic cough in toddler/preschool child
Asthma, Bronchitis whooping cough Cystic fibrosis Croup FB inhalation Tuberculosis Bronchiectasis
Causes of chronic cough in early school years
Asthma
Bronchitis
Mycoplasma pneumonia
Causes of chronic cough in adolescence
Asthma
Psychogenic
smoking
Red flags to look out for in a presentation of cough
Age >50yr smoking Hx Asbestos hisotry exposure Persistent cough Overseas travel TB exposure Haemoptysis Unexplained wt loss Dyspnoea
Probabillty diagnosis in a cough presentation
URTI or acute bronchitis or persistent coughing with URTI due to sinusitis with postnasal drip. or chronic bronchitis. smoking
Serious disorders not to be missed in a presentation of cough
Bronchial carcinoma (P/C worsening cough or bovine cough), pneumocystis jiroveci in HIV pt, foreign body. Asthma in childern (PC noctnatal cough without wheeze). LV Heart failure, cystic fibrosis, pneumothorax
Pitfalls to look out for in diagnosing cough
Atypical pneumonias GORD - night cough Smoking Bronchiectasis Whooping cough Interstitial lung disorders Sarcoidosis
Masquerades to consider in cough
Drugs
IS the pt trying to tell me something with this cough presentation
Anxiety and habit
Thing to ask about in a cough history
Duration Character Pattern/timing sputum production, volume, colour, smell, blood Associated symptoms - chest pain, fever, SOB, Abdo pain, meals, wheezing, Features of infection Feature of cancer Sick contacts Travel or occupation exposture PmHx - Asthma, heart disease Medication FMHx- asthma, cystic fibrosis, TB SoHx - pets, smokers,
Thing to look for when examining a pt with cough
GI
Respiratory distress - grunting, nasal flaring, intercostal recession, tachypnoea, speaking in full sentences
Addition noise - wheeze, stridor, cough
Cyanosis,
Horner syndrome - constricted pupil, ptosis
Vitals - tachypnoea, fever
Resp
Signs of consolidation - reduced AE, crackles, bronchial breathing, dullness on percussion and reduced expansion
Lymphodenopathy in the neck.
Sputum - colour, consistency, presence of particular matter
CVS
signs of congenital heart disease - ??
Peripheral
signs of chronic respiratory condition - finger clubbing, chest deformity
Signs and symptoms of acute Bronchitis
cough and sputum are the main symptoms
wheeze and dyspnoea
scattered wheeze on auscultation
+/- fever or haemoptysis(uncommon)
