Cough

Question 1

Thin and frothy sputum suggests what?

Answer 1

Left ventricular failure.

Question 2

Thick, mucoid to yellow sputum can suggest what?

Answer 2

Asthma

Question 3

Mucopurulent sputum is usually caused by what?

Answer 3

Viral infection and does not require referral.

Question 4

A cough that is worse in the morning may suggest upper airways cough syndrome, bronchiectasis of what?

Answer 4

Chronic bronchitis

Question 5

URTI cough can linger for more than 3 weeks and is termed ‘postviral cough’. However, coughs lasting longer than 3 weeks should be viewed with caution.
3 days duration = most likely URTI.
3 weeks duration = acute or chronic bronchitis.
3 months duration = ?

Answer 5

Chronic bronchitis, tuberculosis and carcinoma becomes more likely diagnosis at 3 months duration.

Question 6

What is the most likely cause of cough in the community setting?

Answer 6

Viral infection

Question 7

What is a likely cause of cough in the community setting?

Answer 7

Upper airways cough syndrome (formerly known as postnasal drip and includes allergies), acute bronchitis.

Question 8

Unlikely causes of cough in the community setting?

Answer 8

Croup, chronic bronchitis, asthma, pneumonia, ACE inhibitor induced.

Question 9

Very unlikely causes of cough in the community setting?

Answer 9

Heart failure
Bronchiectasis
Tuberculosis
Cancer
Pneumothorax
Lung abscess
Nocardiasis 
GORD

Question 10

Cough duration of longer than 14 days might indicate what?

Answer 10

Post viral cough, or possibly indicate a bacterial secondary infection, but this is clinically difficult to establish without sputum samples being analysed.

Question 11

Acute bronchitis aetiology

Answer 11

Common in autumn and winter.
Usually lasts for 7-10 days but up to 3 weeks not uncommon.
Dyspnoea and wheeze sometimes seen.

Question 12

Laryngotracheobronchitis is also known as

Answer 12

Croup.
Occurs in late evening and night, often follows an UTRI.
Infants aged 3 months and 6 years old.
The cough can be violent and bark like.
Majority of children see symptoms improve within 48 hours. Post this:
Treatment is a steriod firstline, dexamethasome liquid, dexol.

Question 13

Croup age range

Answer 13

Infants aged 3 months to 6 years old.

Question 14

Croup symptoms

Answer 14

Late evening and night cough that can be violent and bark like.

Question 15

Croup duration

Answer 15

Most children see improvement within 48 hours.

Question 16

Croup treatment

Answer 16

Steriod, oral dexamethasome.

Question 17

Patients with chronic bronchitis often present with what?

Answer 17

A long-standing history of recurrent acute bronchitis in which episodes become increasingly severe and persist for increasing duration until the cough becomes continual.

Question 18

Asthma defining symptoms

Answer 18

Coughing, wheeze, chest tightness and SoB.

Worse at night and provoked by triggers.

Question 19

Symptoms of Community acquired pneumonia

Answer 19

Non-productive cough which is painful (24-48 hours), which quickly becomes productive, with sputum being stained red. Cough tends to be worse at night and patient will be unwell, with a high fever, malaise, headache, breathlessness, and experience pleuritic pain (pain in the sides) that worsens on inspiration.

Question 20

A cough with pleuritic pain (pain in the sides) on inspiration could be

Answer 20

CAP

Question 21

A number of medicines may cause bronchoconstriction, which presents as cough or wheeze. What is the most common medicine? What about less common causes?

Answer 21

ACEi. most common.

Also NSAIDs and beta-blockers.

Question 22

Heart failure is one of the unlikely causes of cough seen in the community. What are often the first symptoms a patient will experience?

Answer 22

SoB, orthopnoea (SoB when lying flat) and dyspnoea at night.

Question 23

Bronchiectasis is another unlikely cause of cough in the community. What is it characterised?

Answer 23

Patient has a chronic cough of very long duration, which produces copious amounts of mucopurulent sputum (green-yellow in colour) that is usually foul smelling.

Cough tends to be worse in the morning and evening.

Question 24

Gastro-oesophageal reflux disease (GORD) does not usually present with cough but patients with this condition might cough when?

Answer 24

Lying down

Question 25

Persistent nocturnal cough in children suggests

Answer 25

Possible Asthma

Question 26

Based on studies, what is the only expectorant with any evidence of effectiveness?

Answer 26

Guaifenesin

Question 27

Demulcents, such as simple linctus, work on what principle?

Answer 27

Theoretical basis that they reduce irritation by coating the pharynx and so prevent coughing. There is no evidence for their efficacy and they are used mainly for their placebo effect.

Question 28

In terms of cough suppressants, what are first-line?

Answer 28

Dextromethorphan and pholcodeine.

Question 29

In 2008, the MHRA recommended what regarding the treatment of coughs and colds in children?

Answer 29

Cough and cold mixtures should not be used in children under 6 years of age, and should only be used in children aged 6-12 on the advice of a pharmacist or doctor and treatment limited to 5 days or less.

Question 30

Children aged between 6 and 12 years should take what dose of Guaifenesin at what frequency?

Answer 30

100mg four times a day

Question 31

Adults should take what dose of Guaifenesin at what frequency?

Answer 31

200mg four times daily

Question 32

Cough treatment for children aged under 6

Answer 32

Drink more fluid and potentially try a non-pharmacological cough mixture such as a demulcent.

Question 33

Routine use of antihistamines is unjustified in treating non-productive cough. However, the sedative effects from antihistamines can, on occasion, be useful to allow what?

Answer 33

The patient to have an uninterrrupted nights sleep.

Question 34

What are the likely side effects of pholcodeine?

Answer 34

Sedation possible - increased with other sedating medicines, alcohol etc.

Question 35

Who should avoid/use pholcodeine and dextromorphan with care?

Answer 35

Asthmatics

Question 36

What patients should use antihistamines (diphenhydramine) with care?

Answer 36

Glaucoma, Prostate enlargement.

Question 37

What cough medicines should be avoided in pregnancy?

Answer 37

Codiene, 3rd trimester only.