Cough Flashcards
Describe the timescales of acute and chronic coughs.
Acute - < 3 weeks
Chronic - > 8 weeks
List some other key features of the history of presenting complaint.
Acute or chronic Constant or intermittent Productive or dry Blood Timing Character
Why is it important to ascertain whether the cough is constant or intermittent?
Constant – suggests intrinsic pathology
Intermittent – suggests that there may be an exogenous trigger
Describe the typical appearance of the sputum in:
COPD
Infection
Bronchiectasis/lung abscess
- COPD White or clear - Infection Yellow or green - Bronchiectasis/Lung Abscess Large volumes of purulent sputum that is green or rusty
List diseases that can cause the following patterns of blood in the sputum:
Blood-streaked sputum
Pink, frothy sputum
Frank blood
- Blood-streaked sputum Infection (e.g. atypical pneumonia – Klebsiella pneumonia) Bronchiectasis - Pink, frothy sputum Pulmonary oedema - Frank blood TB Lung cancer PE Rare disease (e.g. Wegner’s granulomatosis, Goodpasture’s syndrome)
List some diseases that cause cough that is worse at night.
Asthma
GORD
Pulmonary oedema
What do the following types of cough indicate: Wheezy cough Bovine cough Dry cough Gurgling/wet cough Whooping cough
- Wheezy cough Airway obstruction due to asthma or COPD - Bovine cough Due to vocal cord paralysis (left recurrent laryngeal nerve) usually due to a Pancoast lung tumour - Dry cough Bronchitis Interstitial lung disease - Gurgling/Wet cough Bronchiectasis - Whooping cough Infection caused by Bordatella pertussis
List some common environmental triggers of cough that you should ask the patient about.
Smoking
Occupation
Pets
Change in house/office
List some significant features of the past medical history in a patient presenting with cough.
Asthma GORD Rhinitis/sinusitis Heart failure Recent chest infection
Which drug is commonly associated with causing cough?
ACE inhibitors
Why is it important to ask about the patient’s travel history?
Consider TB-endemic regions (e.g. South-East asia)
What important detail in the history may increase the likelihood of an infectious cause to the cough?
Close contact with others with cough
List some key symptoms that are associated with diseases that cause cough. Include the diseases that they are associated with in your answer.
- Fevers, night sweats, weight loss Malignancy, TB - Breathlessness Asthma, COPD, pneumonia, pulmonary oedema - Chest pain (pleuritic) Pneumonia, pneumothorax, PE, pleurisy - Wheeze COPD, asthma, other airway obstruction
List some causes of: Acute dry cough Acute productive cough Chronic dry cough Chronic productive cough
- Acute Dry Cough Asthma Rhinitis/sinusitis with post-nasal drip Upper respiratory tract infection Drug-induced - Acute Productive Cough Lower respiratory tract infection COPD TB - Chronic Dry Cough Asthma GORD Post-nasal drip Smoking Lung cancer - Chronic Productive Cough Bronchiectasis TB Lung cancer
List some signs of respiratory distress on physical examination.
High rest rate
Use of accessory muscles
Peripheral cyanosis
Confusion
What might tender cervical lymphadenopathy suggest?
Upper respiratory tract infection
List some features of COPD that can be found on examination.
Chest wall deformity (e.g. barrel chest)
Intercostal recession
Signs of right heart failure (peripheral oedema, raised JVP, parasternal heave, tricuspid regurgitation)
Asterixis
List some blood tests that may be useful in a patient with cough.
ABG – assess progression towards respiratory falure
FBC – signs of infection (high WCC)
CRP
U&Es – check dehydration, urea is a useful way of gaging severity of pneumonia
Blood cultures
Why might you perform an ECG in a patient with a cough?
AF can occur secondary to pneumonia
Check for signs of right heart strain
Which pathogens that cause pneumonia produce antigens that can be detected in the urine?
Streptococcus pneumoniae
Legionella pneumophila
Why are sputum cultures rarely useful?
They are often contaminated by commensal bacteria
Which scoring system is used to assess the severity of pneumonia?
CURB-65
What are the different components of CURB-65?
Confusion Urea Respiratory rate Blood pressure 65+ yrs old
List some complications of pneumonia.
Pleural effusion
Empyema
Abscess
Septicaemia
What are the three most common causes of a chronic cough in non-smokers?
Asthma
GORD
Post-nasal drip
Why shouldn’t you give 100% oxygen to patients with COPD?
It diminishes the hypoxic drive to breathe – this results in the patient becoming very hypercapnic
It also diminishes hypoxic vasoconstriction leading to VQ mismatch
