Cough Flashcards
Open questions to ask about cough
Acute/chronic Constant/intermittent Productive/dry Blood Time of coughing
Directed questions about cough
Smoking Asthma Allergies Recent rhinitis/sinusitis GORD Drug history Travel
Factors associated with cough to suggest possible cause
Constitutional changes (fever, night sweats, weight loss)
Breathlessness
Chest pain
Wheeze
Acute vs chronic cough definition
Acute <3 weeks
Chronic >8 weeks
What does presence of sputum indicate
Inflammation and/or infection
Describe the sputum in COPD patients
White or clear sputum
When is green or rusty sputum seen?
Bronchiectasis
Lung abscess
When is asthma worst?
Nighttime
5 types of coughs and associated pathology
Wheezy - Airway obstruction Bovine - Vocal cord paralysis Dry - Pulmonary fibrosis Gurgling - Bronchiectasis Whooping - Pertussis infection
What type of chest pain is notable in cough?
Pleuritic chest pain
Causes of dry acute cough
Major:
Asthma
Rhinitis/sinusitis with post-nasal drip
Upper respiratory tract infection
Minor: Drug induced Smoke/toxin inhalation Inhaled foreign body Lung cancer Pulmonary oedema
Causes of productive acute cough
Major:
Lower respiratory tract infection
COPD
Minor:
TB
Causes of chronic dry cough
Major:
Asthma
GORD
Post-nasal drip
Minor: Smoking Lung cancer Drug indued COPD Pulmonary oedema Non-asthmatic eosinophilic bronchitis Psychogenic
Causes of chronic productive cough
Chronic bronchitis
Bronchiectasis
TB
Lung cancer
Congenital: CF, Kartagener’s syndrome
Main signs to look for on physical examination suggesting infection
Systemic features
Respiratory distress
Tender cervical lymphadenopathy
Lung characterisatics
Systemic features to look for on physical examination of cough
Fever
Sweats
Tachycardia
Respiratory distress features to look for on physical examination of cough
Respiratory rate
Breathing difficulties
Cyanosis
Confusion
In a patient with cough, what would tender cervical lymphadenopathy suggest?
Upper respiratory tract infection
What does a vocal resonance examination differentiate
Consolidation (increased resonance) and effusion (reduced resonance)
What physical exam differentiates lung consolidation and effusion
Vocal resonance
Notable signs in patients with cough and COPD history
Chest wall deformities
Intercostal recession
Signs of right heart failure
Asterixis
Intercostal recession is a sign of…
Severe COPD
List signs of right heart failure
Peripheral oedema Raised JVP Parasternal heave Loud or palpable P2 heart sound Tricuspid regurgitation
Main investigations for coughing
Blood tests
Imaging
