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 (cough)
- 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
- Cold
- Exercise
- worsening in spring/summer
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
- Asthma
- Rhinitis/sinusitis with post-nasal drip
- Upper respiratory tract infection
- Drug-induced
List some causes of: Acute productive cough
- Lower respiratory tract infection
- COPD
- TB
List some causes of: Chronic dry cough
- Asthma
- GORD
- Post-nasal drip
- Smoking
- Lung cancer
List some causes of: Chronic productive cough
- Bronchiectasis
- TB
- Lung cancer
List some signs of respiratory distress on physical examination.
- High resp rate
- Use of accessory muscles
- Difficulty competing sentences
- 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. hyperexpansion, 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?
- To rule out AF +ischaemia which 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 (AMTS <8/10)
- Urea >7mM
- Respiratory rate >30/min
- Blood pressure <90SBP and/or <60 DBP
- 65+ yrs old
Which antibiotics are commonly given to patients with CAP and HAP pneumonia and why?
- CAP:
- Amoxicillin
- Clarithromycin: Atypical mycoplasma (legionella)
- HAP:
- Metronidazole: anaerobes- HAP is often caused by gastric aspiration due to ineffective swallow/ post-op
List some complications of pneumonia.
- Pleural effusion
- Empyema
- Abscess
- Septicaemia
- If with COPD- could get burst of bullae –> pneumothorax like symptoms
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? Therefore which masks are used to administer O2?
It diminishes the hypoxic drive to breathe – this results in the patient becoming very hypercapnic It also diminishes hypoxic vasoconstriction leading to VQ mismatch
Venturi mask used instead
