Cough Flashcards
Timeframe
Onset- when did you first notice the cough
Progression- has it changed recently
Timing- is it there all the time/ worse at any point in the day/ vary with seasons or weather
Triggers- does anything set it off
Relevant systems review
FWAR
Cardiorespiratory- sputum (normal for you), haemoptysis, chest pain (if yes do SOCRATES), palpitations, SOB (quantify exercise tolerance), wheeze, leg swelling
GI- do you suffer from heart burn (can irritate the vocal cords)
Anyone else in the house unwell?
Pneumonia
Acute productive cough
Associated sob/ pleuritic chest pain/ haemoptysis/ wheeze
Systemic Sx eg. Fever
Often a background of respiratory disease (COPD/ bronchiectasis)
NB- consider whether it could be the first presentation of HIV eg. PJP
Asthma
Nocturnal cough Intermittent wheeze SOB Diurnal variation Exacerbating factors Background of atopy eg. Eczema or hay fever
Post nasal drip
Chronic sinusitis
Short history of a cough with a recent URTI but otherwise well
Runny nose, congestion, sore throat, sinusitis and throat clearing
COPD
Chronic productive cough and wheeze
Chronic SOB (usually within a week of starting therapy)
Progressive disability
Significant smoking history
Others
GORD
ACE inhibitor
IPF
Bronchiectasis
Lung tumour
Haemoptysis
Weight loss
Signifcant smoking history
Paraneoplastic syndromes (small cell lung cancer)
Recurrent chest infections/ chest discomfort
Occupation/ lifestyle
Exposure to asbestos or other chemicals
Do you or anybody that you live with smoke
GORD
Overweight person with retrosternal burning pain worse on lying flat
Acid brash, with regurgitation of sour material after eating a large meal
Hoarse voice and periodic clearing of throat
Bronchiectasis
Precipitated by recurrent infections or a particularly bad infection
Produce a large amount of sputum per day (cup fills)
Haemoptysis or brethlessness may be seen
CF associated with bronchiectasis
COVID19
COVID is now a differential for anyone who presents with a cough
Ask about vaccines, loss of sense of taste and smell
May see COVID pneumonitis on an XRay
Patients perspective
How has it affected you
Ideas
Concerns
Expectations
PMH
Asthma COPD
Medications
Allergies
Ace inhibitors