Cough

Question 1

What questions about the cough itself should be asked (PC)

Answer 1

1. Acute (<3 weeks) or chronic (>8 weeks). Between this could be due to recovering acute illness or developing chronic illness.
2. Constant or intermittent? - intermittent cough = extrinsic trigger e.g. allergy. Constant cough = intrinsic cause
3. Productive or dry? - sputum = inflammation/infection. COPD patients may produce white or clear sputum. Infection = green/yellow sputum.
4. Blood present? - blood streaked sputum = infection/bronchiectasis. Pink/frothy sputum = pulmonary oedema. Frank blood = TB/lung cancer/pulmonary embolus/bronchiectasis, etc.
5. Timing - asthma worse at night/early morning. Pulmonary oedema + GORD worse at night.
6. Character - wheezy cough = airway obstruction due to asthma/COPD. Breathy/bovine cough = vocal cord paralysis. Dry cough = bronchitis/ILD. Gurgling/wet cough = bronchiectasis.

Question 2

What infection causes a whooping cough

Answer 2

Pertussis

Question 3

What class of drugs can cause a cough

Answer 3

ACEi

Question 4

Why is it very important to ask about travel?

Answer 4

May have travelled to area where TB is prevalent

Question 5

3 major ddx of acute dry cough

Answer 5

Asthma
Rhinitis/sinusitis with postnasal drip
URTI
(Drug induced)

Question 6

3 major ddx of acute productive cough

Answer 6

LRTI
COPD
TB

Question 7

3 major ddx of chronic dry cough

Answer 7

Asthma
GORD
Post nasal drip

Question 8

3 major ddx of chronic productive cough

Answer 8

Bronchiectasis
TB
Lung cancer

Question 9

Cervical lymphadenopathy in patients with cough suggests infection where

Answer 9

URTI

Question 10

How are breath sounds affected in:
Effusion
Pneumonia

Answer 10

Breath sounds in effusion = reduced

Breath sounds in pneumonia = bronchial

Question 11

Asterixis is a sign of what in relation to CO2?

Answer 11

Increased levels of CO2

Question 12

What blood tests would you do in a patient with cough

Answer 12

ABG
FBC - raised WCC in infection, neutrophilia if bacterial
CRP
U&Es - urea indicator of pneumonia severity
Blood cultures - if infection should do a blood test before administering Abx

Question 13

In terms of imaging, CXR and ECG is done. Why ECG?

Answer 13

Rule out ischaemia or AF secondary to pneumonia. May see right heart strain in COPD patients

Question 14

What is the CURB-65 score

Answer 14

Used to calculate severity of pneumonia and determine need for hospitalisation

Confusion
Urea
Respiratory rate > 30/min
BP 
>65

Question 15

What are the 3 most common causes of chronic cough in a non smoker

Answer 15

Asthma
Postnasal drip
GORD

Question 16

Postnasal drip is largely a diagnosis of exclusion. If inhalers don’t work, what might you want to try

Answer 16

Antihistamines and or nasal decongestants

Question 17

High BMI and heartburn point to what cause of cough

Answer 17

GORD

Question 18

On a CXR, hilar location of consolidation may indicate what type of lung cancer

Answer 18

Squamous cell carcinoma

Question 19

What type of pneumonia can have a persistent post infectious cough?

Answer 19

Viral pneumonia

Treat with antitussives / inhaled corticosteroids / inhaled ipratropium bromide

Question 20

If someone has blood-streaked sputum and have visited a TB rife country, the likely diagnosis is pulmonary TB. What is the management of this

Answer 20

Isolate them in a negative pressure side room until deemed non-infective