Cough Flashcards
Important causes of cough
- Acute
- Viral tracheitis
- Acute bronchitis
- PNA - Chronic
- GERD
- Post-nasal drip
- Asthma/reactive airway disease
- ACEI
- Post-infectious
- Infectious (pertussis, TB)
- Chronic bronchitis
- Bronchiectasis
- Pleural effusion
- Lung CA
- CHF
Hx for cough
- Onset
- Duration
- Exacerbating/alleviating factors
- Associated symptoms (fever, chills, weight loss, URI, postnasal drip, dyspnea, wheezing, chest pain, heartburn)
- Presence or absence of hemoptysis
- Tobacco Hx
- Exposures
- Relevant PMH (lung disease, allergies, meds esp ACEI)
PE for cough
- RR and level of respiratory distress, pulse Ox
- Pharyngeal signs of post nasal drip
- Lymph nodes
- Rales, rhonchi, wheeze
- Signs of pulomonary consolidation
- Extremities (clubbing, cyanosis, edema)
Potential labs for cough
- CXR
- Pleural fluid cell count and chemistries
- PFTs
- Sputum gram stain and sputum acid-fast stain
- Sputum culture and sensitivities
- Barium swallow
- Upper endoscopy
- Sputum cytology
- Chest CT
Pt counseling in cough
- Environmental contributors to disease
- Pneumococcal and flu immunizations
- Smoking cessation
- Dx, Px, and Tx, f/u
- Elicit input and questions from the pt and his/her family about the management plan
30 M SOB, cough, wheezing that worsens in cold air, several such episodes in past 4 months
DDx
- Asthma
- GERD
- Bronchitis
- PNA
- Foreign body
Workup
- CBC
- CXR
- Peak flow measurment
- PFTs
- Methacholine challenge test
56 F SOB, productive cough for 3 months each yr for past 2 years, heavy smoker
DDx
- COPD, chronic bronchitis
- Bronchiectasis
- Lung CA
- TB
Workup
- CBC
- Sputum gram stain and Cx
- CXR
- PFTs
- CT-chest
- PPD
58 M with 1 week pleuritis chest pain, fever, chills, cough with purulent yellow sputum, heavy smoker with COPD
DDx
- PNA
- COPD exacerbation (bronchitis)
- Lung abscess
- Lung cancer
- TB
- Pericarditis
Workup
- CBC
- Sputum gram stain and Cx
- CXR
- CT-chest
- ECG
- PPD
25 F 2 weeks of nonproductive cough, three weeks ago had sore throat and runny nose
DDx
- Atypical PNA
- Reactive airway disease
- URI-associated cough (“post-infectious”)
- Post-nasal drip
- GERD
Workup
- CBC
- Induced sputum gram stain and culture
- CXR
- IgM detection for Mycoplasma pneumoniae
- Urine Legionella antigen
65 M worsening cough for 6 months, hemoptysis, dyspnea, weakness, weight loss, heavy smoker
DDx
- Lung CA
- TB
- Lung abscess
- COPD
- Vasculitis (Wegener)
- Interstitial lung disease
- CHF
Workup
- CBC
- Sputum gram stain, culture, cytology
- CXR
- CT-chest
- PPD
- Bronchoscopy
55 M increased dyspnea and sputum for past 3 days, COPD, stopped using inhalers last week, stopped smoking 2 days ago
DDx
- COPD exacerbation (bronchitis)
- Lung CA
- PNA
- URI
- CHF
Workup
- CBC
- CXR
- PFTs
- Sputum gram stain and culture
- CT-chest
34 F nurse presents with worsening cough of 6 wks duration, weight loss, fatigue, night sweats, fever, history of contact with TB patients
DDx
- TB
- PNA
- Lung abscess
- Vasculitis
- Lymphoma
- Mets CA
- HIV/AIDS
- Sarcoidosis
Workup
- CBC
- PPD
- Sputum gram stain, acid-fast stain, and culture
- CXR
- CT-chest
- Bronchoscopy
- HIV antibody
35 M SOB and cough, has had unprotected sex with multiple sexual partners and recently exposed to pt with active TB
DDx
- TB
- PNA (including PCP)
- Bronchitis
- CHF (cardiomyopathy)
- Asthma
- Acute HIV infection
Workup
- CBC
- PPD
- Sputum gram stain, acid-fast stain, silver stain, and culture
- CXR
- HIV antibody
50 M cough exacerbated by lying down at night and improved by propping up on 3 pillows, also exertional dyspnea
DDx
- CHF
- Cardiac valvular disease
- GERD
- Pulmonary fibrosis
- COPD
- Postnasal drip
Workup
- CBC
- CXR
- ECG
- Echo
- PFTs
- BNP
