Cough and breathlessness

Question 1

what is the difference between signs and symptoms

Answer 1

Signs – observed

Symptoms – experienced by patients

Question 2

what is the difference between SOB and tight chest

Answer 2

SOB inc RR and dec SaO2

Tight chest dec PEFR and wheeze

Question 3

what is a cough

Answer 3

Ptussive reflex
Irritation – medulla – inspiration – closed glottis – contraction – expulsion
Protective – aspiration and clearance
Can be problematic – oedema and rib fractures
vagus nerve stimulation

Question 4

what are types of coughs

Answer 4

whooping and barking
productive
bovine
smokers
fruity vs dry
acute, subacute, chronic

Question 5

what are causes of cough

Answer 5

Chronic
Irritation or infection
Acute
Medications, asthma, rhinitis, oesophageal reflex, cancer

Question 6

what does sputum look like

Answer 6

quantity, colour, smell, blood

Question 7

what does haemoptysis

Answer 7

frothy and pink, bright red or dark (altered)

Question 8

what is dyspnoea

Answer 8

Red flag
Obstructive or restrictive
Acute – trauma and obstruction, infection, PTX, PE, panic
Chronic – anaemia, HF, metabolic, COPD, asthma, fibrosis, cancer

Question 9

how can dyspnoea be treated

Answer 9

ABCs
Syrups and linctus
Avoidance 
Quarantine
Antibiotics 
Inhalers

Question 10

what are the impacts of a cough

Answer 10

affects sleep, affects carer/partner, pain in ribs (can get associated rib fractures) and throat (can get associated vocal cord oedema affecting voice),
stress incontinence, cough syncope

Question 11

how can a cough categories

Answer 11

duration - acute:<2weeks, persistent:2-8weeks, chronic:>8weeks
pattern
sound
triggers
sputum 
nature of onset

food relationship, factors that make it worse, haemoptysis

Question 12

what does the colour of the haemoptysis mean

Answer 12

Bright red (pulmonary infarct, rupture of pharynx capillaries)
Rusty (pneumonia)
Pink and frothy (heart failure or other causes of pulmonary oedema)

Question 13

common causes of haemoptysis

Answer 13

Acute infection, bronchial carcinoma, TB, PI

occasionally trauma, vascular abnormalities, bleeding disorders

Question 14

what are naso and nasopharyngeal considerations for a cough

Answer 14

rhinosinusitis - cough, post nasal drip, clear throat/tickle, congestion, nasal discharge, hoarseness - resolve cough
URTI

Question 15

What are tracheo-bronchial considerations for a cough

Answer 15

Asthma
COPD
Bronchiectasis
Cancer (bronchogenic carcinoma, SCLC, environmental)
Infection (acute - CAP, chronic - TB)

Question 16

What (gastro-oesophageal origin) might cause a cough

Answer 16

GORD/reflux
may have no gastric symptoms
cough receptors in oesophagus - aspirate stomach contents
confirm with successful anti-GORD therapy

Question 17

What medication can cause a cough

Answer 17

ACE inhibitors

possibly beta blockers

Question 18

what is SOB

Answer 18

difficult or laboured breathing, associated with a distressing feeling of not being able to breathe enough / get enough air in (dyspnoea)
Same history as cough

Question 19

What are causes of SOB

Answer 19

sudden - inhaled foreign body, Ptx, PE
days - pneumonia, HF
weeks - Pleural effusion, anaemia
months - cancer, fibrosis
years - muscle weakness, COPD, fibrosis, obesity

Question 20

what is hyperventilation

Answer 20

‘inappropriate’ over-breathing…often associated with sensation of dyspnoea
significant proportion of chronic SOB in a community setting
likely cause of SOB in younger rather than older person

Question 21

what is hyperventilation characterised by

Answer 21

SOB, sighing speech and worse with stress rather than exercise
Physical symptom of anxiety (inc. palpitations)
Management -reassurance, rebreathing and relaxation techniques