Cough (oxford clin cases) Flashcards
What is an acute cough?
Less than 3 weeks
What is a chronic cough?
More than 8 weeks
What character may a cough be if its been resent for more than 3 weeks but less than 8 weeks?
An acute cough in the recovery process
A chronic cough that is developing
What trigger does a constant cough indicate?
Intrinsic
What trigger does an intermittent cough indicate?
Extrinsic
What pathology does a productive cough indicate?
Infection or inflammation
What pathology does a productive cough with white or clear sputum indicate?
COPD
What pathology does a productive cough with yellow or green sputum indicate?
Infection
What pathology does a productive cough with large volumes of sputum indicate?
Bronchiecstasis
What pathology does a productive cough with pink and frothy sputum indicate?
Pulmonary oedema
What pathology does a productive cough with blood streaked sputum indicate?
Infection or bronchiecstasis
What pathology may a cough be if its worse at night?
Asthma
Pulmonary oedema
GORD
What pathology may a wheezy cough be?
Asthma or COPD
What pathophysiology underlies a wheezy cough?
Airway obstruction
What pathophysiology underlies a bovine cough?
Vocal chord paralysis
What type of cough is seen in bronchitis?
Dry
What type of cough is seen in interstitial lung disease?
Dry
What type of cough is seen in bronchiecstasis?
Gurgling or wet
What type of cough is seen in pertussis infection?
Whooping cough
What drugs are commonly known to cause a cough?
ACE inhibitors
What type of contact is required for the transmission of TB?
Prolonged close contact eg family members
What pathologies cause cough with breathlessness that is worse on exertion?
Asthma
COPD
Pneumonia
Pulmonary oedema
What type of breathlessness will malignancy cause?
Not worse on exertion
What pathology can you suspect with a cough presents with pleuritic chest pain?
Pneumothorax Pulmonary embolism Pneumonia Muscle pull (due to aggressive coughing) Fractured rib
What differentials will cause an acute dry cough?
Asthma
Upper resp tract infection
Drugs eg ACE inhibitors
Rhinitis/ sinusitis
What differentials will cause an acute productive cough?
Lower resp tract infection (pneumonia, bronchitis)
COPD
What differentials will cause a chronic dry cough?
Asthma GORD Smoking Lung cancer COPD
What differentials will cause a chronic productive cough?
Bronchiectasis
TB
Lung cancer
What is a sign of severe COPD?
Intercostal recession
What are some symptoms and signs of a cough that is due to infection?
Productive cough, usually green/ yellow in colour Fever Tachycardia High resp rate Sweating Tremor/shaking Cervical lymphadenopathy Reduced chest expansion Change in vocal resonance
What will be seen on FBC if someone has an infection that is specifically bacterial?
Neutrophilia
What investigation can indicate the severity of pneumonia?
Urea level
What investigation should be done on patients with a cough when you suspect pathology is infectious and why?
Blood cultures- to identify the causative agent so if first line abx don’t work you can give more specific ones
Why should you always do an ECG in someone who has a cough?
To rule out ischaemia or atrial fib that may be a result of pneumonia
What tool is used to assess those with community acquired pneumonia?
CURB-65
What is CURB-65
A tool that is sued to assess those with community accquired pneumonia and decide if they need to be hospitalised
What score on CRUB-65 indicates a need for hosiptalisation?
2 or above
What does CURB-65 stand for?
C= confusion that is new to the patient U= urea that is high R= resp rate that is high (over 30/min) B= blood pressure (low ie under 90 systolic and under 60 diastolic) 65= age over 65 yrs old
Should you do a sputum analysis when someone has pneumonia? Explain
Not needed unless you suspect and abnormal causative organism or unless the first line antibiotics don’t work
What happens to blood pressure in pneumothorax?
It is reduced, ie hypotension
Will someone with pneumothorax have a temperature?
No
What are the causes of a chronic cough in a non smoker?
Asthma
GORD
What is FEV1:FVC in those with asthma?
Less than 0.7
What factors in the history of someone with a chronic cough make a diagnosis of asthma less likely?
Productive cough Other symptoms like dizziness, chest pain Lack of breathlessness or wheeze Presence of a cold Significant smoking history Cardiac history
How is asthma most commonly diagnosed?
FEV1: FVC
Can also do peak exp flow rate
What will accompany a cough in suspected GORD?
Heartburn
Overweight
How does an ACE inhibitor cause a cough?
They lead to a build up of bradykinins in the lungs which causes inflammation and leads to a cough
How long does a cough from viral pneumonia last? How is it treated
It can continue for a long time after the infectious period has subsided, it can be treated initially with antivirals or antibiotics, and then afterwards with cough suppressants/ inhaled corticosteroids/ antihistamines etc
What is it important to remember when administering oxygen to patients with COPD?
Do not give them 100% oxygen
What device is used to administer oxygen to someone with COPD?
Venturi mask
If someone has a bovine cough and lung cancer, what can you suspect has happened?
Recurrent laryngeal nerve palsy- the tumor has compressed or otherwise compromised the RLN
What branch of the recurrent laryngeal nerve is most commonly compromised and why?
The right branch- it is longer and loops under the aorta so it can be more affected by chest pathology
