Unit 3 - Approach to the Coughing Patient

Question 1

The coughing mechanism is a _____ mechanism that works with the mucociliary apparatus.

Answer 1

protective

Question 2

What medical history must you obtain when determining the cause of coughing?

Answer 2

Duration, progression, associations (time of day), triggers, character of cough, and other systemic signs

Question 3

What are potential triggers for a cough?

Answer 3

the owner is a smoker, perfume/air fresheners, household cleaners, dusty kitty litter, and house construction

Question 4

What environmental exposure can cause a cough?

Answer 4

boarding/grooming, obtained from a shelter, outdoors/travel history, walks, dog parks, show/agility competitor, heartworm prevention, other sick animals in the house

Question 5

When determining the cause of a cough, what should you look for/do on the PE?

Answer 5

tracheal and cervical palpation, nasal discharge, changes in weight, fundic examination, skin lesions, cardiac abnormalities, lymphadenopathy, and rectal examination

Question 6

What does a non-productive cough sound like?

Answer 6

usually loud, harsh, and paroxysmal

Question 7

What is a goose-honk most commonly associated with?

Answer 7

upper airway disease - trachea and mainstem bronchi

Question 8

What is a productive cough?

Answer 8

when sputum is expectorated from the lower airways

Question 9

What is productive cough most commonly associated with?

Answer 9

lower airway disease or pulmonary parenchymal disease

Question 10

How does a productive cough sound like?

Answer 10

it is typically softer in volume - a huff - can be confused with vomiting

Question 11

Coughing is _____ in cats, so it should be persued ______.

Answer 11

uncommon, aggressively

Question 12

What is coughing most commonly associated with in cats?

Answer 12

lower airway disease (asthma is the most common)

Question 13

How do you know if a cough is cardiogenic in nature?

Answer 13

It is classically worse at night, there is exercise intolerance and tachypnea at rest, and there is perihilar edema on radiographs that is responsive to furosemide

Question 14

What are the locations where non-cardiogenic coughs come from?

Answer 14

upper (large) airway, lower (small) airway, parenchymal, and less commonly pleural space

Question 15

What are the infectious causes of upper airway coughs?

Answer 15

infectious tracheobronchitis, parasitic (filaroides), or hilar lymph node enlargement

Question 16

Are upper airway coughs typically productive or non-productive?

Answer 16

non-productive

Question 17

What are the non-infectious causes of upper airway coughs?

Answer 17

tracheal collapse, compressive masses, or foreign bodies

Question 18

What can cause lower airway cough?

Answer 18

inflammatory airway disease or smoke/chemical irritant inhalation

Question 19

What are the causes of inflammatory airway disease?

Answer 19

canine chronic bronchitis, feline lower airway disease, eosinophilic bronchopneumopathy

Question 20

What are the infectious causes of parenchymal disease cough?

Answer 20

bacterial pneumonia, fungal disease, heartworm infection, parasitic, or Toxoplasma

Question 21

What are the non-infectious causes of parenchymal disease cough?

Answer 21

neoplasia, lung lobe torsion, and non-cardiogenic pulmonary edema

Question 22

What are the common ‘first tier’ tests for diagnosing underlying causes of cough?

Answer 22

CBC, throacic rads, fecal examination, heartworm testing, and cytology (skin lesions, nasal discharge, and lymph nodes)

Question 23

What are common ‘second tier’ tests for diagnosing underlying causes of cough?

Answer 23

Cardiac evaluation, chemistry panel, urinalysis, airway sampling (for type of pneumonia), advanced imaging, lung aspirate/biopsy, bronchoscopy, and thoracotomy

Question 24

What does TTW stand for?

Answer 24

transtracheal wash

Question 25

What does ETW stand for?

Answer 25

endotracheal wash

Question 26

When is TTW or ETW indicated?

Answer 26

for diffuse disease

Question 27

How do you perform TTW or ETW?

Answer 27

Place a catheter to the level of the carina, insert saline (patient must be able to cough), recover the saline for cytology and culture

Question 28

What is BAL and when is it indicated?

Answer 28

Bronchoalveolar lavage - indicated for localized disease - scope is used to perform this

Question 29

If you decide to do empiric antibiotic therapy, what guidelines should you follow?

Answer 29

limit to one course, discontinue 1-2 weeks prior to sampling airways, informed client consent (may complicate future diagnosis/tx if unsuccessful)

Question 30

What is an antitussive?

Answer 30

a drug used to prevent or relieve a cough

Question 31

What are the most effective antitussives (general)?

Answer 31

opioids

Question 32

What opoids can be used for antitussives?

Answer 32

butorphanol, hydrocodone, loperamide, diphenoxylate

Question 33

What is combined with hydrocodone to prevent human abuse?

Answer 33

anti-cholinergics

Question 34

When wouldn’t you use an antitussive?

Answer 34

the vast majority of lower airway coughs - contraindicated in causes of pneumonia

Question 35

What condition do we use antitussives in?

Answer 35

collapsing trachea cases

Question 36

What abnormal breath sound will you hear with a cardiogenic cough?

Answer 36

crackles

Question 37

What other disease process, aside from CHF, can cause a cardiogenic cough?

Answer 37

advanced mitral valve disease, specifically causing cardiomegaly, that causes the left atrium to push on the mainstem bronchi