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Respi > Approach to cough > Flashcards

Approach to cough Flashcards

1
Q

What are the differentials for acute cough (<3 weeks)?

A

1) Infectious: URTI, LRTI
2) Non infectious: allergen e.g. cats, smoke
3) Others (non respiratory): Foreign body aspiration, acute exacerbation of chronic cough

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2
Q

What are the differentials for acute cough (>8 weeks)?

A

Respiratory

  • Infective: TB, Bronchiectasis, Pneumonia, Infectious exacerbations of non infective cause
  • Non infective: interstitial lung disease, malignancy, COPD, asthma

Non respiratory

  • GERD
  • ACE inhibitors
  • Cardiac cough i.e. heart failure
  • Allergic rhinitis without post nasal discharge
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3
Q

What are the clinical features suggestive of TB?

A
  • Low grade fever, SOB, sputum, haemoptysis
  • Chronic IFLASH
  • Constitutional sx: LOW, LOA, night sweats
  • Travel, contact hx
  • Immunocompromised
  • Upper lobe consolidation, bilateral hilar lymphadenopathy
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4
Q

What are the clinical features suggestive of bronchiectasis?

A
  • Copious purulent green sputum
  • Haemoptysis
  • Clubbing, coarse creps, rhonchi
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5
Q

What are the clinical features suggestive of recurrent infections?

A
  • A/W fever, SOB, sputum production
  • Bronchial breath sounds, dullness to percussion, fine creps, increased vocal resonance
  • Consolidation on CXR
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6
Q

What are the clinical features suggestive of malignancy?

A
  • Dyspnea
  • Diminished breath sounds, focal wheezing (obstruction)
  • LOW, LOA
  • Haemoptysis
  • Family hx
  • Smoking
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7
Q

What are the clinical features suggestive of COPD?

A
  • Cough + sputum (clear or white) production on most days over a 3-month period in each of 2 years
  • Long smoking hx
  • Barrel chest, emphysematous changes possible
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8
Q

What are the clinical features suggestive of asthma?

A
  • A/W dyspnea, wheezing, chest tightness
  • diurnal variation
  • reversibility (normal at baseline)
  • Ppt by dust / smoke / exercise / cold
  • Ask about severity, treatment compliance, exposures
  • Atopic history, family history
  • Reversible airway obstruction on spirometry
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9
Q

What are the clinical features suggestive of ILD?

A
  • Dry cough a/w SOB
  • Fine end-inspiratory crepitations, clubbing
  • Occupation history, Drug Hx
  • Autoimmune sx: joint pain, red eyes, alopecia, rash
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10
Q

What are the clinical features suggestive of chronic rhinitis + post nasal drip?

A
  • Frequent throat clearing
  • Rhinorrhea, sneezing, itch, anosmia
  • Conjunctivitis
  • PND: Sensation of liquid dripping into back of throat
  • Precipitated by contact with dust mites; or wakes up in the morning w/ stuffy nose
  • PMH and FH of Atopy
  • Nose exam: polyps, inflammation, secretions
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11
Q

What are the clinical features suggestive of GERD?

A
  • A/W heart burn, sour taste in mouth

- Cough worse at night/on lying down/post prandial

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12
Q

What are the clinical features suggestive of ACE-I?

A
  • Tickling, scratchy or itchy sensation in throat
  • Usually 1 week of starting therapy
  • Resolves within 4 days of stopping therapy
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13
Q

What are the clinical features suggestive of cardiac cough?

A
  • History of Heart Issues
  • PND, Orthopnoea
  • LL Swelling, Dyspnoea
  • Reduced Effort Tolerance
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14
Q

What are the specific characters of cough to ask for in the history?

A
  • Normal: explosive, percussive in character
  • Whooping: Bordetella pertussis
  • Bovine: breathy, non-explosive. Suggests vocal cord paralysis
  • Wheezy: asthma, COPD
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15
Q

What are the triggers of cough to ask for in the history?

A
  • Nocturnal – asthma; or pulmonary edema/GERD (when lying flat)
  • Seasonal cough – atopic asthma
  • Cold weather – COPD, bronchitis
  • Allergens/occupation – asthma
  • Post exercise – asthma
  • Eating or drinking – aspiration, GERD
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16
Q

What are the relieving factors of cough to ask for in the history?

A
  • Sitting up
  • Nebulisers
  • GTN
17
Q

What is the nature of the sputum to ask for in the history?

A

Dry – ILD, ACE, GERD, Post nasal drip

Colour

  • Clear or white: COPD
  • Yellow or green: infection, asthma (caused by eosinophils)
  • Pinkish: pulmonary oedema

Consistency
- Firm plugs: asthma

Volume

  • Large volumes: bronchiectasis.
  • Most days over 3-month period for 2 or more consecutive years – chronic bronchitis

Haemoptysis - First confirm haemoptysis (vs hematemesis)

18
Q

What to ask about the associated features of cough would you ask the patient if you suspect pulmonary disease?

A
  • SOB
  • Pleuritic (sharp, localized, worse on deep inspiration and coughing) – pneumonia, pneumothorax, pulmonary embolus
  • Fever (with chills and rigors)
19
Q

What to ask about the associated features of cough would you ask the patient if you suspect asthma, COPD?

A

Wheeze, rhonchi

20
Q

What to ask about the associated features of cough would you ask the patient if you suspect TB

A

Night sweats, LOA, LOW

21
Q

What to ask about the associated features of cough would you ask the patient if you suspect malignancy?

A

LOA, LOW

22
Q

What to ask about the associated features of cough would you ask the patient if you suspect nasal or sinus disease?

A
  • Rhinitis: nasal blockage, sneezing, runny nose, fever

- Sinusitis: pain in face, headaches, changes in head position affecting cough, fever

23
Q

What to ask about the associated features of cough would you ask the patient if you suspect reflux?

A
  • After meal, when talking or singing
  • Symptoms of choking, heartburn, sour taste in mouth
  • Worse when lying down
24
Q

What is the drug history would you ask about in a patient with cough?

A
  • ACE-I
  • PE risk factors: OCP
  • NSAIDs, Beta-blockers: may cause bronchospasm
  • Methotrexate, amiodarone: Interstitial lung disease
25
Q

What is the fam history would you ask about in a patient with cough?

A
  • Ischemic heart disease
  • Lung Cancer
  • Atopic diseases
  • Emphysema (alpha1 antitrypsin deficiency)
  • Thromboembolic disease
  • Connective tissue diseases
26
Q

What is the social history would you ask about in a patient with cough?

A
  • Smoking/alcohol
  • Occupational and home environment

Asbestos – lung fibrosis, pleural cancer, lung cancer

Dust, damp accommodation, occupational exposures (eg. Flour) – asthma

Animals/birds – allergens for asthma, allergic alveolitis

27
Q

What is the risk factors would you ask about in a patient with cough?

A

Travel history

Infectious contacts: TB

Thromboembolic risk factors

  • Immobility
  • Recent surgery
  • Oral contraceptives

Respi (13 decks)

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