Respiratory- Common PC wheeze

Question 1

Cough- questions to ask about

Answer 1

1. Duration of the cough
2. Whether it is present everyday
3. If it is intrusive/uncontrollable or deliberate to clear throat
4. Whether it produces sputum (ask colour, consistency, volume)
5. Any haemoptysis
6. Any triggers (swallowing, cold, allergens)
7. Smoking
8. Associated Sx: wheeze, GORD, altered voice or swallowing
9. DHx

Question 2

Patholophysiology- Airway inflammation

Answer 2

• asthma
• COPD
• persisting airway reactivity following acute bronchitis
• bronchiectasis

Question 3

Features in Hx or exam- airway inflammation

Answer 3

• affects children and some adults
• associated wheeze
• Hx of smoking and intermittent sputum
• cough persisting after infection
• daily purulent sputum for long periods
• pneumonia or whooping cough
• recurrent haemoptysis

Question 4

Features in Hx/examination- lung Ca

Answer 4

• persistent cough, especially in smokers
• any haemoptysis
• pneumonia that fails to clear in 4-6/52

Question 5

Features in Hx/exam- Rhinitis with post nasal drip

Answer 5

• chronic sneezing
• nasal blockage/discharge

Question 6

Oesophageal reflux- features in Hx/exam

Answer 6

• heartburn or reflux after eating
• particularly on bending or lying
• nocturnal and daytime cough

Question 7

Drug affects- features in Hx/exam

Answer 7

ACEI

Question 8

ILD- features in Hx/exam

Answer 8

• persistent dry cough
• fine inspiratory crackles at bases

Question 9

Idiopathic cough- features in Hx/exam

Answer 9

• long history with no signs and negative Ix
• diagnosis of exclusion

Question 10

Cough other facts

Answer 10

• Green or yellow sputum suggests bronchial infection
• large volumes over time suggest Bronchiectasis
• in patients with malignancy at the left hilum, damage to the left recurrent laryngeal nerve may paralyse the left vocal cord, making the voice hoarse without explosive cough