7. Cough

Question 1

Describe the timescales of acute and chronic coughs.

Answer 1

Acute - < 3 weeks

Chronic - > 8 weeks

Question 2

List some other key features of the history of presenting complaint.

Answer 2

Acute or chronic 
Constant or intermittent 
Productive or dry 
Blood
Timing
Character

Question 3

Why is it important to ascertain whether the cough is constant or intermittent?

Answer 3

Constant – suggests intrinsic pathology

Intermittent – suggests that there may be an exogenous trigger

Question 4

Describe the typical appearance of the sputum in:

COPD, infection and bronchiectasis/lung abscess

Answer 4

COPD - White or clear
Infection - Yellow or green
Bronchiectasis/Lung Abscess - Large volumes of purulent sputum that is green or rusty

Question 5

List diseases that can cause blood-streaked sputum

Answer 5

Infection (e.g. atypical pneumonia – Klebsiella pneumonia)

Bronchiectasis

Question 6

Name a disease that can cause pink, frothy sputum

Answer 6

Pulmonary oedema

Question 7

Name a disease that can cause frank blood

Answer 7

TB
Lung cancer
PE
Rare disease (e.g. Wegner’s granulomatosis, Goodpasture’s syndrome)

Question 8

List some diseases that cause cough that is worse at night

Answer 8

Asthma
GORD
Pulmonary oedema

Question 9

What does a wheezy cough indicate

Answer 9

Airway obstruction due to asthma or COPD

Question 10

What does a bovine cough indicate

Answer 10

Due to vocal cord paralysis (left recurrent laryngeal nerve) usually due to a Pancoast lung tumour

Question 11

What does a dry cough indicate

Answer 11

Bronchitis

Interstitial lung disease

Question 12

What does a gurgling/wet cough indicate

Answer 12

Bronchiectasis

Question 13

What does a whooping cough indicate

Answer 13

Infection caused by Bordatella pertussis

Question 14

List some common environmental triggers of cough that you should ask the patient about.

Answer 14

Smoking
Occupation
Pets
Change in house/office

Question 15

List some significant features of the past medical history in a patient presenting with cough.

Answer 15

Asthma
GORD
Rhinitis/sinusitis
Heart failure 
Recent chest infection

Question 16

Which drug is commonly associated with causing cough?

Answer 16

ACE inhibitors

Question 17

Why is it important to ask about the patient’s travel history?

Answer 17

Consider TB-endemic regions (e.g. South-East asia)

Question 18

What important detail in the history may increase the likelihood of an infectious cause to the cough?

Answer 18

Close contact with others with cough

Question 19

List some key symptoms that are associated with diseases that cause cough. Include the diseases that they are associated with in your answer.

Answer 19

Fevers, night sweats, weight loss -> Malignancy, TB

Breathlessness -> Asthma, COPD, pneumonia, pulmonary oedema

Chest pain (pleuritic) -> Pneumonia, pneumothorax, PE, pleurisy

Wheeze - COPD, asthma, other airway obstruction

Question 20

List some causes of an acute dry cough

Answer 20

Asthma
Rhinitis/sinusitis with post-nasal drip
Upper respiratory tract infection
Drug-induced

Question 21

List some causes of an acute productive cough

Answer 21

Lower respiratory tract infection
COPD
TB

Question 22

List some causes of a chronic dry cough

Answer 22

Asthma
GORD 
Post-nasal drip 
Smoking 
Lung cancer

Question 23

List some causes of a chronic productive cough

Answer 23

Bronchiectasis
TB
Lung cancer

Question 24

List some signs of respiratory distress on physical examination.

Answer 24

High rest rate
Use of accessory muscles
Peripheral cyanosis
Confusion

Question 25

What might tender cervical lymphadenopathy suggest?

Answer 25

Upper respiratory tract infection

Question 26

List some features of COPD that can be found on examination.

Answer 26

Chest wall deformity (e.g. barrel chest) Intercostal recession Signs of right heart failure (peripheral oedema, raised JVP, parasternal heave, tricuspid regurgitation) Asterixis

Question 27

List some blood tests that may be useful in a patient with cough.

Answer 27

ABG – assess progression towards respiratory falure FBC – signs of infection (high WCC) CRP U&Es – check dehydration, urea is a useful way of gaging severity of pneumonia Blood cultures

Question 28

Why might you perform an ECG in a patient with a cough?

Answer 28

AF can occur secondary to pneumonia | Check for signs of right heart strain

Question 29

Which pathogens that cause pneumonia produce antigens that can be detected in the urine?

Answer 29

Streptococcus pneumoniae | Legionella pneumophila

Question 30

Why are sputum cultures rarely useful?

Answer 30

They are often contaminated by commensal bacteria

Question 31

Which scoring system is used to assess the severity of pneumonia?

Answer 31

CURB-65

Question 32

What are the different components of CURB-65?

Answer 32

``` Confusion Urea Respiratory rate Blood pressure 65+ yrs old ```

Question 33

List some complications of pneumonia.

Answer 33

Pleural effusion Empyema Abscess Septicaemia

Question 34

What are the three most common causes of a chronic cough in non-smokers?

Answer 34

Asthma GORD Post-nasal drip

Question 35

Why shouldn’t you give 100% oxygen to patients with COPD?

Answer 35

It diminishes the hypoxic drive to breathe – this results in the patient becoming very hypercapnic It also diminishes hypoxic vasoconstriction leading to VQ mismatch