Cough (oxford clin cases)

Question 1

What is an acute cough?

Answer 1

Less than 3 weeks

Question 2

What is a chronic cough?

Answer 2

More than 8 weeks

Question 3

What character may a cough be if its been resent for more than 3 weeks but less than 8 weeks?

Answer 3

An acute cough in the recovery process

A chronic cough that is developing

Question 4

What trigger does a constant cough indicate?

Answer 4

Intrinsic

Question 5

What trigger does an intermittent cough indicate?

Answer 5

Extrinsic

Question 6

What pathology does a productive cough indicate?

Answer 6

Infection or inflammation

Question 7

What pathology does a productive cough with white or clear sputum indicate?

Answer 7

COPD

Question 8

What pathology does a productive cough with yellow or green sputum indicate?

Answer 8

Infection

Question 9

What pathology does a productive cough with large volumes of sputum indicate?

Answer 9

Bronchiecstasis

Question 10

What pathology does a productive cough with pink and frothy sputum indicate?

Answer 10

Pulmonary oedema

Question 11

What pathology does a productive cough with blood streaked sputum indicate?

Answer 11

Infection or bronchiecstasis

Question 12

What pathology may a cough be if its worse at night?

Answer 12

Asthma
Pulmonary oedema
GORD

Question 13

What pathology may a wheezy cough be?

Answer 13

Asthma or COPD

Question 14

What pathophysiology underlies a wheezy cough?

Answer 14

Airway obstruction

Question 15

What pathophysiology underlies a bovine cough?

Answer 15

Vocal chord paralysis

Question 16

What type of cough is seen in bronchitis?

Answer 16

Dry

Question 17

What type of cough is seen in interstitial lung disease?

Answer 17

Dry

Question 18

What type of cough is seen in bronchiecstasis?

Answer 18

Gurgling or wet

Question 19

What type of cough is seen in pertussis infection?

Answer 19

Whooping cough

Question 20

What drugs are commonly known to cause a cough?

Answer 20

ACE inhibitors

Question 21

What type of contact is required for the transmission of TB?

Answer 21

Prolonged close contact eg family members

Question 22

What pathologies cause cough with breathlessness that is worse on exertion?

Answer 22

Asthma
COPD
Pneumonia
Pulmonary oedema

Question 23

What type of breathlessness will malignancy cause?

Answer 23

Not worse on exertion

Question 24

What pathology can you suspect with a cough presents with pleuritic chest pain?

Answer 24

Pneumothorax
Pulmonary embolism
Pneumonia
Muscle pull (due to aggressive coughing)
Fractured rib

Question 25

What differentials will cause an acute dry cough?

Answer 25

Asthma Upper resp tract infection Drugs eg ACE inhibitors Rhinitis/ sinusitis

Question 26

What differentials will cause an acute productive cough?

Answer 26

Lower resp tract infection (pneumonia, bronchitis) | COPD

Question 27

What differentials will cause a chronic dry cough?

Answer 27

``` Asthma GORD Smoking Lung cancer COPD ```

Question 28

What differentials will cause a chronic productive cough?

Answer 28

Bronchiectasis TB Lung cancer

Question 29

What is a sign of severe COPD?

Answer 29

Intercostal recession

Question 30

What are some symptoms and signs of a cough that is due to infection?

Answer 30

``` Productive cough, usually green/ yellow in colour Fever Tachycardia High resp rate Sweating Tremor/shaking Cervical lymphadenopathy Reduced chest expansion Change in vocal resonance ```

Question 31

What will be seen on FBC if someone has an infection that is specifically bacterial?

Answer 31

Neutrophilia

Question 32

What investigation can indicate the severity of pneumonia?

Answer 32

Urea level

Question 33

What investigation should be done on patients with a cough when you suspect pathology is infectious and why?

Answer 33

Blood cultures- to identify the causative agent so if first line abx don't work you can give more specific ones

Question 34

Why should you always do an ECG in someone who has a cough?

Answer 34

To rule out ischaemia or atrial fib that may be a result of pneumonia

Question 35

What tool is used to assess those with community acquired pneumonia?

Answer 35

CURB-65

Question 36

What is CURB-65

Answer 36

A tool that is sued to assess those with community accquired pneumonia and decide if they need to be hospitalised

Question 37

What score on CRUB-65 indicates a need for hosiptalisation?

Answer 37

2 or above

Question 38

What does CURB-65 stand for?

Answer 38

``` 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 ```

Question 39

Should you do a sputum analysis when someone has pneumonia? Explain

Answer 39

Not needed unless you suspect and abnormal causative organism or unless the first line antibiotics don't work

Question 40

What happens to blood pressure in pneumothorax?

Answer 40

It is reduced, ie hypotension

Question 41

Will someone with pneumothorax have a temperature?

Answer 41

No

Question 42

What are the causes of a chronic cough in a non smoker?

Answer 42

Asthma | GORD

Question 43

What is FEV1:FVC in those with asthma?

Answer 43

Less than 0.7

Question 44

What factors in the history of someone with a chronic cough make a diagnosis of asthma less likely?

Answer 44

``` Productive cough Other symptoms like dizziness, chest pain Lack of breathlessness or wheeze Presence of a cold Significant smoking history Cardiac history ```

Question 45

How is asthma most commonly diagnosed?

Answer 45

FEV1: FVC | Can also do peak exp flow rate

Question 46

What will accompany a cough in suspected GORD?

Answer 46

Heartburn | Overweight

Question 47

How does an ACE inhibitor cause a cough?

Answer 47

They lead to a build up of bradykinins in the lungs which causes inflammation and leads to a cough

Question 48

How long does a cough from viral pneumonia last? How is it treated

Answer 48

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

Question 49

What is it important to remember when administering oxygen to patients with COPD?

Answer 49

Do not give them 100% oxygen

Question 50

What device is used to administer oxygen to someone with COPD?

Answer 50

Venturi mask

Question 51

If someone has a bovine cough and lung cancer, what can you suspect has happened?

Answer 51

Recurrent laryngeal nerve palsy- the tumor has compressed or otherwise compromised the RLN

Question 52

What branch of the recurrent laryngeal nerve is most commonly compromised and why?

Answer 52

The right branch- it is longer and loops under the aorta so it can be more affected by chest pathology