Topic Info - BotMed Application

TopicName

Chronic cough

ClinicalTests

CBC: infection (neutrophilic leukocytosis in pneumonia, lymphocytosis in TB) or allergic etiology (e.g., eosinophilia in asthma);
Tuberculin skin test;
Sputum culture: suspected bacterial pneumonia, TB;
Nasopharyngeal swab/deep nasopharyngeal aspirate culture and PCR for pertussis: indicated in patients with subacute/chronic cough, esp. if associated with an inspiratory whoop and/or post-tussive vomiting 
Blood culture: suspected pneumonia;
Arterial blood gas analysis: patients with dyspnea and those with suspected life-threatening causes of acute cough;

ImagingStudies

Chest x-ray (pneumonia, TB)
x-ray of paranasal sinuses (sinusitis)
Chest CT (bronchiectasis (diagnostic test), lung cancer, foreign body aspiration)
Bronchoscopy (Foreign body aspiration, Lung cancer)
Spirometry: ddx obstructive lung disease (e.g., asthma, COPD) and restrictive lung disease (e.g., interstitial lung disease)
Bronchial challenge test (metacholine challenge test; bronchodilator reversibility test): ddx asthma from other obstructive lung disease
BNP, ECG, and ECHO: (CHF)
Endoscopy, 24-hour esophageal pH monitoring, and/or barium swallow: patients with chronic cough suspected to be due to GERD/achalasia that is not responsive to a trial of PPIs

PhysicalExams

Vitals + puls ox.  – tachycardia, tachypnea, hyper/hypotensive, fever;
General appearance – signs of distress, LOC, sense of doom, restlessness;
HEENT - Exam of nasal mucosa, oropharynx – erythema, lymphadenopathy, examine pharynx;
Heart – JVP distention, murmurs, carotid bruits;
Respiratory – symmetric chest expansion, orthopnea, dullness/ consolidation, hyper resonance, wheeze, stridor, rales, rhonchi, intercostal retraction/ use of secondary respiratory muscles, dry or productive cough;
Peripheral vascular – cyanosis, clubbing, edema;

Comment

> 8 weeks duration;
1. HIV;
2. Any fever? --> pneumonia.. no fever --> COPD, CHF, CKD;
Acute/subacute vs. chronic, increased frequency of cough if chronic, timing; presence/description of sputum, presence of hemoptysis; associated symptoms (constitutional, URI, postnasal drip, dyspnea, wheezing, chest pain, heartburn); exacerbating and alleviating factors, exposures; smoking history; history of lung disease, posttussive emesis, or heart failure; allergies; medications (especially ACE inhibitors).

WebLink

https://www.aafp.org/afp/2011/1015/p887.html