Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

Cough 415

➣With meals (aspiration secondary to neurologic dysfunction)

■Character of cough:

➣Dry (pulmonary fibrosis)

➣Productive (chronic bronchitis)

➣Purulent (bronchiectasis)

➣Hemoptysis scant: infectious bronchitis, chronic bronchitis or

cancer; massive: bronchiectasis

■Recent respiratory infection (cough may last >2 mo due to transient

bronchial hyperreactivity)

■Aggravating factors:

➣Post-nasal drip, rhinitis, sinus tenderness and drainage

➣Dyspepsia

➣Medications (ACE inhibitors)

➣Tobacco (chronic cough in 75% of smokers)

➣Exercise (asthma)

➣Environmental exposures (cold air, fumes, dust, asbestos, mold,

animal dander); at home, work or secondary to hobby; does time

away alleviate symptoms?

■Alleviating factors: what medications have alleviated symptoms?

■Personal or family history of asthma, eczema or allergies

Signs & Symptoms

■Fluid behind tympanic membranes (TM) suggests otitis media; hair

touching TM may cause cough

■Pale, edematous nasal mucosa suggests allergies

■Hoarseness or stridor suggests laryngotracheal disease

■Oropharyngeal secretions and cobblestone mucosa suggests post-

nasal drip

■Neck mass or enlarged thyroid may impinge on trachea and cause

cough

■Wheezing: asthma, chronic bronchitis and emphysema; when uni-

lateral, it suggests a partially obstructing mass

■Wet rales: pneumonia; “Velcro” rales (usually best heard on slow

inspiration): interstitial lung disease

■Evaluate cranial nerves IX and X (gag reflex) to assess risk for aspira-

tion

tests

Laboratory

■WBC count with differential (eosinophilia in asthma and allerg-

ies)