CASE 26 - Persistent Cough

Question 1

Will I get better if I stop smoking?

Answer 1

Well, we still have to sort out exactly what is causing your cough.

If you stop smoking, your chronic cough should improve. But regardless of what is causing your cough, smoking cessation will significantly decrease your cancer risk in the long term.

Question 2

Specific Qs:

Answer 2

1. Changes in the cough during the day?
2. Progression of cough during the past month?
3. Do you cough at night?
4. Color — Odor — Consistency — Blood — Amount of blood.

Question 3

PEx:

Answer 3

1. Head and neck exam ==> Inspected mouth, throat, lymph nodes.
2. CV ==> A.
3. Chest ==> A + P + P.
4. Abdo ==> A + P.
5. Extr ==> I.

Question 4

DDx:

Answer 4

1. Pulmonary TB.
2. Lung cancer.
3. Typical pneumonia.
4. Lung abscess.
5. Atypical pneumonia.
6. COPD exacerbation.
7. Postnasal drip.
8. GERD.
9. Asthma.
10. ACEIs.

Question 5

Workup:

8

Answer 5

1. PPD or QuantiFERON gold.
2. CBC.
3. Blood cultures.
4. Sputum Gram stain, AFP smear, routine and mycobacterial sputum cultures, and cytology.
5. CXR—PA and lateral.
6. CT chest.
7. Bronchoscopy.
8. Lung biopsy.