DDx of Cough (Henry)

- Types of coughs
o Cough of recent origin, with fever and other sx of respiratory tract infections
§ Acute bronchitis
§ Pneumonia

o Chronic cough
§ With wheezing (asthma)
§ With copious purulent sputum (bronchiectasis)
§ Chronic bronchitis

o Irritating dry cough
§ Lung carcinoma
§ Oesophageal reflux à acid irritation of lungs
§ Late interstitial pulmonary fibrosis
§ ACE-inhibitors usage
§ Pulmonary TB

o Cough that wakes a person from sleep
§ Cardiac failure
§ Acid reflux from oesophagus into lungs

- Cough as described from the patient’s perspective
o Barking quality
§ Associated with inflammation of the epiglottis

o Loud and brassy
§ Tracheal compression of tumour

o Bovine cough
§ Associated with recurrent laryngeal nerve palsy à due to vocal cords not able to close properly

o Cough worse at night
§ Asthma
§ Heart failure

o Cough that comes on immediately after drinking or eating
§ Tracheo-oesophageal fistula
§ Oesophageal reflux

Oxford Handbook of Clinical Diagnosis, 2nd edition, pg 298-301
Talley and O Connor, 5th edition, pg 93-

DDx Haemoptysis
Red flags: Malignancy or TB
Haemoptysis vs. Haematemesis vs. epistaxis?
Haemoptysis: Blood is coughed up, frothy, alkaline, bright red. Melaena if enough blood is swallowed.
Haematemesis: Acidic and dark. However, ruptured oesophageal varices / Mallory Weiss tears can definitely be a cause of vomiting bright red blood.
Blood not mixed with sputum suggests lung infarction (PE) or trauma.
Haemoptysis rarely needs treating, but if massive (eg. Trauma, TB, cancer, AV malformation, hydatid cyst) the danger is drowning in blood. (lobe resection, endobronchial tamponade, arterial embolization)
AV malformation à abnormal connection between an artery and vein. Prone to bleeding.
Hydatid cyst à Some parasite.

Respiratory causes
1.) Traumatic à Wounds, post-intubation, foreign body.
2.) Infective à Bronchiectasis, acute bronchitis, pneumonia, lung abscess, TB, acute on chronic COPD, fungi.
3.) Neoplastic à Primary or secondary
4.) Vascular à Lung infarction (PE), vasculitis (pulmonary haemorrhage in Wegener’s granulomatosis), RA, SLE, AV malformation
5.) Parenchymal à Diffuse interstitial fibrosis, sarcoidosis (granulomatous inflammatory disease), haemosiderosis (iron overload disorder), Goodpasture’s syndrome (autoimmune), cystic fibrosis.

Cardiovascular (pulmonary hypertension)

1.) Pulmonary odema, mitral stenosis, aortic aneurysm

Bleeding diatheses à susceptibility to bleeding (coagulopathy)

Oxford clinical handbook.