Diagnosis And Treatment Of Cough

5 Questions | By Uscsom_im | Last updated: May 2, 2019 | Total Attempts: 196

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Questions and Answers

1.

A 27-year-old woman with no significant medical history presents for initial evaluation of cough of 4 months' duration. Her cough is worse with exertion and at night and has occasionally wakened her from sleep. She denies experiencing any wheezing. She does not smoke, and she has no history of atopic skin changes. On physical examination, the patient's respiratory rate is normal. The cardiopulmonary examination is also normal. For this patient, which of the following interventions should be undertaken at this time?
- A.
  
  Trial of oral steroids
- B.
  
  Trial of inhaled steroids
- C.
  
  Pulmonary function tests with methacholine challenge
- D.
  
  Transthoracic echocardiogram
- E.
  
  Bronchoscopy with transbronchial biopsy
2.

A 22-year-old woman with no significant medical history is seen for evaluation of cough. Ten days ago, she developed conjunctivitis, nasal drainage, cough, and fever. All symptoms have resolved except for the cough. She is now experiencing paroxysms of cough; on two occasions, she experienced episodes of emesis following cough. There have been no reports of similar symptoms in her community, but the patient does report traveling to see family members 1 month ago. Her cousin had similar symptoms of upper respiratory tract infection; her cousin's symptoms resolved after taking antibiotics. The patient usually smokes 1 pack of cigarettes daily and has done so for 3 years; she has been unable to smoke for the past 5 days. What is the most likely cause of this patient's subacute cough?

Discuss
- A.
  
  Chronic bronchitis
- B.
  
  Viral upper respiratory tract infection
- C.
  
  Gastroesophageal reflux disease (GERD)
- D.
  
  Bordetella pertussis infection
3.

A 57-year-old man presents for initial evaluation of cough. The cough has been present for 6 months. Initially, it was intermittent in nature, but it now occurs daily. He denies having any sputum or experiencing fever, chills, weight loss, shortness of breath, chest pain, dyspnea on exertion, or orthopnea. He quit smoking cigarettes 30 years ago after having smoked 1 pack a day for 5 years. He drinks 2 or 3 alcoholic beverages most nights. His medical history is significant for type 2 diabetes mellitus and hypertension. He takes metformin, hydrochlorothiazide, and lisinopril. On examination, the patient weighs 245 lb, and he has a body mass index (BMI) of 30. Except for the patient's obesity, results of HEENT, neck, cardiopulmonary, and abdominal examinations are within normal limits. Over the past 6 months, the patient has tried cough suppressants, nasal steroids, and antireflux therapy, without results. What is the most likely cause of this patient's chronic cough?

Discuss
- A.
  
  Chronic bronchitis
- B.
  
  Allergic rhinitis
- C.
  
  GERD
- D.
  
  Heart failure
- E.
  
  Use of angiotensin-converting enzyme (ACE) inhibitors
4.

A 57-year-old man is seen for evaluation of cough. He has been experiencing cough with nasal drainage for the past 3 weeks. These symptoms were preceded by sinus congestion and nasal drainage that lasted for about 1 week. He denies having sputum or experiencing fever or chills, and he states that he has otherwise been feeling well. On examination, the patient has no fever. His oropharyngeal examination is normal, and his lungs are clear. He does frequently clear his throat during the examination. How would you confirm the diagnosis of upper airway cough syndrome (UACS) for this patient?

Discuss
- A.
  
  Laryngoscopy with biopsy
- B.
  
  Bronchoscopy with endobronchial biopsy
- C.
  
  Observing a clinical response to oral steroids
- D.
  
  Observing a clinical response to levofloxacin
- E.
  
  Observing a clinical response to antihistamine and decongestants
5.

A 65-year-old man presents for evaluation of cough. He has been experiencing episodes of cough for the past 2 to 3 months. The cough is worse at night. The cough does not produce sputum. The patient denies experiencing any weight loss, fever, or chills. He is a lifetime nonsmoker. He denies having any occupational exposures to lung irritants. He reports occasional epigastric discomfort, especially at night. His medical history is significant for hypertension and osteoarthritis. He takes hydrochlorothiazide and occasionally ibuprofen and acetaminophen. On examination, the patient weighs 240 lb. He has a BMI of 32. HEENT, neck, cardiovascular, pulmonary, and gastrointestinal examinations are normal. A chest x-ray is unremarkable. The patient has tried an empirical regimen of inhaled steroids and montelukast, without response. Of the following, which is the most appropriate approach to confirm a diagnosis of chronic cough associated with GERD in this patient?

Discuss
- A.
  
  Resolution of cough after discontinuing hydrochlorothiazide
- B.
  
  Resolution of cough after initiation of oral steroids
- C.
  
  Resolution of cough after initiation of antireflux therapy
- D.
  
  Response to botulinum toxin injection to lower esophageal sphincter
- E.
  
  24-Hour esophageal pH monitoring

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