Cough Objectives and References

Objectives:

By the end of the Family Medicine clerkship, a medical student will be able to:

1. Conduct a patient interview and appropriate focused physical examination to identify the common and important causes of cough, particularly

a. Acute causes

         Infectious (viral/bacterial)

         Exacerbation of Asthma

         Exacerbation of COPD

         Post-viral cough

         Exacerbation of CHF

b. Chronic causes (including screening for red flags, eg. weight loss, hemoptysis)

         Post-nasal drip

         GERD

         Asthma (refer to Asthma Objectives)

         COPD/Smoking

         Infection (eg. tuberculosis)

         Medication (i.e. ACE Inhibitor)

         Congestive Heart Failure

         Neoplasm

2. Include an appropriate environmental, occupational, and travel history as part of the patient interview.

3. Propose a relevant initial investigation plan (e.g. chest xray, spirometry) for a patient with cough.

4. Recognize a patient with respiratory distress (e.g. hypoxia, tachypnea, etc.) and seek immediate help.  

5. Suggest a preliminary/initial management plan for patients with cough, particularly for the acute and chronic causes listed above, avoiding unnecessary use of antibiotics.


References:


Recommended Resources Addressing the Objectives

Evaluation of the patient with chronic cough (5 pages)

Objectives covered: 1ab, 2 (partially), 3, 5

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

Benich JJ,3rd, Carek PJ. Evaluation of the patient with chronic cough. Am Fam Physician 2011 Oct 15;84(8):887-892.

PMID:22010767

Acute Respiratory Distress Syndrome: Diagnosis and Management (6 pages)

Objectives covered: 4

http://www.aafp.org/afp/2012/0215/p352.pdf

Saguil A, Fargo M. Acute respiratory distress syndrome: diagnosis and management. Am Fam Physician 2012 Feb 15;85(4):352-358.

PMID:22335314

Severe respiratory syndromes: travel history matters (3 pages)

Objectives covered: 2 (travel hx)

http://www.ncbi.nlm.nih.gov/pubmed/23820509

Hon KL. Severe respiratory syndromes: travel history matters. Travel Med Infect Dis 2013 Sep-Oct;11(5):285-287.

PMID:23820509

Additional resources

Article with a more in-depth look at pathogenesis, process, and complications of cough (10 pages)

Objectives covered: 1ab, 5

http://www.ncbi.nlm.nih.gov/pubmed/20172252

Madison JM, Irwin RS. Cough: a worldwide problem. Otolaryngol Clin North Am 2010 Feb;43(1):1-13, vii.

PMID:20172252

Top 10 causes of cough in family medicine, plus clinical pearls (1 page):

Objectives covered: 1ab

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1952600/

Ponka D, Kirlew M. Top 10 differential diagnoses in family medicine: Cough. Can Fam Physician 2007 Apr;53(4):690-691.

PMID:17872721


Canadian Thoracic Society COPD Recommendations 2008 Update


Tops Guidelines: Can Respir J V:15 Suppl A 2008


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