Pulmonology Book

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Chronic Cough Evaluation in Children

Aka: Chronic Cough Evaluation in Children
  1. History
    1. Nature of cough
      1. Croupy cough
      2. Loose rattling cough
      3. Throat clearing (Hawking) suggests postnasal drip
      4. Dry brassy cough ("kak kak kak")
    2. Cough Timing
      1. Cough during sleep
        1. Post Nasal discharge
        2. Bronchospasm
      2. Cough on awakening (Sputum productive)
        1. Consider Cystic Fibrosis
      3. Cough with Feeding
        1. Gastroesophageal Reflux disease
        2. Aspiration
        3. Discoordinated swallow
      4. Psychogenic cough disappears with sleep
      5. Seasonal cough
        1. Spring or fall: Allergic Rhinitis
        2. Winter: Bronchospasm from irritation
  2. Examination
    1. General
      1. Evaluate pediatric height and weight curves
    2. Head and neck
      1. Evaluate for Acute Sinusitis
      2. Evaluate for Allergic Rhinitis
    3. Chest
      1. Anteroposterior Diameter
      2. Localized crackles and Wheezes
      3. Resonance
      4. Decreased air entry or lag
    4. Digital Clubbing
  3. Imaging
    1. Chest XRay
  4. Labs
    1. Sputum exam
    2. Purified Protein Derivative (PPD)
    3. Sweat Chloride
    4. Pulmonary Function Testing

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