Cough History Taking | OSCE Tips
Cough history taking is a crucial skill that is frequently tested in OSCEs. This tutorial offers a methodical way to collect a cough history during an OSCE.
Presenting complaint (PC):
What brought you here today?
History presenting complaint (HPC):
Onset: when did it start? Is it constant or intermittent?
Duration of cough: how long have you had the cough for?
Note
Cough is >3 months: COPD.
Cough is worse at night: Asthma.
Cough worse when lying flat: Heart failure or GORD.
Frequency of cough: how often are you coughing?
Type of cough (dry or productive): are you coughing up anything?
Note:
Dry cough likely: Asthma
Coughing up blood : Pulmonary Embolism, Tuberculosis , Bronchiectasis or cancer.
Sputum production: Pneumonia
Pink, frothy sputum: Heart failure
Precipitating or exacerbating factors: is it worse at night? Or during exercise?
Associate symptoms: any wheeze, sore throat, chest pain, gastrointestinal symptoms,Recent respiratory tract infection, Recent travel history, Peripheral oedema fever?
Now is a good idea to ask Ideas, Concerns & Expectations (ICE)
Past medical history (PMH):
Is there any chronic illness that I should know about that we have not covered?
If yes: ask about severity and if this has caused them to be admitted to hospital (for example an exacerbation of asthma requiring admission).
Drug history (DH):
Are you taking any medication? If so, any side effects.
Note: common s/e from an ACEi (for example Ramipril) is a persistent dry cough.
Family history (FMH):
Is there any family history of asthma, eczema, heart disease or DVT/PE I should know about?
Social History (SH):
Do you smoke? Any recent travel? Occupation?
Possible differential diagnosis:
Respiratory causes:
Respiratory infection generally causes a productive cough, shortness of breath and fever.
Asthma - nocturnal cough, intermittent wheeze, sob on exercises? Caused by a Pet? Environmental?
COPD - produce cough (chronic), sob, smoking history
Lung tumour - haemoptysis, weight loss, smoking history
Pulmonary embolism (PE): sharp, pleuritic chest pain, hemoptysis, calf pain (symptoms of DVT), recent long travel, oral contraceptive.
Cardiac causes:
Heart failure: pink frothy sputum, sob/cough worse when lying down
Gastrointestinal causes:
Gastro-oesophageal reflux disease (GORD): cough worse with certain foods e.g spicy, heartburn symptoms, sensation of something stuck in throat.
Investigation:
Bedside: respiratory examination, Oxygen saturation (SPO2), pulse/heart rate (HR), blood pressure (BP), respiratory rate (RR)
Bloods : full blood count (FBC), urea and electrolyte (U&E), c-reactive protein (CRP) + Erythrocyte Sedimentation Rate (ESR) and Brain natriuretic peptide (BNP)
Imaging: Chest XR
Spirometry
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