PEM Source

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Question: Cough

Your next patient, actually your next 10 patients, are brought in by their parents because they have been coughing for 2 weeks. Match the characteristic of the cough with the appropriate treatment (you may use letters twice or not at all). (Cannot answer on-line – jot down your answers and then check back for discussion).

  1. Dry cough worse at night and when out in the cold air
  2. Cough that sounds like a seal or dog barking
  3. Cough with an inspiration between each cough (staccato cough)
  4. Wet phlegmy cough accompanied by nasal congestion
  5. Paroxysms of cough with post-tussive vomiting
  1. Albuterol
  2. Amoxicillin
  3. Azithromycin
  4. Dark honey
  5. Dexamethasone

pemsou5_wp • May 2, 2023

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  1. Kelly May 2, 2023 - 9:21 am Reply

    1A, 2E, 3C, 4B 5C
    There are several characteristic pediatric coughs to know. A dry cough that is worse at night, in the cold air, or with exercise can be reactive airways or cough-variant asthma, especially in an atopic patient or a patient with strong family history of atopic diseases. A barking cough is associated with croup, both viral and spasmodic / recurrent allergic. A staccato cough in young infants is associated with chlamydial pneumonia. A wet phlegmy cough with nasal congestion is the cough of a standard viral URI; however, if it has been present and unremitting for 10-14 days, consider empiric treatment for bacterial sinusitis. The key is unremitting. Coughs that improve but don’t completely resolve, then return, are more likely serial viral URIs, especially in young kids in daycare, preschool, or early elementary grades, with frequent exposure to other sick kids. Paroxysms of cough, with or without the characteristic whoop, and post-tussive vomiting are associated with pertussis. Dark honey may calm any of the coughs and is worth a try (the child should be past their first birthday to avoid infant botulism risks). Another cough characterized as honking, harsh, or with frequent throat-clearing is the habit cough, usually developing in schoolage children after an initial other cause of cough has resolved. The cough does not occur when the child is asleep.

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