Clinical Scenarios

Clinical Scenario



By the end of Family Medicine Clerkship, students 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.

Clinical Cards



Recommended Resources Addressing the Objectives

Evaluation of the patient with chronic cough (5 pages)

Objectives covered: 1ab, 2 (partially), 3, 5
Benich JJ,3rd, Carek PJ. Evaluation of the patient with chronic cough. Am Fam Physician 2011 Oct 15;84(8):887-892.

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

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

Severe respiratory syndromes: travel history matters (3 pages)

Objectives covered: 2 (travel hx)
Hon KL. Severe respiratory syndromes: travel history matters. Travel Med Infect Dis 2013 Sep-Oct;11(5):285-287.

Additional Resources

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

Objectives covered: 1ab, 5
Madison JM, Irwin RS. Cough: a worldwide problem. Otolaryngol Clin North Am 2010 Feb;43(1):1-13, vii.

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

Objectives covered: 1ab
Ponka D, Kirlew M. Top 10 differential diagnoses in family medicine: Cough. Can Fam Physician 2007 Apr;53(4):690-691.