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A 53-year-old male is accompanied by his wife to your office and complains of a cough. The cough began 6 weeks ago and has been especially bothersome several nights over the past month. He does not produce any sputum and denies shortness of breath, chest pain, or wheezing. He takes an antacid once or twice a day to “settle my stomach.” He smoked 3 packs of cigarettes per day until 1 year ago, when he quit “cold turkey.” He denies any significant medical history and only takes 1 aspirin a day. He specifically denies any history related to cardiac disorders. He has not recently lost weight nor had any cold symptoms, fevers, or night sweats. His wife reports that he snores at night, and she adds, “He’s always hacking and clearing his throat.” In order to sleep better, he has recently started to have a shot of whiskey before going to bed.
What is the most likely cause for the cough? |
| | A) | Gastroesophageal reflux. |
| | B) | Lung cancer. |
| | C) | Aspirin use. |
| | D) | Alcohol abuse. |
| | E) | Congestive heart failure. |
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2 | |
On physical examination, you note a well-nourished male in no distress. His vital signs are normal. His lungs are clear to auscultation. The nasal and oropharyngeal mucosae are intact, moist, and not inflamed. The remainder of the exam is unremarkable. You suspect GERD, but also entertain other diagnoses.
Which of the following is your next step in managing this patient’s cough? |
| | A) | Start ranitidine or another H-2 blocker. |
| | B) | Order spirometry. |
| | C) | Order 24-hour esophageal pH monitoring. |
| | D) | Refer for esophageal endoscopy. |
| | E) | Obtain a chest x-ray. |
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3 | |
He does not respond after 2 months of empiric treatment, and he is becoming more concerned. The examination is unchanged. Chest x-ray is remarkable for flattened diaphragms but is otherwise negative. Spirometry is normal with a normal flow volume loop.
Which of the following management options is LEAST likely to benefit this patient? |
| | A) | Combination antihistamine and decongestant. |
| | B) | Inhaled corticosteroid. |
| | C) | Inhaled beta-2 agonist. |
| | D) | Antibiotics. |
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