Question

A 77-year-old woman presents with a cough of several weeks duration. The patient has seen 2 physicians for the cough; the 1st time was about 6 weeks ago, and the 2nd was 4 weeks ago. She was given antibiotics and a steroid inhaler. The cough is still there throughout the day, and it is particularly bothersome at night. She states the cough started after a mild upper respiratory tract infection that has cleared. She denies wheezing, shortness of breath, or chest pain. She has no symptoms referable to the head and neck; in particular, she has no throat pain or postnasal drip. Her past medical history is significant for celiac disease, and she follows a strict gluten-free diet. She also has mild hypertension; it is controlled with thiazides. She denies a history of asthma, smoking, or exposure to second-hand smoke.

On exam, her vital signs are normal. You observe an elderly woman in no acute distress; her HEENT, heart, abdominal, and lung exams are within normal limits. A chest X-ray is also within normal limits.

What would be the next step in the management of this patient?

1. Prescribe a decongestant/antihistamine
2. Prescribe a trial of prednisone
3. Perform sinus X-rays
4. Prescribe a proton pump inhibitor
5. Prescribe a cough suppressant, like codeine

Answer 1

The next step in the management of this patient would be to perform sinus X-rays. The patient's history and examination findings suggest that she may have chronic sinusitis, which can cause a chronic cough.

Step-by-step explanation:

The next step in the management of this patient would be to perform sinus X-rays. The patient's history and examination findings suggest that she may have chronic sinusitis, which can cause a chronic cough. Sinus X-rays can help to confirm this diagnosis and guide further management.