What question would have been asked, When the cough first started, any factors that may have caused the cough (recent respiratory infections, exposure, new medication, seasonal allergies, work and hobbies) He did begin lisinopril 3 months before the cough began. We would also ask if the cough is worse upon rising, at bedtime, during exercise?

What question would have been asked, When the cough first started, any factors that may have caused the cough (recent respiratory infections, exposure, new medication, seasonal allergies, work and hobbies) He did begin lisinopril 3 months before the cough began. We would also ask if the cough is worse upon rising, at bedtime, during exercise? Does anything make the cough better or worse? What is the quality of the cough- dry and hacking or wet? Does the cough produce any sputum? Is the cough worse when laying down? 2. Physical aspects of exam? Check ears- looking for cerumen or any hairs impinging on the tympanic membrane. Examine nose for discharge, edema, polyps. Check for sinus tenderness. Examine throat for postnasal drip. Palpate the neck, checking for enlarged lymph nodes or masses. Assess the thorax and chest to rule out cardiac or pulmonary issues. Auscultate the lungs. Would order a CBC with diff to check for potential bacterial infection. If there were signs of pneumonia or symptoms worsened we would do a chest x-ray. May also order chest CT if patients symptoms worsen. Spirometry may help determine obstructive lung disease. 3. Likely cause of cough? At this point, I’m leaning towards the lisinopril as the cause. ACE inhibitors have a dry, irritating cough as a common side effect. His physical exam was normal and I see no indication for pneumonia at this time. 4. Differential diagnoses? COPD, Pneumonia, environmental allergies 5. Any tests that should be completed before producing a diagnosis? Check the CBC with diff just to ensure the WBC is not high. Otherwise, at this time ACE inhibitor-induced cough is our functioning diagnosis. 6. Treatment? Tessalon perles would be a reasonable treatment at this point, while switching our hypertension medication. Another ACE inhibitor would cause the same side effect. We will try switching to an angiotensin II receptor blocker to manage hypertension instead. Losartan 50 mg PO daily. Educate on stopping lisinopril, beginning losartan instead. Side effects may include cold symptoms, muscle cramps, stomach pain or diarrhea, headache or dizziness, and insomnia. Instruct patient to report any side effects. Please add 1 referenceShow more