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Upper Airway Cough Syndrome — RACP Adult Medicine MCQ

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EasyRespiratoryUpper Airway Cough SyndromeRACP Adult Medicine

A 50-year-old man presents with a 6-month history of chronic cough worse at night, with throat clearing, nasal congestion, and cobblestone appearance of the posterior pharynx on examination. CXR is normal. Spirometry is normal. He has no heartburn. What is the most likely cause?

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Correct answer: D — Upper airway cough syndrome (post-nasal drip)

Chronic cough with throat clearing, nasal congestion, and cobblestoned posterior pharynx (lymphoid hyperplasia) is upper airway cough syndrome (previously post-nasal drip). Causes include allergic rhinitis, non-allergic rhinitis, and chronic sinusitis. First-line treatment is intranasal corticosteroid spray (e.g., fluticasone or mometasone) and second-generation antihistamine.

Reference: eTG Respiratory – 2024 – Chronic Cough; ACCP 2024