COUGH /SHORTNESS OF BREATH

Question 1

30 yo M presents with shortness of
breath, cough, and wheezing that worsen
in cold air. He has had several such
episodes over the past four months.

Answer 1

Asthma CBC
GERD CXR
Bronchitis Peak flow measurement
Pneumonitis PFTs
Foreign body Methacholine challenge test

Question 2

56 yo F presents with shortness of breath
as well as with a productive cough that
has occurred over the past two years for
at least three months each year. She is a
heavy smoker.

Answer 2

COPD—chronic bronchitis CBC
Bronchiectasis Sputum Gram stain and culture
Lung cancer CXR
Tuberculosis PFTs
CT—chest
PPD

Question 3

58 yo M presents with pleuritic chest
pain, fever, chills, and cough with
purulent yellow sputum. He is a heavy
smoker with COPD.

Answer 3

Pneumonia CBC
Bronchitis Sputum Gram stain and culture
Lung abscess CXR
Lung cancer CT—chest
Tuberculosis ECG
Pericarditis PPD

Question 4

25 yo F presents with two weeks of a
nonproductive cough. Three weeks ago
she had a sore throat and a runny nose.

Answer 4

Atypical pneumonia CBC
Reactive airway disease Induced sputum Gram stain and culture
URI-associated (“postinfectious”) CXR
Postnasal drip IgM detection for Mycoplasma pneumoniae
GERD Urine Legionella antigen

Question 5

65 yo M presents with worsening cough
over the past six months together with
hemoptysis, dyspnea, weakness, and
weight loss. He is a heavy smoker.

Answer 5

Lung cancer CBC
Tuberculosis Sputum Gram stain, culture, and cytology
Lung abscess CXR
COPD CT—chest
Vasculitis (i.e., Wegener’s) PPD
Interstitial lung disease Bronchoscopy
CHF

Question 6

55 yo M presents with increased dyspnea
and sputum production over the past
three days. He has COPD and stopped
using his inhalers last week. He also
stopped smoking two days ago.

Answer 6

COPD exacerbation (bronchitis) CBC
Lung cancer PFTs
Pneumonia Sputum Gram stain and culture
URI CT—chest
CHF

Question 7

34 yo F nurse presents with worsening
cough of six weeks’ duration together
with weight loss, fatigue, night sweats,
and fever. She has a history of contact
with tuberculosis patients at work

Answer 7

Tuberculosis CBC
Pneumonia PPD
Lung abscess Sputum Gram stain, acid-fast stain, and culture
Vasculitis CXR
Lymphoma
Metastatic cancer CT—chest
HIV/AIDS Bronchoscopy
Sarcoidosis HIV antibody

Question 8

35 yo M presents with shortness of breath
and cough. He has had unprotected sex
with multiple sexual partners and was
recently exposed to a patient with active
tuberculosis.

Answer 8

Tuberculosis CBC
Pneumonia (including Pneumocystis jiroveci) PPD
Bronchitis Sputum Gram stain, acid-fast -
CHF (cardiomyopathy) stain, silver stain, and culture
Asthma CXR
Acute HIV infection HIV antibody

Question 9

50 yo M presents with a cough that
is exacerbated by lying down at night
and improved by propping up on three
pillows. He also reports exertional
dyspnea.

Answer 9

CHF CBC
Cardiac valvular disease CXR
GERD ECG
Pulmonary fibrosis Echocardiography
COPD PFTs
Postnasal drip BNP