NSG 6320 ADULT HEALTH ADULTS
AND GERONTOLOGY WEEK 3
RESPIRATORY COUGH STUDY
GUIDE WITH QUESTIONS AN
EXAM
1. A 45-year-old presents with cough, rhinorrhea, and low-grade fever for 3 days.
Symptoms began after her child brought home a cold. What is the most likely etiology?
Answer: Viral upper respiratory infection (URI)
Rationale: Acute cough lasting < 3 weeks is most commonly due to viral URI.
Antibiotics are not indicated.
2. A 70-year-old nursing home resident develops confusion, lethargy, and a new cough
with purulent sputum. Temperature is 101.2°F. What is the most appropriate next step?
Answer: Chest x-ray and empiric antibiotics
Rationale: Elderly patients with pneumonia often present with confusion rather
than fever or respiratory distress. Delaying treatment increases mortality.
3. A 32-year-old presents with abrupt onset of fever, chills, and productive cough with
rust-colored sputum. Chest x-ray shows lobar consolidation. What is the likely
pathogen?
Answer: Streptococcus pneumoniae
Rationale: Pneumococcal pneumonia classically presents with abrupt onset, lobar
consolidation, and rust-colored sputum.
,4. A 28-year-old with no past medical history presents with dry cough, fever, and
headache. Chest x-ray shows patchy infiltrates. She recently returned from a camping
trip. What is the likely pathogen?
Answer: Mycoplasma pneumoniae
Rationale: “Atypical pneumonia” presents with dry cough, extrapulmonary
symptoms, and patchy infiltrates. Common in young adults.
5. A 55-year-old with COPD presents with increased dyspnea, increased sputum
purulence, and increased sputum volume. What is this clinical triad called?
Answer: Acute exacerbation of COPD (AECOPD)
Rationale: The “Anthonisen criteria” for exacerbation includes increased dyspnea,
sputum purulence, and sputum volume.
6. A 40-year-old presents with acute cough, wheezing, and chest tightness after
exposure to a friend’s cat. What is the first-line treatment?
Answer: Inhaled short-acting beta-agonist (albuterol)
Rationale: Acute bronchospasm due to allergen exposure is treated with rescue
bronchodilators.
7. A 75-year-old presents with acute cough and unilateral leg swelling. She is
tachycardic and hypoxic. What is the most concerning diagnosis?
Answer: Pulmonary embolism (PE)
Rationale: Acute cough with hypoxia and unilateral leg swelling raises suspicion
for PE. Wells score and CT angiography are indicated.
8. A 2-year-old presents with barking cough, stridor, and low-grade fever. What is the
diagnosis?
Answer: Croup (laryngotracheobronchitis)
, Rationale: Croup presents with seal-like barking cough and stridor, typically in
young children.
9. A 65-year-old with heart failure presents with acute cough, frothy pink sputum, and
dyspnea. Lung auscultation reveals crackles. What is the underlying mechanism?
Answer: Cardiogenic pulmonary edema
Rationale: Left ventricular failure leads to increased hydrostatic pressure, causing
transudate into alveoli, presenting as cough with pink frothy sputum.
10. A 50-year-old presents with acute cough after choking during a meal. He is now
coughing persistently and has diminished breath sounds on the right. What is the most
likely cause?
Answer: Foreign body aspiration
Rationale: Sudden onset of cough following choking suggests aspiration. Focal
decreased breath sounds may indicate obstruction.
11. A 30-year-old presents with acute cough, fever, pleuritic chest pain, and a friction
rub on auscultation. What is the diagnosis?
Answer: Acute pericarditis
Rationale: Pericardial friction rub with pleuritic pain that improves leaning
forward is classic for pericarditis.
12. A 68-year-old presents with acute cough and hemoptysis. He has a 40-pack-year
smoking history. What is the most concerning diagnosis?
Answer: Lung cancer
Rationale: Hemoptysis in an older smoker requires urgent evaluation for
malignancy, though bronchitis is a more common cause.
13. A 22-year-old presents with acute cough, sore throat, and fever. Rapid antigen test
is positive. What is the most appropriate treatment?
AND GERONTOLOGY WEEK 3
RESPIRATORY COUGH STUDY
GUIDE WITH QUESTIONS AN
EXAM
1. A 45-year-old presents with cough, rhinorrhea, and low-grade fever for 3 days.
Symptoms began after her child brought home a cold. What is the most likely etiology?
Answer: Viral upper respiratory infection (URI)
Rationale: Acute cough lasting < 3 weeks is most commonly due to viral URI.
Antibiotics are not indicated.
2. A 70-year-old nursing home resident develops confusion, lethargy, and a new cough
with purulent sputum. Temperature is 101.2°F. What is the most appropriate next step?
Answer: Chest x-ray and empiric antibiotics
Rationale: Elderly patients with pneumonia often present with confusion rather
than fever or respiratory distress. Delaying treatment increases mortality.
3. A 32-year-old presents with abrupt onset of fever, chills, and productive cough with
rust-colored sputum. Chest x-ray shows lobar consolidation. What is the likely
pathogen?
Answer: Streptococcus pneumoniae
Rationale: Pneumococcal pneumonia classically presents with abrupt onset, lobar
consolidation, and rust-colored sputum.
,4. A 28-year-old with no past medical history presents with dry cough, fever, and
headache. Chest x-ray shows patchy infiltrates. She recently returned from a camping
trip. What is the likely pathogen?
Answer: Mycoplasma pneumoniae
Rationale: “Atypical pneumonia” presents with dry cough, extrapulmonary
symptoms, and patchy infiltrates. Common in young adults.
5. A 55-year-old with COPD presents with increased dyspnea, increased sputum
purulence, and increased sputum volume. What is this clinical triad called?
Answer: Acute exacerbation of COPD (AECOPD)
Rationale: The “Anthonisen criteria” for exacerbation includes increased dyspnea,
sputum purulence, and sputum volume.
6. A 40-year-old presents with acute cough, wheezing, and chest tightness after
exposure to a friend’s cat. What is the first-line treatment?
Answer: Inhaled short-acting beta-agonist (albuterol)
Rationale: Acute bronchospasm due to allergen exposure is treated with rescue
bronchodilators.
7. A 75-year-old presents with acute cough and unilateral leg swelling. She is
tachycardic and hypoxic. What is the most concerning diagnosis?
Answer: Pulmonary embolism (PE)
Rationale: Acute cough with hypoxia and unilateral leg swelling raises suspicion
for PE. Wells score and CT angiography are indicated.
8. A 2-year-old presents with barking cough, stridor, and low-grade fever. What is the
diagnosis?
Answer: Croup (laryngotracheobronchitis)
, Rationale: Croup presents with seal-like barking cough and stridor, typically in
young children.
9. A 65-year-old with heart failure presents with acute cough, frothy pink sputum, and
dyspnea. Lung auscultation reveals crackles. What is the underlying mechanism?
Answer: Cardiogenic pulmonary edema
Rationale: Left ventricular failure leads to increased hydrostatic pressure, causing
transudate into alveoli, presenting as cough with pink frothy sputum.
10. A 50-year-old presents with acute cough after choking during a meal. He is now
coughing persistently and has diminished breath sounds on the right. What is the most
likely cause?
Answer: Foreign body aspiration
Rationale: Sudden onset of cough following choking suggests aspiration. Focal
decreased breath sounds may indicate obstruction.
11. A 30-year-old presents with acute cough, fever, pleuritic chest pain, and a friction
rub on auscultation. What is the diagnosis?
Answer: Acute pericarditis
Rationale: Pericardial friction rub with pleuritic pain that improves leaning
forward is classic for pericarditis.
12. A 68-year-old presents with acute cough and hemoptysis. He has a 40-pack-year
smoking history. What is the most concerning diagnosis?
Answer: Lung cancer
Rationale: Hemoptysis in an older smoker requires urgent evaluation for
malignancy, though bronchitis is a more common cause.
13. A 22-year-old presents with acute cough, sore throat, and fever. Rapid antigen test
is positive. What is the most appropriate treatment?
