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I-Human Case Study Week 3 Shortness of Breath 60-Year-
Old Female Outpatient Clinic Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed Rationales |
100% Verified – Pass Guaranteed – A+ Graded
History Taking & Differential Diagnosis
Q1: Ms. Jenkins, a 60-year-old female, presents to the outpatient clinic complaining of shortness
of breath. She states it started gradually over the last three weeks but has worsened significantly
in the past two days. Which of the following questions is most critical to ask first to differentiate
between a cardiac and pulmonary cause?
A. "Do you have a family history of lung disease?"
B. "Is your shortness of breath worse when you lie flat to sleep at night?"
C. "Have you been traveling long distances recently?"
D. "What type of diet do you typically eat?"
Correct Answer: B
Rationale: Asking about orthopnea (shortness of breath when lying flat) is a key discriminator for
heart failure, as fluid redistributes centrally when supine, whereas pulmonary causes like COPD
or pneumonia may not necessarily vary strictly by position.
Q2: Ms. Jenkins reports that she needs to prop herself up on three pillows to sleep comfortably,
and sometimes wakes up gasping for air. She also mentions she has noticed her shoes feeling
tighter recently. Based on this history, which differential diagnosis is the most likely primary
driver?
A. Community-acquired pneumonia
B. Acute pulmonary embolism
C. Decompensated heart failure
D. Chronic obstructive pulmonary disease (COPD)
Correct Answer: C
Rationale: Orthopnea, paroxysmal nocturnal dyspnea (waking up gasping), and peripheral edema
(tight shoes) are classic hallmarks of fluid overload seen in decompensated heart failure.
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Q3: When inquiring about the quality of her breathing, Ms. Jenkins describes it as a "feeling of
air hunger" and notes she gets very tired after walking half a block. She denies wheezing but
notes she has had a dry cough occasionally. Which associated symptom would most strongly
suggest an ischemic cardiac origin rather than just heart failure?
A. Hemoptysis
B. Fever and chills
C. Chest pressure radiating to the left arm
D. Post-nasal drip
Correct Answer: C
Rationale: While heart failure causes dyspnea, chest pressure radiating to the arm is a classic sign
of myocardial ischemia (angina), which could be the underlying cause of the heart failure
exacerbation, whereas hemoptysis suggests pulmonary or vascular issues.
Q4: You review Ms. Jenkins' past medical history. She has a history of hypertension but was
never diagnosed with asthma or COPD. She was recently started on Lisinopril for her blood
pressure. Given the new medication, what specific question regarding her cough is important to
differentiate side effects from pathology?
A. "Is the cough productive of yellow or green sputum?"
B. "Is the cough dry, hacking, and persistent throughout the day?"
C. "Does the cough occur primarily after eating spicy foods?"
D. "Do you cough only when you are outside in the cold?"
Correct Answer: B
Rationale: ACE inhibitors like Lisinopril are well-known to cause a dry, hacking, persistent
cough in a significant percentage of patients; distinguishing this side effect from a cough due to
pulmonary edema or bronchitis is crucial for medication management.
Q5: Ms. Jenkins admits she smoked "a pack a day" for about 25 years but quit 5 years ago. How
should you document and interpret this smoking history in terms of risk for shortness of breath?
A. 25 pack-year history; significant risk for COPD and cardiovascular disease
B. 5-year history; risk is negligible since she quit
C. 20 pack-year history; risk is limited to lung cancer only
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D. Social smoker; no significant contribution to current dyspnea
Correct Answer: A
Rationale: Pack-years are calculated by packs per day multiplied by years smoked (1 x 25 = 25
pack-years), which constitutes a significant risk factor for developing both COPD and coronary
artery disease, contributing to her current presentation.
Q6: During the review of systems, Ms. Jenkins mentions she has felt "fluttering" in her chest
occasionally. Which cardiac arrhythmia is most commonly associated with the sensation of
palpitations and acute worsening of shortness of breath in a 60-year-old with potential heart
failure?
A. Atrial fibrillation
B. First-degree heart block
C. Sinus bradycardia
D. Premature ventricular contractions (PVCs)
Correct Answer: A
Rationale: Atrial fibrillation causes an irregularly irregular heartbeat (often felt as palpitations)
and loss of atrial kick, which can significantly decompensate a patient with underlying heart
failure, causing acute dyspnea.
Q7: You consider pulmonary embolism (PE) in your differential. Which question is most relevant
to assess her risk factors for a PE?
A. "Have you had any recent unexplained weight loss?"
B. "Have you had any recent surgeries, long car rides, or periods of immobility?"
C. "Do you have a history of seasonal allergies?"
D. "Have you been exposed to anyone with tuberculosis?"
Correct Answer: B
Rationale: Virchow’s triad includes stasis; recent surgery, long travel, or immobility are major
risk factors for deep vein thrombosis (DVT) and subsequent pulmonary embolism.
I-Human Case Study Week 3 Shortness of Breath 60-Year-
Old Female Outpatient Clinic Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed Rationales |
100% Verified – Pass Guaranteed – A+ Graded
History Taking & Differential Diagnosis
Q1: Ms. Jenkins, a 60-year-old female, presents to the outpatient clinic complaining of shortness
of breath. She states it started gradually over the last three weeks but has worsened significantly
in the past two days. Which of the following questions is most critical to ask first to differentiate
between a cardiac and pulmonary cause?
A. "Do you have a family history of lung disease?"
B. "Is your shortness of breath worse when you lie flat to sleep at night?"
C. "Have you been traveling long distances recently?"
D. "What type of diet do you typically eat?"
Correct Answer: B
Rationale: Asking about orthopnea (shortness of breath when lying flat) is a key discriminator for
heart failure, as fluid redistributes centrally when supine, whereas pulmonary causes like COPD
or pneumonia may not necessarily vary strictly by position.
Q2: Ms. Jenkins reports that she needs to prop herself up on three pillows to sleep comfortably,
and sometimes wakes up gasping for air. She also mentions she has noticed her shoes feeling
tighter recently. Based on this history, which differential diagnosis is the most likely primary
driver?
A. Community-acquired pneumonia
B. Acute pulmonary embolism
C. Decompensated heart failure
D. Chronic obstructive pulmonary disease (COPD)
Correct Answer: C
Rationale: Orthopnea, paroxysmal nocturnal dyspnea (waking up gasping), and peripheral edema
(tight shoes) are classic hallmarks of fluid overload seen in decompensated heart failure.
,2
Q3: When inquiring about the quality of her breathing, Ms. Jenkins describes it as a "feeling of
air hunger" and notes she gets very tired after walking half a block. She denies wheezing but
notes she has had a dry cough occasionally. Which associated symptom would most strongly
suggest an ischemic cardiac origin rather than just heart failure?
A. Hemoptysis
B. Fever and chills
C. Chest pressure radiating to the left arm
D. Post-nasal drip
Correct Answer: C
Rationale: While heart failure causes dyspnea, chest pressure radiating to the arm is a classic sign
of myocardial ischemia (angina), which could be the underlying cause of the heart failure
exacerbation, whereas hemoptysis suggests pulmonary or vascular issues.
Q4: You review Ms. Jenkins' past medical history. She has a history of hypertension but was
never diagnosed with asthma or COPD. She was recently started on Lisinopril for her blood
pressure. Given the new medication, what specific question regarding her cough is important to
differentiate side effects from pathology?
A. "Is the cough productive of yellow or green sputum?"
B. "Is the cough dry, hacking, and persistent throughout the day?"
C. "Does the cough occur primarily after eating spicy foods?"
D. "Do you cough only when you are outside in the cold?"
Correct Answer: B
Rationale: ACE inhibitors like Lisinopril are well-known to cause a dry, hacking, persistent
cough in a significant percentage of patients; distinguishing this side effect from a cough due to
pulmonary edema or bronchitis is crucial for medication management.
Q5: Ms. Jenkins admits she smoked "a pack a day" for about 25 years but quit 5 years ago. How
should you document and interpret this smoking history in terms of risk for shortness of breath?
A. 25 pack-year history; significant risk for COPD and cardiovascular disease
B. 5-year history; risk is negligible since she quit
C. 20 pack-year history; risk is limited to lung cancer only
, 3
D. Social smoker; no significant contribution to current dyspnea
Correct Answer: A
Rationale: Pack-years are calculated by packs per day multiplied by years smoked (1 x 25 = 25
pack-years), which constitutes a significant risk factor for developing both COPD and coronary
artery disease, contributing to her current presentation.
Q6: During the review of systems, Ms. Jenkins mentions she has felt "fluttering" in her chest
occasionally. Which cardiac arrhythmia is most commonly associated with the sensation of
palpitations and acute worsening of shortness of breath in a 60-year-old with potential heart
failure?
A. Atrial fibrillation
B. First-degree heart block
C. Sinus bradycardia
D. Premature ventricular contractions (PVCs)
Correct Answer: A
Rationale: Atrial fibrillation causes an irregularly irregular heartbeat (often felt as palpitations)
and loss of atrial kick, which can significantly decompensate a patient with underlying heart
failure, causing acute dyspnea.
Q7: You consider pulmonary embolism (PE) in your differential. Which question is most relevant
to assess her risk factors for a PE?
A. "Have you had any recent unexplained weight loss?"
B. "Have you had any recent surgeries, long car rides, or periods of immobility?"
C. "Do you have a history of seasonal allergies?"
D. "Have you been exposed to anyone with tuberculosis?"
Correct Answer: B
Rationale: Virchow’s triad includes stasis; recent surgery, long travel, or immobility are major
risk factors for deep vein thrombosis (DVT) and subsequent pulmonary embolism.
