Page 1 of 135
FULL Grand Rounds Case Study + Acute
Bronchitis, COPD & Pneumonia Workup |
2026 with complete solutions.
Q1. Acute bronchitis is best defined as:
A) Bacterial infection of the lung parenchyma
B) Inflammation of the bronchi and bronchioles, usually viral
in origin, lasting <3 weeks
C) Chronic airflow obstruction with irreversible airway damage
D) Inflammation of the pleura
Answer: B
Rationale: Acute bronchitis is an acute, self-limited inflammation
of the large airways, typically caused by viruses (rhinovirus,
influenza, etc.). It lasts 10–14 days but cough may persist for up
to 3 weeks. It differs from pneumonia (parenchymal involvement)
and COPD (chronic, usually progressive).
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Q2. The most common cause of acute bronchitis in otherwise
healthy adults is:
A) Mycoplasma pneumoniae
B) Viral infection (e.g., rhinovirus, coronavirus, influenza)
C) Streptococcus pneumoniae
D) Bordetella pertussis
Answer: B
Rationale: Over 90% of acute bronchitis cases are viral.
Bacterial causes (e.g., Mycoplasma, Bordetella) are much less
common. Antibiotics are rarely indicated.
Q3. (Scenario) A 35-year-old otherwise healthy patient presents
with 4 days of cough productive of clear sputum, low-grade
fever (37.8°C), and nasal congestion. Vital signs are normal.
Chest auscultation reveals scattered rhonchi. The most
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appropriate next step is:
A) Chest X-ray
B) Supportive care with hydration and antitussives;
reassurance
C) Oral azithromycin
D) Sputum culture
Answer: B
Rationale: This presentation is typical of viral acute bronchitis.
Antibiotics are not indicated. Chest X-ray is not needed without
red flags (hypoxia, tachypnea, focal rales, fever >38.5°C).
Reassurance and symptomatic treatment are appropriate.
Q4. In acute bronchitis, the cough typically lasts:
A) 1–2 days
B) 1–3 weeks (often 10–14 days; up to 3 weeks)
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C) 4–6 weeks
D) >8 weeks
Answer: B
Rationale: Cough is the hallmark. It may persist for 2–3 weeks
even after other symptoms resolve. Post-infectious cough is
common.
Q5. Which of the following findings should prompt a chest X-ray
in a patient with suspected acute bronchitis?
A) Cough for 3 days
B) Heart rate 120 bpm, respiratory rate 28/min, and oxygen
saturation 89%
C) Low-grade fever (37.5°C)
D) Clear sputum production
Answer: B
Rationale: Hypoxia, tachypnea, and tachycardia are red flags
FULL Grand Rounds Case Study + Acute
Bronchitis, COPD & Pneumonia Workup |
2026 with complete solutions.
Q1. Acute bronchitis is best defined as:
A) Bacterial infection of the lung parenchyma
B) Inflammation of the bronchi and bronchioles, usually viral
in origin, lasting <3 weeks
C) Chronic airflow obstruction with irreversible airway damage
D) Inflammation of the pleura
Answer: B
Rationale: Acute bronchitis is an acute, self-limited inflammation
of the large airways, typically caused by viruses (rhinovirus,
influenza, etc.). It lasts 10–14 days but cough may persist for up
to 3 weeks. It differs from pneumonia (parenchymal involvement)
and COPD (chronic, usually progressive).
,Page 2 of 135
Q2. The most common cause of acute bronchitis in otherwise
healthy adults is:
A) Mycoplasma pneumoniae
B) Viral infection (e.g., rhinovirus, coronavirus, influenza)
C) Streptococcus pneumoniae
D) Bordetella pertussis
Answer: B
Rationale: Over 90% of acute bronchitis cases are viral.
Bacterial causes (e.g., Mycoplasma, Bordetella) are much less
common. Antibiotics are rarely indicated.
Q3. (Scenario) A 35-year-old otherwise healthy patient presents
with 4 days of cough productive of clear sputum, low-grade
fever (37.8°C), and nasal congestion. Vital signs are normal.
Chest auscultation reveals scattered rhonchi. The most
,Page 3 of 135
appropriate next step is:
A) Chest X-ray
B) Supportive care with hydration and antitussives;
reassurance
C) Oral azithromycin
D) Sputum culture
Answer: B
Rationale: This presentation is typical of viral acute bronchitis.
Antibiotics are not indicated. Chest X-ray is not needed without
red flags (hypoxia, tachypnea, focal rales, fever >38.5°C).
Reassurance and symptomatic treatment are appropriate.
Q4. In acute bronchitis, the cough typically lasts:
A) 1–2 days
B) 1–3 weeks (often 10–14 days; up to 3 weeks)
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C) 4–6 weeks
D) >8 weeks
Answer: B
Rationale: Cough is the hallmark. It may persist for 2–3 weeks
even after other symptoms resolve. Post-infectious cough is
common.
Q5. Which of the following findings should prompt a chest X-ray
in a patient with suspected acute bronchitis?
A) Cough for 3 days
B) Heart rate 120 bpm, respiratory rate 28/min, and oxygen
saturation 89%
C) Low-grade fever (37.5°C)
D) Clear sputum production
Answer: B
Rationale: Hypoxia, tachypnea, and tachycardia are red flags
