1|Page
NR 601: PRIMARY CARE OF THE MATURING AND
AGED FAMILY – WEEK 2## COPD CASE STUDY: PART
1 (2025/2026)## HIGH-YIELD | GOLD GUIDELINES |
CLINICAL REASONING
## Table of Contents
| Section | Content |
|---------|---------|
| 1 | Case Presentation |
| 2 | Focused History Questions |
| 3 | Physical Examination Findings |
| 4 | Differential Diagnoses |
| 5 | Diagnostic Workup |
| 6 | Initial Management Plan |
| 7 | Clinical Reasoning & Rationales |
| 8 | Practice Questions (10) with Answers |
---
,2|Page
## Section 1: Case Presentation
**Patient:** James T., 68-year-old male
**Chief Complaint:** “I can’t catch my breath and I’ve been coughing
for months.”
**History of Present Illness (HPI):**
Mr. James presents to the primary care clinic with progressive dyspnea
on exertion over the past 2 years, worsening over the last 3 months. He
reports a daily productive cough (white-to-clear sputum) for most days
of the week, worse in the mornings. He experiences occasional
wheezing. He notes that he cannot walk one block without stopping to
catch his breath. He has had 2 episodes of “chest colds” in the past year
requiring antibiotics. No hemoptysis, fever, or night sweats. No
orthopnea or paroxysmal nocturnal dyspnea (PND). He denies chest pain
or palpitations.
**Past Medical History (PMH):**
- Hypertension (diagnosed 10 years ago) – controlled with lisinopril
- Hyperlipidemia – on atorvastatin
- GERD (reflux) – occasional omeprazole
- No asthma, no heart failure, no diabetes
**Medications:**
, 3|Page
- Lisinopril 10 mg daily
- Atorvastatin 20 mg daily
- Omeprazole 20 mg PRN
**Allergies:** No known drug allergies (NKDA)
**Social History:**
- **Smoking:** 50 pack-year history (1.5 packs/day × 35 years). Quit 2
months ago after a scare with “not being able to breathe.”
- **Alcohol:** 2–3 beers per week
- **Occupation:** Retired factory worker (exposed to dust and fumes
for 30 years)
- **Living situation:** Lives with wife in a two-story home. Bedroom
upstairs – notes he now avoids stairs.
**Family History:**
- Father: COPD, died at age 72 from lung cancer
- Mother: Hypertension
- No known alpha-1 antitrypsin deficiency in family
**Review of Systems (ROS) – Positive findings:**
- **Respiratory:** Dyspnea on exertion, chronic cough, sputum
production, wheezing
NR 601: PRIMARY CARE OF THE MATURING AND
AGED FAMILY – WEEK 2## COPD CASE STUDY: PART
1 (2025/2026)## HIGH-YIELD | GOLD GUIDELINES |
CLINICAL REASONING
## Table of Contents
| Section | Content |
|---------|---------|
| 1 | Case Presentation |
| 2 | Focused History Questions |
| 3 | Physical Examination Findings |
| 4 | Differential Diagnoses |
| 5 | Diagnostic Workup |
| 6 | Initial Management Plan |
| 7 | Clinical Reasoning & Rationales |
| 8 | Practice Questions (10) with Answers |
---
,2|Page
## Section 1: Case Presentation
**Patient:** James T., 68-year-old male
**Chief Complaint:** “I can’t catch my breath and I’ve been coughing
for months.”
**History of Present Illness (HPI):**
Mr. James presents to the primary care clinic with progressive dyspnea
on exertion over the past 2 years, worsening over the last 3 months. He
reports a daily productive cough (white-to-clear sputum) for most days
of the week, worse in the mornings. He experiences occasional
wheezing. He notes that he cannot walk one block without stopping to
catch his breath. He has had 2 episodes of “chest colds” in the past year
requiring antibiotics. No hemoptysis, fever, or night sweats. No
orthopnea or paroxysmal nocturnal dyspnea (PND). He denies chest pain
or palpitations.
**Past Medical History (PMH):**
- Hypertension (diagnosed 10 years ago) – controlled with lisinopril
- Hyperlipidemia – on atorvastatin
- GERD (reflux) – occasional omeprazole
- No asthma, no heart failure, no diabetes
**Medications:**
, 3|Page
- Lisinopril 10 mg daily
- Atorvastatin 20 mg daily
- Omeprazole 20 mg PRN
**Allergies:** No known drug allergies (NKDA)
**Social History:**
- **Smoking:** 50 pack-year history (1.5 packs/day × 35 years). Quit 2
months ago after a scare with “not being able to breathe.”
- **Alcohol:** 2–3 beers per week
- **Occupation:** Retired factory worker (exposed to dust and fumes
for 30 years)
- **Living situation:** Lives with wife in a two-story home. Bedroom
upstairs – notes he now avoids stairs.
**Family History:**
- Father: COPD, died at age 72 from lung cancer
- Mother: Hypertension
- No known alpha-1 antitrypsin deficiency in family
**Review of Systems (ROS) – Positive findings:**
- **Respiratory:** Dyspnea on exertion, chronic cough, sputum
production, wheezing
