05-12-2009, 06:29 AM
A 52-year-old male construction worker is seen in
the emergency department (ED) at a local hospital
with complaints of persistent cough for the past
4 months. He has been relatively healthy until a few
months ago, when he lost his mother and developed
severe depression which left him socially and
professionally paralyzed. He has stopped doing any
exercise or outdoor activity and spends most of his
time at home eating, sleeping, and watching TV. In
addition, he has noticed a 20-lb weight gain over
this period but attributes it to his lack of exercise
and increased food intake. His cough is worse at
night, or any time when he lies down to sleep, and
he notices a burning sensation in his throat associated
with it. It is not associated with fever or chills, and
his wife complains that he is constantly clearing his
throat after meals. He smoked a few cigarettes per
day as a young man in the Navy but quit more
than 30 years ago. He denies recent travel or incarceration
and has no recollection of any sick contacts.
On examination, he is afebrile and appears mildly
obese. His lung examination is clear. His oropharynx
is red and mucosal membranes are dry and not
inflamed.
5. Which of the following statements describes
the likely cause of his chronic cough?
(A) The patient likely suffers from a common
cold due to a viral infection and will
improve with symptomatic medications.
(B) The patient most likely suffers from
chronic bronchitis exacerbated by a
bacterial infection.
© The patient has developed gastroesophageal
reflux disease (GERD).
(D) The patient has developed late-onset
occult asthma.
(E) The patient has a œnervous cough due
to severe depression.
the emergency department (ED) at a local hospital
with complaints of persistent cough for the past
4 months. He has been relatively healthy until a few
months ago, when he lost his mother and developed
severe depression which left him socially and
professionally paralyzed. He has stopped doing any
exercise or outdoor activity and spends most of his
time at home eating, sleeping, and watching TV. In
addition, he has noticed a 20-lb weight gain over
this period but attributes it to his lack of exercise
and increased food intake. His cough is worse at
night, or any time when he lies down to sleep, and
he notices a burning sensation in his throat associated
with it. It is not associated with fever or chills, and
his wife complains that he is constantly clearing his
throat after meals. He smoked a few cigarettes per
day as a young man in the Navy but quit more
than 30 years ago. He denies recent travel or incarceration
and has no recollection of any sick contacts.
On examination, he is afebrile and appears mildly
obese. His lung examination is clear. His oropharynx
is red and mucosal membranes are dry and not
inflamed.
5. Which of the following statements describes
the likely cause of his chronic cough?
(A) The patient likely suffers from a common
cold due to a viral infection and will
improve with symptomatic medications.
(B) The patient most likely suffers from
chronic bronchitis exacerbated by a
bacterial infection.
© The patient has developed gastroesophageal
reflux disease (GERD).
(D) The patient has developed late-onset
occult asthma.
(E) The patient has a œnervous cough due
to severe depression.