I Human Case Week 7 – Reason for Encounter:
Fatigue & Cough (2026) NEW UPDATED CLINICAL
SUMMARY & SOAP NOTE TRAINING GUIDE
Chief Complaint & History of Present Illness (HPI)
1. What is the most common initial step in evaluating a patient presenting with fatigue
and cough?
A) Ordering a chest X-ray
B) Performing a detailed History of Present Illness (HPI) ✓
C) Starting empiric antibiotics
D) Running a complete metabolic panel
2. When characterizing a cough for the HPI, which of the following is the LEAST important
to ask?
A) Is it productive or dry?
B) What time of day is it worst?
C) What is the exact sound it makes? ✓
D) How long has it been going on?
3. A patient describes a "productive cough." What critical follow-up question must you
ask?
A) Does it make you dizzy?
B) What is the color and consistency of the sputum? ✓
C) Does it hurt your throat?
D) Do you have a fever when you cough?
4. The duration of a cough is crucial for differential diagnosis. A cough lasting 3 weeks is
typically classified as:
A) Acute
B) Subacute ✓
C) Chronic
D) Persistent
5. What associated symptom, if present with fatigue and cough, would most raise
concern for a cardiac issue?
A) Sore throat
B) Orthopnea (shortness of breath when lying flat) ✓
, C) Rhinorrhea (runny nose)
D) Myalgia (muscle aches)
6. In the context of fatigue, asking about "anhedonia" is screening for what?
A) Liver disease
B) Depression ✓
C) Anemia
D) Thyroid disorder
7. A patient reports their fatigue is worse in the evening. This pattern is most suggestive
of:
A) Depression
B) Chronic Fatigue Syndrome
C) Obstructive Sleep Apnea
D) Normal daily exertion or stress ✓
8. What key question helps differentiate dyspnea (shortness of breath) from simple
fatigue?
A) "Do you feel weak?"
B) "Do you feel like you can't get enough air?" ✓
C) "Are you tired all the time?"
D) "Do you have trouble concentrating?"
9. Hemoptysis (coughing up blood) in a patient with fatigue and cough is a red flag for all
EXCEPT:
A) Lung cancer
B) Tuberculosis
C) Congestive Heart Failure (CHF)
D) Common cold ✓
10. For a complete HPI, you should use the OLD CARTS mnemonic. What does the "S"
stand for?
A) Sound
B) Severity ✓
C) Sputum
D) Seasonality
Past Medical, Surgical, Family, and Social History (PMH, PSH, FH, SH)
11. Which past medical history is most directly linked to a new cough and fatigue?
A) Asthma or COPD ✓
, B) Appendectomy
C) Cataracts
D) Osteoarthritis
12. A history of deep vein thrombosis (DVT) increases the risk for what cause of cough and
fatigue?
A) Pneumonia
B) Pulmonary Embolism (PE) ✓
C) Lung cancer
D) Bronchitis
13. What social history element is the single greatest risk factor for COPD and lung cancer?
A) Alcohol use
B) Sedentary lifestyle
C) Tobacco smoking ✓
D) Illicit drug use
14. In a patient with fatigue, what surgical history is most relevant?
A) Recent surgery (can cause anemia or deconditioning) ✓
B) Knee surgery 20 years ago
C) Cesarean section 15 years ago
D) Wisdom tooth extraction
15. A family history of early-onset emphysema should lead you to suspect what genetic
condition?
A) Cystic Fibrosis
B) Alpha-1 Antitrypsin Deficiency ✓
C) Huntington's Disease
D) Marfan Syndrome
16. What social history question is crucial for assessing potential exposure to respiratory
pathogens?
A) "What is your marital status?"
B) "Have you traveled recently or been exposed to sick contacts?" ✓
C) "What is your highest level of education?"
D) "Do you use public transportation?"
17. Occupational history is vital. Asbestos exposure is a risk factor for:
A) Tuberculosis
B) Mesothelioma and Lung Cancer ✓
, C) Asthma
D) Bronchiectasis
18. Which element of the social history is a key screening question for depression, a cause
of fatigue?
A) "Do you have friends?"
B) "Do you feel safe at home?"
C) "Have you ever felt down, depressed, or hopeless?" ✓
D) "What do you do for fun?"
19. A patient with a history of HIV/AIDS presenting with cough and fatigue should be
aggressively worked up for:
A) Common cold
B) Opportunistic infections (e.g., PJP) ✓
C) Seasonal allergies
D) GERD
20. Which vaccination history is most relevant for an adult with a persistent cough?
A) Tdap (Tetanus, diphtheria, pertussis) ✓
B) HPV
C) Shingles
D) MMR
Review of Systems (ROS)
21. In the Constitutional ROS, what besides fatigue is important to ask?
A) Fever, chills, night sweats, weight loss ✓
B) Rash and itching
C) Blurred vision
D) Hearing loss
22. Asking about "post-nasal drip" and "facial pain" in the ENT ROS is screening for what
cause of cough?
A) Sinusitis ✓
B) Pharyngitis
C) Laryngitis
D) Epiglottitis
23. What cardiovascular symptom, if positive, would be a major red flag?
A) Occasional palpitations
B) Chest pain, especially if exertional ✓
Fatigue & Cough (2026) NEW UPDATED CLINICAL
SUMMARY & SOAP NOTE TRAINING GUIDE
Chief Complaint & History of Present Illness (HPI)
1. What is the most common initial step in evaluating a patient presenting with fatigue
and cough?
A) Ordering a chest X-ray
B) Performing a detailed History of Present Illness (HPI) ✓
C) Starting empiric antibiotics
D) Running a complete metabolic panel
2. When characterizing a cough for the HPI, which of the following is the LEAST important
to ask?
A) Is it productive or dry?
B) What time of day is it worst?
C) What is the exact sound it makes? ✓
D) How long has it been going on?
3. A patient describes a "productive cough." What critical follow-up question must you
ask?
A) Does it make you dizzy?
B) What is the color and consistency of the sputum? ✓
C) Does it hurt your throat?
D) Do you have a fever when you cough?
4. The duration of a cough is crucial for differential diagnosis. A cough lasting 3 weeks is
typically classified as:
A) Acute
B) Subacute ✓
C) Chronic
D) Persistent
5. What associated symptom, if present with fatigue and cough, would most raise
concern for a cardiac issue?
A) Sore throat
B) Orthopnea (shortness of breath when lying flat) ✓
, C) Rhinorrhea (runny nose)
D) Myalgia (muscle aches)
6. In the context of fatigue, asking about "anhedonia" is screening for what?
A) Liver disease
B) Depression ✓
C) Anemia
D) Thyroid disorder
7. A patient reports their fatigue is worse in the evening. This pattern is most suggestive
of:
A) Depression
B) Chronic Fatigue Syndrome
C) Obstructive Sleep Apnea
D) Normal daily exertion or stress ✓
8. What key question helps differentiate dyspnea (shortness of breath) from simple
fatigue?
A) "Do you feel weak?"
B) "Do you feel like you can't get enough air?" ✓
C) "Are you tired all the time?"
D) "Do you have trouble concentrating?"
9. Hemoptysis (coughing up blood) in a patient with fatigue and cough is a red flag for all
EXCEPT:
A) Lung cancer
B) Tuberculosis
C) Congestive Heart Failure (CHF)
D) Common cold ✓
10. For a complete HPI, you should use the OLD CARTS mnemonic. What does the "S"
stand for?
A) Sound
B) Severity ✓
C) Sputum
D) Seasonality
Past Medical, Surgical, Family, and Social History (PMH, PSH, FH, SH)
11. Which past medical history is most directly linked to a new cough and fatigue?
A) Asthma or COPD ✓
, B) Appendectomy
C) Cataracts
D) Osteoarthritis
12. A history of deep vein thrombosis (DVT) increases the risk for what cause of cough and
fatigue?
A) Pneumonia
B) Pulmonary Embolism (PE) ✓
C) Lung cancer
D) Bronchitis
13. What social history element is the single greatest risk factor for COPD and lung cancer?
A) Alcohol use
B) Sedentary lifestyle
C) Tobacco smoking ✓
D) Illicit drug use
14. In a patient with fatigue, what surgical history is most relevant?
A) Recent surgery (can cause anemia or deconditioning) ✓
B) Knee surgery 20 years ago
C) Cesarean section 15 years ago
D) Wisdom tooth extraction
15. A family history of early-onset emphysema should lead you to suspect what genetic
condition?
A) Cystic Fibrosis
B) Alpha-1 Antitrypsin Deficiency ✓
C) Huntington's Disease
D) Marfan Syndrome
16. What social history question is crucial for assessing potential exposure to respiratory
pathogens?
A) "What is your marital status?"
B) "Have you traveled recently or been exposed to sick contacts?" ✓
C) "What is your highest level of education?"
D) "Do you use public transportation?"
17. Occupational history is vital. Asbestos exposure is a risk factor for:
A) Tuberculosis
B) Mesothelioma and Lung Cancer ✓
, C) Asthma
D) Bronchiectasis
18. Which element of the social history is a key screening question for depression, a cause
of fatigue?
A) "Do you have friends?"
B) "Do you feel safe at home?"
C) "Have you ever felt down, depressed, or hopeless?" ✓
D) "What do you do for fun?"
19. A patient with a history of HIV/AIDS presenting with cough and fatigue should be
aggressively worked up for:
A) Common cold
B) Opportunistic infections (e.g., PJP) ✓
C) Seasonal allergies
D) GERD
20. Which vaccination history is most relevant for an adult with a persistent cough?
A) Tdap (Tetanus, diphtheria, pertussis) ✓
B) HPV
C) Shingles
D) MMR
Review of Systems (ROS)
21. In the Constitutional ROS, what besides fatigue is important to ask?
A) Fever, chills, night sweats, weight loss ✓
B) Rash and itching
C) Blurred vision
D) Hearing loss
22. Asking about "post-nasal drip" and "facial pain" in the ENT ROS is screening for what
cause of cough?
A) Sinusitis ✓
B) Pharyngitis
C) Laryngitis
D) Epiglottitis
23. What cardiovascular symptom, if positive, would be a major red flag?
A) Occasional palpitations
B) Chest pain, especially if exertional ✓
