NR 603 Frank Russo iHuman Case Study
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1. What is Frank Russo’s chief complaint?
A) Chest pain and palpitations
B) Progressive shortness of breath worsening over several weeks
C) Fever and productive cough for one day
D) Fatigue and unintentional weight loss for one month
Answer: B
Explanation: The case explicitly notes that the patient’s principal
complaint is shortness of breath that has been getting progressively
worse over the last few weeks. While he also reports a dry cough, night
sweats, and fatigue, these are associated symptoms, not the primary
reason for the encounter.
2. How long has Frank Russo been off antiretroviral therapy (ART)?
A) A few months
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B) Approximately one year
C) More than two years
D) He has always been adherent
Answer: C
Explanation: The case details indicate that Frank has known HIV but has
been off ART for more than two years. This history of non-adherence
places him at high risk for a low CD4 count and subsequent
opportunistic infections, such as Pneumocystis jirovecii pneumonia.
3. Which of the following symptoms is NOT typically associated with
Frank’s presentation of PCP?
A) Progressive dyspnea over weeks
B) Non-productive cough
C) Hemoptysis
D) Fevers and night sweats
Answer: C
Explanation: Hemoptysis is not a classic feature of PCP. The typical
presentation is subacute, with progressive exertional dyspnea, a non-
productive cough, and constitutional symptoms like fever and night
sweats. Hemoptysis would raise suspicion for other conditions like
tuberculosis, malignancy, or bacterial pneumonia.
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4. Frank reports that his shortness of breath is most noticeable during
which activity?
A) While resting supine
B) While walking up stairs or exerting himself
C) Immediately after eating a large meal
D) Only during episodes of coughing
Answer: B
Explanation: The dyspnea in PCP is classically exertional and
progressive. Patients often report that activities such as climbing stairs
or walking short distances become increasingly difficult over time,
reflecting the declining pulmonary reserve and impaired gas exchange.
5. What does Frank state about his cough?
A) It is productive with green sputum
B) It is dry and non-productive
C) It is bloody and mucoid
D) He has no cough at all
Answer: B
Explanation: Frank describes a dry, non-productive cough. This is
consistent with PCP, where the cough is typically irritative and without
significant sputum production. Productive cough would suggest a
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bacterial etiology, and hemoptysis would point toward TB or
malignancy.
6. Frank endorses which of the following constitutional symptoms?
A) Morning headache and dizziness
B) Night sweats and subjective fevers
C) Polyuria and polydipsia
D) Joint swelling and morning stiffness
Answer: B
Explanation: Night sweats and fevers are common constitutional
symptoms in HIV-related opportunistic infections, including PCP. They
reflect the systemic inflammatory response and are key components of
the history that support an infectious etiology.
7. Frank mentions that he has had these symptoms for approximately
how long before seeking care?
A) One day
B) One week
C) Several weeks
D) Six months
Answer: C