The physician enters the room, greets Rob and asks him what brought him in. Rob mentions that he notices a shortness of breath when climbing ladders and he tires easily. He thought he needed to exercise more, but after several months, it has only gotten worse. He has also noticed that he is always coughing and is sometimes producing pinkish phlegm. The physician then asks Rob a series of questions concerning his lifestyle and records the answers on his Electronic Health Record (EHR). The first question involves his smoking history. Rob informs the physician that he has been smoking for 24 years – typically smoking about ten packs a week. When he is stressed he finds himself taking more smoke breaks. The physician shakes his head discouragingly.


The physician reviews Rob’s vital signs, taken by the nurse on his arrival. Then he begins the physical exam by listening to Rob’s heart and asking him to cough, an easy task for him. Rob sounds congested and coughs several more times, no longer on command.


While in the physician’s office, Rob has a regular chest x-ray to check his respiratory system.


  1. Internet Research: Rob’s symptoms include shortness of breath, pink/red/rust-colored phlegm, wheezing, fatigue, frequent colds and a chronic cough. Using WebMD’s Symptom Checker, what might he have, if anything?


  2. Internet Research: Are there any other possible diagnoses?


  3. Review Rob’s PCP EHR: You notice his cholesterol results are high or borderline high. What are his test results?

    Internet Research: Are high cholesterol and smoking related? How so?


  4. Review Rob’s VPE: Why does Rob’s physician order the chest X-ray and what does it reveal?

    Internet Research: What further tests will be scheduled to confirm the diagnosis?


View Rob’s EHR – PCP Chart   Virtual Physical Exam