NursingCase studyRespiratory disorders

Comprehensive COPD case study differential guide

A Week 2 comprehensive case study on a 62-year-old male with persistent cough and shortness of breath, requiring a concise history and physical summary, at least three differential diagnoses with pathophysiology, analysis using pertinent positives and negatives, a ranked differential, evidence-based testing decisions and a table of normal values.

Aug 13, 2026

Editorial process

Last reviewed · August 13, 2026

Written by

Aaron Bishop

MA, Education

assignment interpretation and research-methods coaching across disciplines

Reviewed by

Dr. Nathan Cole

PhD, Rhetoric & Composition

Argumentation and thesis development

On this page

Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

What the COPD case study rubric is actually scoring

The requirements list is written in the language of clinical reasoning assessment, and reading it closely tells you exactly how the marks are distributed. Five numbered tasks, each of which is scored, and the rubric names seven critical elements within the first one alone. What that structure is testing is not whether you can recognise chronic obstructive pulmonary disease in a former smoker with six months of productive cough — the title has already told you the answer — but whether you can build and defend a differential, argue from specific findings, and justify each test with evidence. The diagnosis is the least valuable thing in the paper. The reasoning that reaches it is the assignment. Write the paper as though the diagnosis were genuinely unknown and the reasoning will come out in the right shape. Name the diagnosis last, not first. Grade yourself on whether a reader could reconstruct the ranking from your evidence alone.

The summary is the first task and it has a specific standard: concise, without redundancy or irrelevant information, as if presenting to a preceptor. That is a genuine clinical skill and it is assessed as one. A summary that reproduces the case data in the order it was given has not summarised anything. What a preceptor wants is age, sex, the chief complaint with its duration and trajectory, the pertinent history that bears on the differential, the relevant medications, the significant examination findings, and nothing else. Smoking history, the beta blocker, the body mass index, the family cardiac history and the wheeze belong in it. The tympanic membranes do not. Choosing what to leave out is the work. A useful test is whether every line you kept would change your differential if it were different; if not, cut it. A preceptor's patience is the standard, and it is short.

Three differentials are required and the choice of the second and third is what your reasoning is actually assessed on. The obstructive lung disease answer is unavoidable. The interesting question is what else could produce this presentation in this patient, and the case data has been constructed to support specific alternatives: a reactive airway process is suggested by the wheeze and by the beta blocker; a cardiac cause is suggested by the hypertension, the obesity, the exertional dyspnoea and the family history of early cardiac death. Choose alternatives the case data actually supports, and for each write two or three sentences of pathophysiology that explain how the mechanism would produce these symptoms rather than describing the disease in general. Two or three sentences is a real constraint, and it is met by explaining a mechanism rather than by compressing a textbook entry into fewer words.

The analysis task is where most submissions lose ground and it has an exact form: for each diagnosis, the pertinent positives that argue for it and the pertinent negatives that argue against. Pertinent is the operative word — a negative finding is pertinent only if its absence would be expected to matter for that diagnosis. The absence of peripheral oedema is pertinent to cardiac failure and irrelevant to obstructive lung disease. Doing this properly means going through the history and examination once per diagnosis, which feels repetitive and is exactly what the rubric rewards. Present it in a consistent structure so the assessor can find each element without hunting. Doing it once per diagnosis rather than once for the case also prevents the commonest structural error here, which is a single analysis paragraph that names findings without saying which diagnosis each one argues about. Repetition here is the rubric working, not padding.

Ranking requires you to say why, not merely to order. The ranking is an argument: this diagnosis is most likely because these findings are present and these expected contrary findings are absent, and this one is least likely because a feature you would expect is missing. State the discriminating feature at each step. A ranked list without reasons is the commonest way this element is only partially credited, because the rubric asks for a differential analysed and ranked rather than for a list in order. It is also the element that best predicts how the rest of the paper reads, because a differential ranked with reasons forces the testing section to follow the same logic. Write the ranking before the testing section rather than after it, and the two will agree. A ranking whose order nobody could reconstruct from your reasons is only half credited.

Testing decisions carry their own critical element and the standard is explicit: every test must be supported by an evidence-based argument, and a decision not to test also requires support. So for each investigation, say what it would show, which diagnosis it would move up or down, and why it is appropriate in a primary care setting. Spirometry is the test that confirms or excludes airflow limitation and it is the one the guideline requires for the diagnosis; imaging excludes alternatives rather than confirming the diagnosis; a natriuretic peptide has good negative predictive value for the cardiac alternative. Cite current guidelines rather than a textbook. Finally, build the table of normal values with all four columns the brief specifies, including the reference source for each value, and keep the answer format to what each part demands. Every test you decline also needs its sentence, since the rubric treats a supported decision not to test as equally creditable.

Likely learning objectives

Inferred from the brief — check these against your own rubric.

01
Produce a concise history and physical summary suitable for presentation.
02
Select differentials that the case data actually supports.
03
Write pathophysiology that explains this presentation rather than the disease in general.
04
Distinguish pertinent from incidental negatives for each diagnosis.
05
Justify every test with an evidence-based argument appropriate to primary care.

Assignment instructionsQuoted verbatim

Read the full question

Review every instruction before using the planning guidance that follows.

The “Table of Normal Values” needs to include 4 columns Column 1 – Name of test (i.e. BP, Hematocrit, PaCo2 etc) use the same tests and values from the chart in assignment Column 2 – The test values for M.K. (Patient) Column 3 – Normal Values for patient based Column 4 – reference for where values were found Treatment Options: Part 2 (A) Answers to these questions must be in paragraph form Reference Section (APA Format) Answers to all questions: Part 2 (B) These answers do not need to be in paragraph format Week 2: COPD Case Study Part 1 Example (Initial post due Tuesday, faculty and peer responses due Sunday) Purpose Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group. Activity Learning Outcomes Through this discussion, the student will demonstrate the ability to: Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1)  (CO,2,3,4,5) Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO 2.2) (CO 2,4) Interpret pulmonary function test results. (WO 2.3) (CO 2, 4) Due Date: Student enters initial post to part one by 11:59 p.m. MT on Tuesday; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources AND all direct faculty questions in parts one by Sunday, 11:59 p.m. MT. A 10% late penalty will be imposed for discussions posted after the deadline on Tuesday 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Assignment Comprehensive Case Study On COPD Total Points Possible: 50 Case Study – Part 1 Date of visit: November 20, A 62 year-old Caucasian male presents to the office with persistent cough and recent onset of shortness of breath. Upon further questioning you discover the following subjective information regarding the chief complaint. History of Present Illness Onset 6 months Location Chest Duration Cough is intermittent but frequent, worse in the AM Characteristics Productive; whitish-yellow phlegm Aggravating factors Activity Relieving factors Rest Treatments Tried Robitussin DM without relief of symptoms Severity Unable to walk > 20ft without stopping to catch his breath. Last year at this time he routinely walked 1 mile per day without difficulty Review of Systems (ROS) Constitutional Denies fever, chills, or weight loss Ears Denies otalgia and otorrhea Nose Denies rhinorrhea, nasal congestion, sneezing or post nasal drip. Throat Denies ST and redness Neck Denies lymph node tenderness or swelling Chest Describes a persistent productive cough upon wakening for the last 6 months. Color of phlegm is usually white-yellowish. Shortness of breath with activity. Cardiovascular Denies chest pain and lower extremity edema Comprehensive Case Study On COPD History Medications Metoprolol succinate ER (Toprol-XL) 50mg daily for hypertension; Multivitamin daily PMH Primary hypertension PSH Cholecystectomy, appendectomy Allergies Penicillin (hives) Social Married, 3 children Senior accountant at a risk management firm Habits Former smoker (20 pack-year), quit “cold turkey” when father died; Denies alcohol or illicit drug use. FH Father died of MI & CHF at age 59 years (diabetes, hypertension, smoker) Mother is alive (osteoporosis) Healthy siblings Physical exam reveals the following: Physical Exam Constitutional Adult male in NAD, alert and oriented, able to speak in full sentences VS Temp-98.1, P-66, RR-20, BP 156/94, Height 68.9in, Weight 258 pounds, O2sat 94% on RA Head Normocephalic Ears Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nose Nares patent. Nasal turbinates clear without redness or edema. Nasal drainage is clear. Throat Oropharynx moist, no lesions or exudate. Tonsils ¼ bilaterally. Teeth in good repair, no cavities noted. Neck Neck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. No JVD Cardiopulmonary Heart S1 and S2 with no murmurs, noted. Lungs clear to auscultation bilaterally with faint forced expiratory wheezes in bilateral bases. Respirations unlabored. Legs without edema. Abdomen Soft, non-tender. No organomegaly Requirements/Questions: Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. May use approved medical abbreviations. Avoid redundancy and irrelevant information. Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement (2-3 sentences) of pathophysiology for each. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis. Rank the differential in order of most likely to least likely. Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based practice (EBP) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBP evidence. Comprehensive Case Study On COPD. DISCUSSION CONTENT Category Points % Description Application of Course Knowledge 15 30% 1. A brief AND concise summary of the history and physical (H&P) findings is presented without redundancy or irrelevant information; AND 2. Three (3) appropriate diagnoses in the differential are presented which can explain the patient’s chief complaint; AND 3. A brief statement of pathophysiology is included for each diagnosis; AND 4. Each diagnosis in the differential is analyzed using pertinent positive and negative subjective and objective findings as support; AND 5. The differential is ranked in order from most likely to least likely; AND 6. Clinical reasoning skills are demonstrated by linking testing to diagnoses as applicable; AND 7. Testing decisions are well supported with EBP arguments that are in-line with the clinical scenario and appropriate for the primary care setting (7 critical elements) Support from Evidence-Based Practice (EBP) 15 30% 1. Discussion post is supported with appropriate, scholarly sources; AND 2. Sources are published within the last 5 years (unless it is the most current CPG); AND 3. Reference list is provided and in-text citations match; AND 4. All testing decisions are fully supported with an appropriate EBP argument (4 critical elements) Interactive Dialogue 10 20% 1. Student provides a substantive* response to at least one topic-related post of a peer; AND 2. Evidence from appropriate scholarly sources are included; AND 3. Reference list is provided and in-text citations match; AND 4. Student responds to all direct faculty questions (*) A substantive post adds new content or insights to the discussion thread and information from student’s original post is not reused in peer or faculty response (4 critical elements) Total CONTENT Points= 40 pts ORDER Comprehensive Case Study On COPD DISCUSSION FORMAT Category Points % Description Organization 5 10% 1. Case study response is presented in a logical format, AND 2. Responses are in sequence with the numbered questions AND 3. The case study response is understandable and easy to follow AND 4. All responses are relevant to the case topic (4 critical elements) Grammar, Syntax, Spelling & Punctuation 5 10% Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors* Total FORMAT Points= 10 pts DISCUSSION TOTAL= 50 pts

Turn the brief into deliverables

01
A brief, concise summary of the history and physical findings without redundancy or irrelevant information.
02
A differential diagnosis of at least three, each with two to three sentences of pathophysiology.
03
An analysis of the differential using pertinent positive and negative findings.
04
The differential ranked from most to least likely.
05
Additional tests or procedures with an evidence-based practice argument for each, or support for testing nothing.
06
A Table of Normal Values with four columns: test name, patient value, normal value, and reference source.
07
Treatment options in paragraph form with an APA reference section.

Summary, differential, analysis, ranking, testing

The concise summary

Age, sex, complaint with duration and trajectory, pertinent history, relevant medications and significant findings only.

Differential one

The obstructive process, with pathophysiology explaining this patient's symptom pattern.

Differential two

A reactive airway alternative, noting the features and the medication that support considering it.

Differential three

A cardiac alternative, built from the risk factors and the exertional pattern.

Analysis by pertinent findings

For each diagnosis, the positives arguing for and the pertinent negatives arguing against.

Ranking with reasons

Order the differential and name the discriminating feature at each step.

Testing decisions

Each test with what it shows, which diagnosis it moves, and a guideline supporting its use in primary care.

Which guidelines to cite for the testing argument

Recommended databases

Current respiratory and cardiology clinical practice guidelines
PubMed
NHLBI health topics
Course advanced assessment text

Search sequence

1.
Find the current global strategy document for obstructive lung disease and note what it requires for diagnosis.
2.
Find the current guideline for the reactive airway alternative and note where the two diagnoses are distinguished.
3.
Find the current cardiac failure guideline for the natriuretic peptide argument.
4.
Collect reference ranges from a named laboratory or clinical source for the table's fourth column.
5.
Check that each guideline is the current version, since the rubric requires sources within five years unless the guideline is the most recent.

Reference shortlist

These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.

Nothing here is cleared for citation until you have read it.

01
2024 GOLD Report - Global Initiative for Chronic Obstructive Lung Disease - GOLD
Global Initiative for Chronic Obstructive Lung Disease · 2024
The diagnostic criterion requiring spirometry with post-bronchodilator confirmation; the source for the primary testing argument.
02
COPD - What Is COPD? | NHLBI, NIH
National Heart, Lung, and Blood Institute · 2025
Federal description of risk factors, pathophysiology and diagnosis, useful for the pathophysiology paragraphs.
03
Asthma - What Is Asthma? | NHLBI, NIH
National Heart, Lung, and Blood Institute · 2025
Supports the reactive airway differential, including reversibility as the discriminating feature.
04
Heart Failure - What Is Heart Failure? | NHLBI, NIH
National Heart, Lung, and Blood Institute · 2025
Supports the cardiac differential and the natriuretic peptide testing argument.
05
Chronic Obstructive Pulmonary Disease (COPD) - StatPearls
NCBI Bookshelf · 2023
Concise pathophysiology and differential discussion, useful when writing the two-to-three sentence mechanism paragraphs.

Review before submission

Common mistakes

Reproducing the case data instead of summarising it.
Choosing differentials the case data does not support.
Writing textbook pathophysiology instead of explaining this presentation.
Listing negatives that are not pertinent to the diagnosis under discussion.
Ranking the differential without stating the discriminating feature at each step.
Ordering tests without saying which diagnosis each would move.

Submission checklist

The summary omits everything that does not bear on the differential.
Three or more differentials are given, each supported by case data.
Pathophysiology for each is two to three sentences and specific to this presentation.
Pertinent positives and negatives are given separately for every diagnosis.
The ranking states the discriminating feature at each step.
Each test is tied to a diagnosis it would move and supported by a guideline.
The table of normal values has all four required columns including the reference.

Use this guide to plan and review your own work. Follow your institution's rules and read our academic-integrity policy.