brand logo

Am Fam Physician. 2023;108(6):online

Author disclosure: No relevant financial relationships.

A 71-year-old man presented with a persistent dry cough that had been gradually worsening over the past 30 years. The cough was worse at night, especially while lying flat. He was treated with famotidine for gastroesophageal reflux disease (GERD) and completed a trial of albuterol, without improvement. After a two-week course of omeprazole, the patient perceived moderate improvement in his cough, but it persisted at night. The patient had no other gastrointestinal, cardiac, or respiratory symptoms. He did not have sick contacts, fever, chills, myalgias, headaches, chest pain, fatigue, rash, or dyspnea. He had a history of smoking, seasonal allergies, and eczema. He was not a current smoker.

On examination, the patient was afebrile and normotensive. He had a body mass index of 38 kg per m2 (class 2 obesity) and an oxygen saturation of 92% on room air. He had normal respiratory effort but decreased aeration in the bilateral lung bases. The rest of the physical examination was unremarkable. Chest radiography and subsequent computed tomography (CT) were performed (Figure 1 and Figure 2).

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at To be considered for publication, submissions must meet these guidelines. Email submissions to

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at

Continue Reading

More in AFP

More in PubMed

Copyright © 2023 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.