Question

Mrs X is a 56 year old lady who presents with dyspnea on exertion that has slowly and progressively gotten worse over the last year. She has had a minor non-productive cough. She denies fever, nausea, vomiting or night sweats. Her past medical history is positive for hypertension and hyperlipidemia. Her current medications include simvastatin and lisinopril. She has smoked 1-2 packs of cigarettes daily for 25 years. Her vital are remarkable for respiratory rate of 24 and O2 Sat 89%. Examination reveals a thin female using pursed lip breathing and tripod positioning, the chest is barrel shaped, lung sounds are markedly diminished but there are faint exp wheezes bilaterally. Fingernail clubbing is present bilaterally. Her chest X-ray shows hyperinflation.

Questions

1. The clinical scenario is most consistent with which diagnosis? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.
2. What data in the clinical scenario supports your diagnosis? Make sure to interpret the lab results you list. You may simply list your answers below using a bullet point format. This does not have to be in a complete sentence. Interpret the labs that you list as part of your answer by indicating normal, high or low.
3. What risk factor(s) led to this person’s diagnosis? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.
4. Describe the key pathophysiologic concepts of the diagnosis in question 1. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences.

a. What is the pathological difference between restrictive and obstructive lung disease? Is the diagnosis in question 1 a restrictive of obstructive process?

b. How is the normal ventilatory cycle affected by the primary diagnosis identified in question 1?

c. Define total lung volume (total lung capacity), vital capacity, and forced expiratory volume (FEV1).

d. How does this diagnosis identified in question 1 affect total lung volume, vital capacity, and forced expiratory volume.

e. How and why is diffusion capacity altered by the diagnosis identified in question 1?

f. If you were to draw an ABG on this person, what would you expect his CO₂ level to be high or low and why?

g. Why does this patient have a Barrel Chest?

5. For what actual or potential complications related to the diagnosis in question 1 does she need to be monitored? You may simply list your answer(s) below using a bullet point format. This does not have to be in a complete sentence.

Answer 1

1.The clinical scenario is more consistent with chronic obstructive pulmonary disease ( COPD )

2.The following data from the clinical scenario supports the diagnosis

• Progressed dyspnea
• Non productive cough
• Decreased oxygen saturation
• Purse lip breathing
• Tripod position
• Barrel chest
• Wheezing
• Diminished lung sounds
• Clubbing of nails
• Hyperinflation in chest x ray

3.The risk factors are

• Age
• Smoking

4.The key pathophysiological concept in the diagnosis are

a. The key difference is in COPD a certain amount of air is retained in the lungs after respiration whereas in restrictive lung disease complete air cannot enter the lungs due to restricted inflammation of the lungs to trap all air.

Here the patientis having obstructive lung disease

b. The normal ventilator cycle is affected in the following way in this condition there is retention of carbon dioxide in the lungs thus increasing the arterial carbon dioxide level .This can make the patient gasp for oxygenated air.

c. Total lung volume in simple refers to the amount of air the lungs can hold normally

Vital capacity in simple refers to quantity of a air one can breath out after a complete inspiration

Forced expiratory volume in simple refers to the amount of air one can breath out after taking in a deep breath

d. It affects the total lung volume by leading to increased deposition of carbon dioxide in the lungs causing hypercapnea

It affects the vital capacity by decreasing the expulsion of carbon dioxide from the lungs

The Fev1 is decreased die to hyperinflation