54-year-old man comes to him primary care physician because of gradually worsening shortness of breath. He...

54-year-old man comes to him primary care physician because of gradually
worsening shortness of breath. He also expresses concern that her lips turn blue when she
ascends stairs. On physical examination, the physician notes increased anteroposterior (AP)
diameter of her chest, hyperresonance on percussion of lung fields, and increased respiratory
effort. The patient’s blood pressure is 110/70 mm Hg and her pulse is 90/min. He has had well-
managed diabetes for 10 years and a 30-pack-year history of smoking. The patient is sent for
evaluation of him lung function.
Which is most likely during forced expiration?

Solutions

Expert Solution

The condition of the patient shows that he is suffering from emphysema.

Etiology

Book picture	Patient picture
Cigarette smoking Air pollution Alpha 1 Antitrypsin deficiency Inherited diseases like Marfan's syndrome, Menkes' syndrome	Cigarette smoking

Clinical Manifestation

Book picture	Patient picture
Dyspnea Cough with or without expectoration wheezing loss of weight peptic ulceration hypercapnia barrel chest	Dyspnea wheezing barrel chest ( increase in anteroposterior diameter)

Diagnosis

Book picture

Patient [picture

History
Physical examination

Barrel chest
Pursed lip breathing
breath sounds quite diminished
prolonged exhalation
bluish discoloration of the lips and nail beds
hyper resonance on chest percussion

Barrel chest
Bluish discoloration of the lips
hyper resonance on chest

During emphysema, the damage to the air sacs makes it harder for oxygen to pass in to the blood vessels of the lungs. As a result, the oxygen level in the body is frequently reduced. The body tries to compensate for the low oxygen by breathing more. This makes breathing difficult. As a result the forced vital capacity is reduced. The rate of expiratory flow is also reduced. Also it is very difficult for a person with an obstructive disease to exhale quickly due to the increase in airway resistance. As a result, the FEV/ FVC ratio will be much lower than normal.

Sydney Mullin answered 11 months ago

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