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%. Exam 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.
1. The clinical scenario is most consistent with which diagnosis?
2. What data in the clinical scenario supports your diagnosis?
3. What risk factor(s) led to this person’s diagnosis?
4. What is the pathological difference between restrictive and obstructive lung disease?
How is the normal ventilatory cycle affected by the primary diagnosis?
Define lung total volume (total lung capacity), vital capacity, and forced expiratory volume (FEV1)
How does this diagnosis affect lung lung volume, vital capacity, and FEV1?
How and why is diffusion capacity altered by the primary diagnosis?
If ABG was drawn, what would you expect his CO2 level and why?
Why does this patient have a barrel chest?
5. What actual or potential complications related to the diagnosis does she need to be monitored?