Mini case study ( Pathophysiology II)

  History A 65 years old above barn artisan presents with a arch complaint of added conciseness of animation and a change in the abundance and blush of his sputum for the accomplished week. The sputum is usually bare and clear. However, afresh it has become chicken and continues all day. He has had agitation adopting sputum in the accomplished year. He has become progressively abbreviate of animation over the aftermost bristles years. He is now dyspneic at rest. He denies asthma, adolescence respiratory problems, allergies and any anatomic exposures. Physical Examination Obvious respiratory ache with arresting use of accent muscles.   Patient is moderately adipose and bark is hardly cyanotic. Temperature 99.5; Blood burden 140/90; beating 110; respiratory amount 28. Head/neck acknowledge beefy close veins throughout expiration. Chest reveals added A-P diameter; bargain chest bank excursion; lungs hyperresonant to percussion; diaphragms low and immobile; auscultation reveals a abiding expiratory appearance with beneath animation sounds and ambiguous rhonchi. Heart reveals PMI in epigastrium; affection sounds abroad with approved accent and no murmurs. Extremities acknowledge trace pitting edema of the lower extremities. Chest x-ray reveals hyperinflation of lungs with an access in the retrosternal space; low, bedfast diaphragms; hyperlucent lung fields with absence of vascular arrangement in the ambit but arresting hila and attenuated affection silhouette. EKG reveals low voltage; appropriate axis; ailing P after-effects and clockwise rotation. Laboratory reveals WBC 8,500 with accustomed cogwheel and Hgb 14.7 gm. Pulmonary functions:  FEV1 is decreased; FVC is normal

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