Respiratory Case Study 3 *


Harold Myers,a 58 year-old male, visited his internist with complaints of two months of progressive cough, occasionally coughing up blood, labored breathing, and confusion. He said that for years he had a chronic "smoker's cough" that was worse in the morning., During the last two months, however, his coughing progressed; Harold stated that he went into "coughing fits" that often made catching his breath difficult. He also noticed that his sputum was occasionally blood-tinged. Harold had become so short of breath recently that he got winded easily even when he cooked in the kitchen. These symptoms represented a dramatic change; Harold had been an active golfer for years and until two months ago he prided himself in still being able to walk an entire 18 holes. He had a 60 pack-year smoking history. (Pack-years are defined as the number of packs per day the person smokes multiplied by the number of years the person has smoked; Mr. Myers began smoking one and a half packs per day at the age of 18.)  After a significant for a hospitalization for Pneumococcal pneumonia two years ago, he was prescribed an Albuterol inhaler for occasional wheezing.


Physical Exam was remarkable for the following:

Weight: 150 pounds, down from 170 pounds one year ago.

Height:5 feet 11 inches.

Temperature: 98.6 F

Pulse: 88bpm

Respiration Rate: 24bpm.

Blood Pressure: 140/88

Skin: Revealed a slightly bluish hue to his lips, nailbeds, and ears

Lungs: Revealed decreased breath sounds over the apex of the right lung.

Lymph Nodes: No significant swelling


Laboratory Data:

Serum electrolytes

Sodium = 120 mEq/dl

Other electrolytes were normal


Chest x-ray: solitary nodules appear in right lobe

Elevated white blood cell count



1Describe the mechanics of breathing. Include the relationship between pressure and volume.

How are oxygen and carbon dioxide transported in the blood?

2 Define respiratory surface. Explain the role of partial pressures in exchange of oxygen and carbon dioxide.

3 What is a normal respiratory rate?

4 How significant is the bluish hue to coming up with a potential diagnosis? Explain.

5 Albuterol is a Beta 2 Agonist.  Explain its mechanism of action.

6 Could the incidence of Mr. Myers pneumonia two years been a precursor to his current symptoms? 

7Is there a single disease that can account for symptoms, physical exam findings, and laboratory abnormalities?

Explain each with respect to your diagnosis.

8Discuss the importance of smoking as a contributing factor to the diagnosis.


*adapted from A&P Clinical Case Studies

—Prepared by Marc Walters, M.D., Portland Community College