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
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
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
respiratory surface. Explain the role of partial pressures in exchange of
oxygen and carbon dioxide.
is a normal respiratory rate?
significant is the bluish hue to coming up with a potential diagnosis? Explain.
is a Beta 2 Agonist. Explain
its mechanism of action.
the incidence of Mr. Myers pneumonia two years been a precursor to his current
7Is there a single disease that can account for symptoms, physical exam findings, and laboratory abnormalities?
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