12/06/06

History: Nathaniel

Physical: Justin

Lab: Marlana

1. Build a problem list based on the Hx and  Px .  What diseases have a higher probability of causing these clinical problems in this patient, especially when cough and shortness of breath are present together?  What additional problems have you identified?    Nathaniel

2. What is the basis for chronic bronchitis?  Do we have to consider other possibilities?   Nathaniel

3. Is his occupation important? What are the risks of his occupation ?  Nathaniel

4. Explain the pathogenesis of the following clinical findings: Justin

• Cyanosis     
• Use of accessory muscles   
• Distended jugular veins  
• Increased A-P chest diameter   
• Decreased breath sounds  
• Wheezing  
• Loud S₂ (P₂ and  S₄.
• Tachypnea
• Fever  
• Palpable Liver

5.  What is the nature of respiratory infection?  Does he have Pneumonia? Explain his chest pain. Marlana

6. Correlate and explain the laboratory data. Marlana

Total white blood cell count, Hemoglobin and hematocrit, Chemistries, Electrolytes.

7. How do you interpret his ABG. Marlana

8. How would you explain his hypoxia? Kevin

9. The results of the sputum culture are pending. What do you expect the results to be? What is the rationale, if any, for ordSarag sputum culture? Marlana

10. Interpret his CXR? Describe any abnormalities and correlate with the clinical problem. Marlana

11. Explain the significance, if any, of the results of spirometry. Marlana

12. Determine the rate, rhythm and axis of the patient's electrocardiogram. Describe any abnormalities and correlate with the clinical problem. Kevin

13. What is your diagnosis based upon the data given in the history and physical examination and lab data.  Kevin

14. Describe the pathologic changes that you would expect to find in this patient  Kevin

15. Identify the treatable problems in this patient.  Jennifer

16. How do you treat chronic bronchitis?  Jennifer

17. How will you correct his hypoxia? Jennifer

18.  How can you reduce his work of breathing?  Sara

19. How will you treat his Congestive Heart failure/Corpulmonale ? Sara

20. What can you do to treat Emphysema?  Linda

21. What bronchodilators will you use? Explain the significance, if any, of the results of spirometry  Linda

22. What is the role for steroids?  Linda

23. How will you correct Pulmonary hypertension?  Frankie

24.  Which Antibiotic will you select to treat  respiratory infection?  The results of the sputum culture are pending. What do you expect the results to be? What is the rationale, if any, for ordSarag sputum culture?  Frankie

25. How do you manage his respiratory failure?. Frankie

26. What advise can you give with regards to his occupation? Frankie

27. What is your plan for smoking cessation? Frankie

Case 2: Austine

1. How do you assess severity of Asthma ?

2. How do you manage acute attack of Asthma?

Images: Matthew