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?    

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

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

4. Explain the pathogenesis of the following clinical findings:

•  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.

6. Correlate and explain the laboratory data. 

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

7. How do you interpret his ABG.

8. How would you explain his hypoxia?

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

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

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

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

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

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

15. Identify the treatable problems in this patient.  

16. How do you treat chronic bronchitis?  

17. What advise can you give regards his occupation? 

18. How will you correct his hypoxia? 

19.  How can you reduce his work of breathing?  

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

21. What can you do to treat Emphysema? 

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

23. What is the role for steroids? 

24. How will you correct Pulmonary hypertension?

25.  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 ordering sputum culture? 

26. How do you manage his respiratory failure?.

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

28. What is your plan for smoking cessation?