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

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

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

Explain the pathogenesis of the following clinical findings:

• 4. Cyanosis      Answer
• 5. Use of accessory muscles   Answer
• 6. Distended jugular veins  Answer
• 7. Increased A-P chest diameter   Answer
• 8. Decreased breath sounds  Answer
• 9. Wheezing  Answer
• 10. Loud S₂ (P₂ and  S₄.  Answer

11.  What is the nature of respiratory infection?    Answer

12. Correlate and explain the laboratory data.  Answer

13. How do you interpret his ABG.  Answer

14. 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? Answer

15. Interpret his CXR? Describe any abnormalities and correlate with the clinical problem.  (close the window to return) Answer

16. Explain the significance, if any, of the results of spirometry.   Answer

17. Determine the rate, rhythm and axis of the patient's electrocardiogram. Describe any abnormalities and correlate with the clinical problem. (Close the window to return)  Answer

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

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

Let us next concentrate on management of this patient.

1. Identify the treatable problems in this patient.      My list

2. How do you treat chronic bronchitis?   Answer

3. What advise can you give regards his occupation?  Answer

4. How will you correct his hypoxia?     Answer

5. How can you reduce his work of breathing?   Answer

6. How will you treat his CHF?  Answer

7. What can you do to treat Emphysema?  Answer

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

9. What is the role for steroids?    Answer

10. How will you correct Pulmonary hypertension?   Answer

11.  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?   Answer 

12. How do you manage his respiratory failure?.  Answer

13. When will you consider the patient for Lung reduction Surgery?  

14. Is he a transplant candidate?