Case Study Challenge Client ID: Mr. T,

Case Study Challenge Client ID: Mr. T, a thin, 65-year-old Asian male diagnosed with emphysema Chief Complaint (CC)/History of Present Illness (HPI): has had slight SOB and mild cough with activity during past few years, but is now c/o increasing dyspnea, even at rest, and inability to sleep unless sitting upright. States breathing feels more difficult when he tries to breathe in than when he breathes out. Also states has lost 10 pounds within last 2 months. Past Medical History (PMH): no previous hospitalizations no medications Social History: 70 pack/year history of smoking. States he smokes r/t stress – Mr. T is the VP of a prestigious law firm Physical Exam (PE): VS: T 98.5; P 120; R 30; BP 140/80 Neuro: restless, but alert and oriented. PERRLA. Cranial nerves, sensation, DTRs intact. Strength equal bilaterally. CV: tachycardia, but rhythm regular. Denies chest pain. Peripheral pulses palpable and equal bilaterally. Resp: tachypneic, in acute respiratory distress, using pursed-lip breathing. Sitting on side of bed, leaning on an overbed table. Decreased anteroposterior chest dimensions. Diminished breath sounds, with expiratory wheezes. Using accessory muscles. GI: abdomen soft, nontender. Bowel sounds present. GU: exam unremarkable. Skin: intact, warm and moist. No edema noted. Laboratory/diagnostic data: Reference range Complete blood count: WNL Chemistry profile: Na 140 (134-147) K 3.8 (3.5-5.0) Cl 102 (98-109) CO2 30 (23-33) BUN 38 * (7-20) Cr 0.9 (0.7-1.3) Arterial blood gas: (on room air) pH 7.32 * (7.35-7.45) pCO2 52 * (35-45) pO2 49 * (79-99) HCO3 36 * (22-26) CXR: lung fields relatively clear, no gross cardiac enlargement. Low diaphragm, hyperinflation of the lungs. EKG: sinus tachycardia List 2 elements of case study not consistent with a diagnosis of emphysema, and give rationale for your choices. ___________________________________________________________________________________ Rationale: ____________________________________________________________________________ ___________________________________________________________________________________ Rationale: ___________________________________________________________________________

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