Case Study #1 Mr. L is a 65-year-old man who is the vice-president of a prestigious law firm. As a result of the stressful nature of his job, Mr. L. has a habit of smoking 2 packs of cigarettes a day and has done so for the past 35 years. During the last few years, Mr. L. has experienced slight shortness of breath and a mild cough with activity and on arising in the morning. Recently, Mr. L. has noticed that he has difficulty climbing the stairs at work, which not only produces fatigue but often requires him to stop at varying intervals so that he may catch his breath. He has also noticed that besides being short of breath with exertion, he tends to experience dyspnea at rest. He has had an approximate weight loss of 10 pounds within the last 2 months. Mr. L. is brought into the emergency room by his wife for evaluation because of his increasing dyspnea and because he must sleep sitting up with the aid of several pillows. On admission to the emergency room, Mr. L. is a thin, frail-looking man in acute respiratory distress. He is restless and tachypneic and uses pursed-lip breathing. He is sitting on the side of the bed, leaning on an over-the-bed table. His vital signs are as follows: Heart Rate 120, Respirations 30, Blood Pressure 140/80. A chest roentgenogram is taken, and arterial blood gases are drawn on room sir. Mr. L.s arterial blood gases indicate the following: PO 39 mmHg, PCO 2 2 52 mmHg, pH 7.32, bicarbonate 36 mEq/L. He is now placed on 2 L of nasal oxygen and is sent to the medical intensive care unit for further treatment and evaluation. The chest roentgenogram reveals a flat, low diaphragm and hyperinflation of the lungs. The lung fields are relatively clear but appear translucent, and no gross cardiac enlargement is seen. Auscultation of the lungs reveals decreased breath sounds with expiratory wheezes. Mr. L.s chest has an increased anteroposterior diameter, and the respiratory accessory muscles are used for ventilation. Pulmonary function tests reveal decreased tidal volume, decreased vital capacity, and prolonged forced expiratory volume. Arterial blood gases are redrawn on 2 L of oxygen. The results are as follows: PO 49 mmHg, PCO 50 mmHg, pH 7.25, bicarbonate 32 mEq/L. 2 2 It is felt that Mr. L. could benefit from a respiratory treatment so a nebulizer treatment with bronchodilators is given to him. After the treatment, Mr. L.s lungs are reauscultated, and it is noted that his wheezes are decreased, he is now less restless, and his respiratory rate has decreased to 22. Arterial blood gases are now redrawn after the treatment and the results now reveal PO 58 2 mmHg, PCO 42 mmHg, and pH 7.38. 2 Of the following choices, which is most likely the cause of Mr. L.s dyspnea? (You can choose more than one answer) Increased lung compliance Decreased elastic recoil Decreased lung compliance Increased elastic recoil Mr. L. has been described to have a barrel chest what are the causes of this in Mr. L.? What caused Mr. L. to retain C.

1. Case Study #1
Mr. L is a 65-year-old man who is the vice-president of a prestigious law firm. As a result of the
stressful nature of his job, Mr. L. has a habit of smoking 2 packs of cigarettes a day and has done
so for the past 35 years.
During the last few years, Mr. L. has experienced slight shortness of breath and a mild cough with
activity and on arising in the morning. Recently, Mr. L. has noticed that he has difficulty climbing
the stairs at work, which not only produces fatigue but often requires him to stop at varying
intervals so that he may catch his breath. He has also noticed that besides being short of breath
with exertion, he tends to experience dyspnea at rest. He has had an approximate weight loss of
10 pounds within the last 2 months. Mr. L. is brought into the emergency room by his wife for
evaluation because of his increasing dyspnea and because he must sleep sitting up with the aid of
several pillows.
On admission to the emergency room, Mr. L. is a thin, frail-looking man in acute respiratory
distress. He is restless and tachypneic and uses pursed-lip breathing. He is sitting on the side of
the bed, leaning on an over-the-bed table. His vital signs are as follows: Heart Rate 120,
Respirations 30, Blood Pressure 140/80. A chest roentgenogram is taken, and arterial blood gases
are drawn on room sir. Mr. L.s arterial blood gases indicate the following: PO
2
39 mmHg, PCO
2
52 mmHg, pH 7.32, bicarbonate 36 mEq/L. He is now placed on 2 L of nasal oxygen and is sent to
the medical intensive care unit for further treatment and evaluation.
The chest roentgenogram reveals a flat, low diaphragm and hyperinflation of the lungs. The lung
fields are relatively clear but appear translucent, and no gross cardiac enlargement is seen.
Auscultation of the lungs reveals decreased breath sounds with expiratory wheezes. Mr. L.s chest
has an increased anteroposterior diameter, and the respiratory accessory muscles are used for
ventilation. Pulmonary function tests reveal decreased tidal volume, decreased vital capacity, and
prolonged forced expiratory volume. Arterial blood gases are redrawn on 2 L of oxygen. The
results are as follows: PO
2
49 mmHg, PCO
2
50 mmHg, pH 7.25, bicarbonate 32 mEq/L.
It is felt that Mr. L. could benefit from a respiratory treatment so a nebulizer treatment with
bronchodilators is given to him. After the treatment, Mr. L.s lungs are reauscultated, and it is noted
that his wheezes are decreased, he is now less restless, and his respiratory rate has decreased to
22. Arterial blood gases are now redrawn after the treatment and the results now reveal PO
2
58
mmHg, PCO
2
42 mmHg, and pH 7.38.
Of the following choices, which is most likely the cause of Mr. L.s dyspnea? (You can choose
more than one answer)
Increased lung compliance
Decreased elastic recoil
Decreased lung compliance
Increased elastic recoil
Mr. L. has been described to have a barrel chest what are the causes of this in Mr. L.?
What caused Mr. L. to retain Carbon Dioxide in the blood (as evidenced by his elevated PCO
2
levels)?
What is the explanation behind Mr. L.s weight loss?
What disease does Mr. L. exhibit please explain your answer using Mr. L.s past history and his

2. current medical status (lab results, clinical presentations, etc.). Please include in your answer a
description of what is happening inside Mr. Ls body as compared to normal physiology.