Question

CHIEF COMPLAINT: "I'm short of breath; I can't stop coughing." HISTORY: Mr. O'Connor is a 62-year-old auto mechanic who presents with progressive shortness of breath for the past several days. His problem began four days ago when "I got a cold." His "cold" consisted of a sore throat, rhinorrhea and myalgia. His job forces him to work in the cold and damp air. At first he just felt tired but later he developed a cough and shortness of breath. Initially, the cough was dry but within 24 hours of onset, it produced abundant yellow- green sputum. He states, "I cough up a cup of this stuff every day." He didn't think much of the cough because he continually coughs during the winter of each year. His wife states that he "hacks and spits up" every morning when he gets up from bed. The shortness of breath has worsened so that he can hardly speak now. He also has pain in the left side of his chest when he coughs. He becomes very tired after walking up a flight of stairs or during a coughing spell. He denies hemoptysis, night sweats, and chills. However, he does complain of swelling of his ankles: "I've had this for more than a year." Mr. O'Connor has been treated for high blood pressure, pneumonias and infections of his hands. He has been treated for similar episodes of coughing and shortness of breath during the past two years. Once he was hospitalized because "I was drinking too much and my pancreas acted up." A previous doctor gave him nitroglycerin. He smokes 1-2 packs of cigarettes per day and has done so for the past 35 years. PHYSICAL EXAMINATION: The patient appears much older than he stated age of 62 years. He is a stocky man who appears haggard, tired and anxious. He speaks with difficulty, quickly becoming breathless. There is cyanosis, which intensifies during coughing spells. Blood pressure is 146/82 mmHg. Apical heart rate is 96/minute and regular. Respiratory rate is 28/minute. Temperature is 100.2 F. Examination of the head and neck reveals the use of accessory muscles during respiration. Jugular veins are dilated to 5 cm. with a prominent "a" wave. Examination of the chest reveals use of accessory respiratory muscles. The anterior-posterior diameter of the chest is increased. Respiration rate is increased; respiration is regular and longer in expiration. Percussion also reveals decreased excursion of the diaphragm (bilateral). Breath sounds are diminished bilaterally. Coarse crackles, rhonchi and expiratory wheezes are heard bilaterally. Most of these sounds clear with coughing. Both feet show hallux valgus. There is pitting edema of the ankles. Diagnosis: Chronic bronchitis.

Answer 1

1.Shortness of breath.

The phrase is 'He speaks with difficulty, quickly become breathless".

2.Rhinos- of the nose

Rhoia- a flowing

Myo-muscle

Algia- pain

Haemo-blood

Ptysis- spitting

Bronchi- airways to the lungs

Itis- inflammation

3.Cyanosis is the bluish discolouration of the skin and mucous membranes, due to deoxygenation.

Coughing spells occurs anytime during eating, drinking, yawning, sneezing or breathing in order to clear the airway.

4.Blood pressure

Renal failure

Asthma

5.Accessory respiratory muscles are used under conditions of high metabolic demands such as respiratory dysfunction.

Eg. Exercise

Asthma attack

6.Tachypnea

7.Percussion is a method of tapping body parts with fingers hands or small instruments,during physical examination.

*to check size, consistency or borders of body organs.

*to identify the presence or absence of fluid in the body.

8.crackles ate dis ordered sounds last lesz than 250ms.

Rhonchi is continous sound last approximately 250ms.

Both crackles and rhonchi caused byblock in upper airway.

It should be identified by using stethescope.