Week 3 Case Study Template
Chief Complaint
A.C., is a 61-year old male with complaints of shortness of
breath. History of Present Illness
A.C. was seen in the emergency room 1 week ago for an acute onset of mid-sternal chest pain.
The event was preceded with complaints of fatigue and increasing dyspnea for 3 months, for
which he did not seek care. He was evaluated by cardiology and underwent a successful and
uneventful angioplasty prior to discharge. Despite the intervention, the shortness of breath has
not improved. Since starting cardiac rehabilitation, he feels that his breathlessness is worse. The
cardiologist has requested that you, his primary care provider, evaluate him for further work-up.
Prior to today, his last visit with your practice was 3 years ago when he was seen for acute
bronchitis and smoking cessation counseling.
Pathophysiology & Clinical Findings of the Disease
1. Are the spirometry results consistent with obstructive or restrictive pulmonary
disease? What is the most likely pulmonary diagnosis for this patient?
The spirometry results are consistent with obstructive pulmonary disease since the
patients forced expiratory volume in 1 second (FEV1) is decreased as seen in obstructive
pulmonary disease, the normal range is >80%. Also the patient’s FEV1/FVC ratio is less
than 70% at a pre-bronchodilator prediction of 69% and a post-bronchodilator prediction
of 64%. The TLC is 125 and the qualifications for Obstructive pulmonary disease has a
TLC range that is considered normal at
>120% (Van Dijk, W., Tan, W., Li, P., Guo, B., Li, S., Benedetti, A., & Bourbeau, J.,
2015). The most likely pulmonary diagnosis for this patient is chronic obstructive
pulmonary disease.
2. Explain the pathophysiology associated with the chosen pulmonary disease.
Individuals who are diagnosed with chronic obstructive pulmonary disease experience
the symptom of shortness of breath because they have difficulty exhaling all the air from
their lungs. This is caused by the airway narrowing inside of their lungs due to damage to
their lungs, therefore exhaled air is more slowly expelled. After fully exhaling, the
individual will still have an abnormally higher amount of air left lingering in their lungs
(Asp, K. C., 2020). COPD is a mixture of small airway diseases like obstructive
bronchiolitis and emphysema and may differ between patients depending on their history,
risk factors and exposure to
, Week 3 Case Study Template
pollutants. Chronic inflammation causes structural changes which narrow the airways
causing limitation to airflow and mucociliary dysfunction (Global Initiative for Chronic
Obstructive Lung Disease, 2018).
3. Identify at least three subjective findings from the case which support the chosen
diagnosis.
One subjective finding from the case which supports the diagnosis of COPD is that the
patient has a 35 pack-year smoking history. The second subjective finding is that the
patient complains of dyspnea with exertion. Lastly, the patient states he has a non-
productive cough in the morning.
4. Identify at least three objective findings from the case which support the chosen
diagnosis.
One objective finding from the case which supports the diagnosis of COPD would be the
assessment of + Bilaterally wheezes noted with forced exhalation along with a prolonged
expiratory phase. The second objective finding would be the results of the chest x-ray
showing the patients lungs appearing hyper-inflated bilaterally with a flattened
diaphragm, consistent findings with COPD. Lastly, the third objective findings from the
case which support the diagnosis would be the spirometry results which was thoroughly
discussed in detail in question one regarding the patients values for FEV1, FEV1/FVC
and TLC.
Chief Complaint
A.C., is a 61-year old male with complaints of shortness of
breath. History of Present Illness
A.C. was seen in the emergency room 1 week ago for an acute onset of mid-sternal chest pain.
The event was preceded with complaints of fatigue and increasing dyspnea for 3 months, for
which he did not seek care. He was evaluated by cardiology and underwent a successful and
uneventful angioplasty prior to discharge. Despite the intervention, the shortness of breath has
not improved. Since starting cardiac rehabilitation, he feels that his breathlessness is worse. The
cardiologist has requested that you, his primary care provider, evaluate him for further work-up.
Prior to today, his last visit with your practice was 3 years ago when he was seen for acute
bronchitis and smoking cessation counseling.
Pathophysiology & Clinical Findings of the Disease
1. Are the spirometry results consistent with obstructive or restrictive pulmonary
disease? What is the most likely pulmonary diagnosis for this patient?
The spirometry results are consistent with obstructive pulmonary disease since the
patients forced expiratory volume in 1 second (FEV1) is decreased as seen in obstructive
pulmonary disease, the normal range is >80%. Also the patient’s FEV1/FVC ratio is less
than 70% at a pre-bronchodilator prediction of 69% and a post-bronchodilator prediction
of 64%. The TLC is 125 and the qualifications for Obstructive pulmonary disease has a
TLC range that is considered normal at
>120% (Van Dijk, W., Tan, W., Li, P., Guo, B., Li, S., Benedetti, A., & Bourbeau, J.,
2015). The most likely pulmonary diagnosis for this patient is chronic obstructive
pulmonary disease.
2. Explain the pathophysiology associated with the chosen pulmonary disease.
Individuals who are diagnosed with chronic obstructive pulmonary disease experience
the symptom of shortness of breath because they have difficulty exhaling all the air from
their lungs. This is caused by the airway narrowing inside of their lungs due to damage to
their lungs, therefore exhaled air is more slowly expelled. After fully exhaling, the
individual will still have an abnormally higher amount of air left lingering in their lungs
(Asp, K. C., 2020). COPD is a mixture of small airway diseases like obstructive
bronchiolitis and emphysema and may differ between patients depending on their history,
risk factors and exposure to
, Week 3 Case Study Template
pollutants. Chronic inflammation causes structural changes which narrow the airways
causing limitation to airflow and mucociliary dysfunction (Global Initiative for Chronic
Obstructive Lung Disease, 2018).
3. Identify at least three subjective findings from the case which support the chosen
diagnosis.
One subjective finding from the case which supports the diagnosis of COPD is that the
patient has a 35 pack-year smoking history. The second subjective finding is that the
patient complains of dyspnea with exertion. Lastly, the patient states he has a non-
productive cough in the morning.
4. Identify at least three objective findings from the case which support the chosen
diagnosis.
One objective finding from the case which supports the diagnosis of COPD would be the
assessment of + Bilaterally wheezes noted with forced exhalation along with a prolonged
expiratory phase. The second objective finding would be the results of the chest x-ray
showing the patients lungs appearing hyper-inflated bilaterally with a flattened
diaphragm, consistent findings with COPD. Lastly, the third objective findings from the
case which support the diagnosis would be the spirometry results which was thoroughly
discussed in detail in question one regarding the patients values for FEV1, FEV1/FVC
and TLC.
