A 72 year old male came to emergency with a complaint of difficulty in breathing

Question

A 72 year old male came to emergency with a complaint of difficulty in breathing and dyspnea (feeling short of breath). You learn he has smoked since he was 18. In the past he had smoked a pack a day but due to finances has a limit of 4 cigarettes a day. He has tried to stop smoking but has been unsuccessful. During your conversation you note he has a persistent and productive (mucus producing) cough he reports he has had this cough for years. His blood pressure is 102 (normal is 60-100), and you note crackling and wheezing when auscultating (listening to sounds produced with a stethoscope) both lungs. No abnormal sounds were noted when auscultating the heart. Distention of neck veins and mild edema at the wrist and ankle were noted. Radiographic analysis demonstrates right ventricular hypertrophy (enlargement). Radiographic analysis of the lungs revealed several dark fields. EKG was unremarkable (normal). In practice questions- please keep in mind that the e denser a tissue is (think bone) the brighter/whiter the tissue appears on a radiograph. 1) Based on the intake interview and diagnostic evidence what organ system is diseased? 2) Why would the patient exhibit slightly elevated blood pressure? 3) Why would the patient exhibit distention of the neck veins?

Explanation / Answer

1. The patient's breathing system /lungs organ system is diseased

2. The patient has exhibited slightly elevated bloos pressure due to cracling and wheezing when auscultating both lungs.

3. The patient has exhibited distention of the neck veins due to right ventricular hypertrophy or enlargement.

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