Ms
Subject:Health SciencePrice: Bought3
Ms. MC is a 59 yo woman with long history of smoking 1 - 1.5 packs/day (20+ years) but is no longer smoking. She notices that she fatigues quickly, is often short of breath, coughs frequently and has ankle swelling. She has trouble sleeping but noted some improvement with extra pillows. You note an increase in anteroposterior chest diameter, prolonged expiratory phase with wheezing. She also has cyanosis of nailbeds with moderate pitting edema bilaterally. Lab tests reveal Hgb is high normal, PaO2 is low at 48 mmHg, O2 saturation is at 80%, PCO2 is significantly elevated (70 mmHg) and HCO3- is also elevated above normal (35 mEq/L). Your diagnosis is a combination of chronic bronchitis and emphysema (COPD). Pulmonary function tests revealed a decrease in Vital Capacity and Expiratory Flow Rate combined with an increase in both Residual Capacity and Functional Residual Capacity. These types of tests could also reveal other conditions, such as asthma, as well as guide treatment to prevent significant attacks.
Question: Why does she have ankle edema? What role does the lung play in hydrostatic pressure changes seen here? What is the effect pulmonary artery pressure and resultant changes to the right side of the heart?
Rubric: Correctly described the cause of the peripheral edema in regards to lung tissue/alveoli (2pt), alveolar surface area changes (2pt), changes in oxygen diffusion and effect on pulmonary artery pressure. Correctly discusses the effect long-term on the right side of the heart and its ability to match input with output of blood efficiently (2pt)
