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Case base learning Respiratory Module CBL 2



A 50 years old male with a history of 20 years of smoking came with complaints of dyspnea. On history cough was productive,dyspnea was progressive initially grade 1.Now the patient is breathless even at rest.Weakness was generalized and increasing with day to day activity.


On Examination:


Vitals   =                                                          Sub Vitals


Pulse:               94/min                         Anemia=         Nil

R/R:                 24/min                         Jaundice=        Nil

Temp:              Afebrile                       Edema=           Nil

B.P:                 110/70mmHg              Clubbing=       Nil

Lymph NodesNot palpable


General:  Patient looks emaciated leaning forward while sitting



On Auscultation:

  • Bilateral crepitations in lower zone.
  • Bronchial breathing with polyphonic wheeze.


On Investigations:

Complete blood picture:

Hb                   16.1 gm/ dL

MCV               78fL

WBC               10,000/Cumm

Neutro             70%

Lympho           28%

Eosino             04%

Mono               03%


Urea/Creatinine/Electrolytes:                          Normal limits.

Liver Function tests:                                       Normal limits.

Arterial blood gases:                                       pH: 7.5, PCO2: 46, PO2: 57,   HCO3: 25


X-ray  Chest:


  • Calcified
  • Hyper inflated lung field.
  • Reticular shadowing.
  • Tubular heart.


Learning Objectives



  1. Describe the major pathological & clinical differences between obstructive and restrictive lung diseases.


  1. Classify the various stages of the given pathology.



  1. Interpret the investigations including; lung capacities, lung volumes & X-Ray Chest findings.


  1. Describe the plan of management with the role of bronchodilators in cases of obstructive lesions.