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Patient Presentation
Raymond Parker is a 55 year old married garage mechanic who, on the insistence of his wife, presents to you, his general practitioner with progressive shortness of breath and cough.
Raymond is clearly obese. He smokes 30 cigarettes a day and has done so for 40 years. He drinks six cans (i.e. four pints) of Carlsberg Special Brew a day. For at least 15 years he has had a chronic productive cough with white sputum, mostly in the mornings, and suffers from two or three respiratory infections per year.
Ten years ago his exercise tolerance was not noticeably reduced. Currently, when walking up the stairs in his flat and when walking with his wife and their small dog in the evenings, shortness of breath stops him after 100 metres. He has noted an intermittent wheeze. His breathlessness and cough is worst first thing in the morning, although he says that this improves after his first morning cigarette.
He now has to sleep propped up with three pillows and reports mild ankle swelling in the last month.
LOBs - Session 1
LOBs - Session 2
Cause of left axis deviation in this case
Conditions in which surfactant levels are reduced
Type I and II respiratory failure
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