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week 4
Week 4 Case Study Prompt (Student version)
A 67-year-old man presents with progressive shortness of breath over 8 months. He
reports:
• Increasing dyspnea with exertion
• Dry, persistent cough
• Fatigue
• Decreased exercise tolerance
• Unintentional 10-pound weight loss
He denies wheezing, chest pain, fever, or recent respiratory infection.
Past medical history includes hypertension and hyperlipidemia. He is a retired
construction worker with 35 years of occupational dust exposure. He smoked 1 pack per
day for 25 years but quit 10 years ago.
Physical Examination
• BP: 132/78 mmHg
• HR: 88 bpm
• RR: 20/min
• SpO₂: 91% on room air
Lung exam reveals:
• Fine, bilateral “Velcro-like” crackles at the lung bases
• No wheezing
• Digital clubbing present
Cardiac exam normal. No peripheral edema.
Diagnostic Data
Pulmonary Function Tests (PFTs):
• Reduced total lung capacity (TLC)
• Reduced forced vital capacity (FVC)
• Normal or increased FEV1/FVC ratio
• Decreased diffusion capacity (DLCO)
Chest X-ray: Bilateral interstitial markings, worse at lung bases
High-Resolution CT (HRCT):
• Reticular opacities
• Honeycombing pattern
• Subpleural and basilar predominance
Laboratory Findings:
Test Result
CBC Normal
CMP Normal
ANA Negative
Rheumatoid factor Negative
ESR Mildly
elevated
Questions
1. Develop a 1- to 2-page case study analysis, examining the patient signs
and symptoms presented in the case study; discussing the primary
cellular pathophysiological processes, and the significance for
symptom development and diagnosis.
2. What role do genetic mutations play in the development of the disease?
3. What are the racial/ethnic factors that would be a risk factor? What are
the lifestyle risk factors?
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