Case Study – Respiratory System Name: _______________________

The patient is a 24 year-old truck driver who recently drove across the country, was admitted to the hospital because of shortness
of breath (dyspnea) and chest pain. Her dyspnea began suddenly three hours before admission. It was associated with chest pain
that the patient described as feeling "like a knife stabbing me in the chest when I breathe in." She also had right leg pain in her
popliteal fossa (the slight depression on the back side of the knee). Physical Examination revealed an anxious-appearing female
in obvious respiratory distress.
Temperature: 100 degrees F
Pulse: 90
Respirations: 28
Blood pressure: 100/60
Skin: No cyanosis
Lungs: Inspiratory rales (crackling sounds) heard over the right base
Legs: Tenderness and erythema (redness) over the right popliteal fossa; mild edema of the right leg from the knee down.
Arterial blood gases:
pH of 7.48, (normal 7.35-7.45 )
pO2 of 70 mmHg. (normal pO2 90-100 mmHg)
pCO2 of 30 mmHg. (normal pCO2 35-45 mmHg)
One possible diagnosis for the patient is a pulmonary embolus.
The patient was placed on intravenous heparin and then began oral Coumadin during her weeklong hospital stay. Both drugs are
anticoagulants which prevent enlargements of blood clots and allow the body's normal clot-dissolving pathways to work. The
patient was sent home with a prescription for Coumadin, and advised to avoid factors that promote blood clotting, such as
smoking, oral contraceptives, and prolonged inactivity (such as driving for long periods without breaks). The patient was able to
stop taking Coumadin after six months.
Answer the following questions:
1. What is an embolism? (1 pt)

2. How are ventilation and perfusion affected in a pulmonary embolus? (1 pt) Circle one: A or B
A. Reduced pulmonary ventilation, excessive perfusion B. Alveolar ventilation is the same, inadequate perfusion

3. The patient was found to have a blood clot in her right popliteal vein. List 3 major blood vessels that an embolus
from here would pass through on the way to the right lung. (3 pt)
R. popliteal vein  ___________________________________________ (limb) 

_______________________________________________ (abdomen) 
_______________________________________________ (thorax)  right lung
3b. Where would a pulmonary embolus most likely lodge, causing the patient’s symptoms? (1 pt) [Hint: a blood vessel
from question 3 above, based on patient’s symptoms].

4. Interpret the patient’s arterial blood gas results: pH of 7.48, pO2 of 70, pCO2 of 30 mmHg (see normal blood
arterial gas results). Discuss in terms of arterial pH, arterial blood pO2 and pCO2. How would you classify this
patient’s acid-base status? Answer in 1 word or phrase (1 pt) [Hint: Textbook 23.6 Effect of O2 and CO2 pressure gradients] (2 pts)

5. Name the three ways in which Carbon dioxide, CO2 is transported? (2 pts)