Chief Resident: Your attention, please. The teaching ward round by Chief physician Professor Clark now begins. Firstly, let's have the case presented by Dr. Grey.
住院总医师：请各位注意了，主任医师 Clark 教授的教学查房现在开始，首先由实习医师 Grey 医生汇报病史。
Intern (Dr. Grey): This 70-year-old man was admitted because of a one-week history of breathlessness and cough with purulent sputum.
实习医师：病人，男性，70 岁，因气急、咳嗽、咳痰 1 周入院。
He had always been coughing with sputum during the past thirty years and tended to getting worse over recent five years, with breathlessness developing.
病人近 30 年来一直有咳嗽、咳痰，近5年来有所加重，伴气急。
The symptoms were usually aggravated by cold weather or alternations of seasons, while tended to ease when the weather was getting warm. Almost every year he had to suffer for one to three months. He was continuously using salbutamol inhalation which did relieve the symptoms most of the time.
One week before admission, he caught a cold and suffered a relapse thereafter. Meanwhile, he had large volumes of purulent sputum and wheezed after moderate movement. He inhaled salbutamol as usual, but it didn't work this time. So he came. The patient has a smoking history of 100 pack years. And his family history was unremarkable. Mainly that's all.
Chief physician: Your presentation is quite clear. Were there any significant physical findings, Dr. Grey?
Intern (Dr. Grey): Yes. We examined the patient carefully and found signs of lung disease, including bucket-like-chest and rhonchi. But there was no cyanosis in the lips and no edema of the legs.
The laboratory tests reported that PaO₂ was 10 kPa and PaCO₂ was 5 kPa. However, WBC count was 9.9 X 10⁹/L, and the neutrophils were 90%. A previous pulmonary function examination showed that the forced expiratory volume in 1 second ( FEV1 ) was 1.5 liters and FEV1/forced vital capacity (FVC) was 50%.
Chief Physician: When was the pulmonary function done?
Intern (Dr. Grey): ( Looking through the chart ) Er... 6 months ago.
Chief physician: How was his condition at that time? I mean whether he was sick or instability?
Intern (Dr. Grey): Sorry, I failed to ask it.
Chief physician: Never mind, but be more careful next time.
Intern (Dr. Grey): Got it, Professor.
Chief Physician: Did he have a fever?
Intern (Dr. Grey): No.
Chief Physician: Well, since we have learned about the history, it’s the very time to visit the patient.
Chief Resident: OK. Let’s go to the ward.
ll. In the Ward 在病房
Chief Resident: Hello, Mr. Black. Our Chief Physician and the Attending Physician are coming to see you.
Patient: Good morning, doctors.
Chief Physician: Good morning, Mr. Black. l'm Dr. Clark. Could you tell me why you are here?
主任医师：早上好，Black 先生，我是 Clark 医生，能告诉我你为什么住医院的吗?
Patient: If only I know why. Anyway, I'm not as young as I was. Only a bit cold has brought me here. I feel so terrible!
Chief Physician: But you look not as old as you are. I suppose you were all well until this outbreak, weren't you?
Patient: Nol at all. In fact, I'm always coughing and wheezing in the past decades. But it's the first time I had to stay in hospital. You know, at the beginning, I was merely coughing, but it developed so fast that I couldn't stand it any more. ( Coughing )
Chief Physician: Don't worry, Mr. Black. What medication did you take before admission?
Patient: ( Taking out the bottle of salbutamol ) Here it is, but it did work anyway, except this time.
Chief Physician: Anything else other than it?
Patient: Mainly this, and sometimes the doctor gave me a few drugs or intravenous injections when I was badly coughing or wheezing.
Chief Physician: Have you felt better since admission?
Patient: Yes. I feel much better this morning.
Chief Physician: You have done the test of pulmonary function, haven't you?
Patient: Yes, several times.
Chief Physician: Do you remember whether you were well when doing the previous one?
Patient: I remember that was six months ago in this summer. I was fairly well then.
病人：嗯，我记得那是 6 个月前，是夏天，当时我还挺好的。
Chief Physician: Mr, Black, you are smoking, aren't you?
Patient: Yes, l have been smoking for 50 years.
病人：是的，我都抽了 50 年了。
Chief Physician: You know, guys, his smoking history is 100 pack a year, that is, if he smokes 1 pack per day, he has been smoking for 100 years. Now he said he had been smoking for 50 years, so we can conclude that he consumed 2 packs per day on average. Mr. Black, could we give you an examination?
Chief Physician: Now Dr. Grey, could you do the examination?
( Intern is examining the patient. )
Intern: The patient is a medium-sized male. He's in consciousness and breathes at a regular rate of 22 per minute. The oral temperature is 36.7 ℃ and the pulse rate is 90 beats per minute ( bpm ).
The blood pressure is 155/95 mmHg. No edema in the face and eyelids. Cyanosis can be seen in the finger tips. And he has clubbed fingers. There's no jugular varicosity or enlargement of superficial lymph nodes. The neck feels soft and the trachea is in the center.
There's no three depressions sign or thyroid enlargement. He has bucket-like-
chest and pervasive rhonchi can be heard in bilateral lungs with a little wheezing rales. The vocal fremitus symmetrically decreases in bilateral lungs.
The heart rate is 94 beats per minute with no arrhythmia or murmurs. The abdomen feels soft with no tenderness or rebound tenderness. Murphy's sign is negative and nothing special in neurological examination.