A 61-year-old male presents to your office with fever and dyspnea on exertion. He has been suffering from chronic, non-productive cough for 1 year. You note late inspiratory crackles on auscultation. Pulmonary function tests reveal an FEV1/FVC ratio of 90% and an FVC that is 50% of the predicted value. Which of the following would you most likely see on a biopsy of this patient's lung?

Linear immunofluorescence along alveolar basement membranes

A 35-year-old female comes to the physician because of a 2-year history of progressive fatigue and joint pain. She has a 1-year history of skin problems and a 4-month history of episodic pallor of her fingers. She reports that the skin of her face, neck, and hands is always dry and itchy; there are also numerous “red spots” on her face. She has become more “clumsy” and often drops objects. She has gastroesophageal reflux disease treated with lansoprazole. She does not smoke. She occasionally drinks a beer or a glass of wine. Her temperature is 36.5°C (97.7°F), blood pressure is 154/98 mm Hg, and pulse is 75/min. Examination shows hardening and thickening of the skin of face, neck, and hands. There are small dilated blood vessels around her mouth and on her oral mucosa. Mouth opening is reduced. Active and passive range of motion of the proximal and distal interphalangeal joints is limited. Cardiopulmonary examination shows no abnormalities. Her creatinine is 1.4 mg/dL. The patient is at increased risk for which of the following complications?

Pulmonary arterial hypertension

Apneic episodes with obstructed upper airways

Chronic inflammatory airflow limitation

Thickening of alveolar membranes

Drug-induced respiratory depression

Diurnal alveolar hypoventilation

Decreased right atrial pressure

FEV1/FVC of 80% with an FEV1 of 82%

Inflammation, fibrosis and cyst formation that is most prominent in subpleural regions

Silica particles (birefringent) surrounded by collagen

Patchy interstitial lymphoid infiltrate into walls of alveolar units

Increased number and activity of goblet cells

Interstitial fibrosis of the lung

Increased ciliated epithelial cells

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