COPD pathophysiology and diagnosis — MCQs

A 63-year-old man with alpha-1-antitrypsin deficiency is brought to the emergency department 1 hour after his daughter found him unresponsive. Despite appropriate care, the patient dies. At autopsy, examination of the lungs shows enlargement of the airspaces in the respiratory bronchioles and alveoli. Enzymatic activity of which of the following cells is the most likely cause of these findings?

A 60-year-old woman presents to the clinic with a 3-month history of shortness of breath that worsens on exertion. She also complains of chronic cough that has lasted for 10 years. Her symptoms are worsened even with light activities like climbing up a flight of stairs. She denies any weight loss, lightheadedness, or fever. Her medical history is significant for hypertension, for which she takes amlodipine daily. She has a 70-pack-year history of cigarette smoking and drinks 3–4 alcoholic beverages per week. Her blood pressure today is 128/84 mm Hg. A chest X-ray shows flattening of the diaphragm bilaterally. Physical examination is notable for coarse wheezing bilaterally. Which of the following is likely to be seen with pulmonary function testing?

A 48-year-old man comes to the physician because of a 3-month history of worsening shortness of breath and cough productive of frothy, whitish sputum. One year ago, he had a similar episode lasting 6 months. He has smoked a pack of cigarettes daily for 25 years. Physical examination shows bluish discoloration of the tongue and lips. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. Further evaluation of this patient is most likely to show which of the following findings?

A 55-year-old woman comes to the physician with a 6-month history of cough and dyspnea. She has smoked 1 pack of cigarettes daily for the past 30 years. Analysis of the sputum sample from bronchoalveolar lavage shows abnormal amounts of an isoform of elastase that is normally inhibited by alpha-1 antitrypsin. The cell responsible for secreting this elastase is most likely also responsible for which of the following functions?

A 62-year-old woman with hypertension and type 2 diabetes mellitus comes to the physician because of increasing shortness of breath and a dry cough over the past 6 months. She has smoked 1 pack of cigarettes daily for the past 40 years. Chest auscultation shows scattered expiratory wheezes in both lung fields. Spirometry shows an FEV1:FVC ratio of 65% and an FEV1 of 70% of predicted. Her diffusing capacity for carbon monoxide (DLCO) is 42% of predicted. Which of the following is the most likely diagnosis?

A 53-year-old woman presents to a physician with a cough which she has had for the last 5 years. She mentions that her cough is worse in the morning and is associated with significant expectoration. There is no history of weight loss or constitutional symptoms like fever and malaise. Her past medical records show that she required hospitalization for breathing difficulty on 6 different occasions in the last 3 years. She also mentions that she was never completely free of her respiratory problems during the period between the exacerbations and that she has a cough with sputum most of the months for the last 3 years. She works in a cotton mill and is a non-smoker. Her mother and her maternal grandmother had asthma. Her temperature is 37.1°C (98.8°F), the pulse is 92/min, the blood pressure is 130/86 mm Hg, and her respiratory rate is 22/min. General examination shows obesity and mild cyanosis. Auscultation of her chest reveals bilateral coarse rhonchi. Her lung volumes on pulmonary function test are given below: Pre-bronchodilator Post-bronchodilator FEV1 58% 63% FVC 90% 92% FEV1/FVC 0.62 0.63 TLC 98% 98% The results are valid and repeatable as per standard criteria. Which of the following is the most likely diagnosis?

A 65-year-old man comes to the physician because of a 10-month history of progressive shortness of breath and a cough productive of a small amount of white phlegm. Bilateral end-expiratory wheezing is heard on auscultation of the chest. Pulmonary function tests show total lung capacity that is 108% of predicted, an FEV1 that is 56% of predicted, and an FEV1:FVC ratio of 62%. Which of the following interventions is most likely to slow the decline in FEV1 in this patient?

A 68-year-old, overweight gentleman with a 20-pack-year history of smoking presents to the primary care physician after noticing multiple blood-stained tissues after coughing attacks in the last month. His vital signs are within normal limits except for an O2 saturation of 93% on room air. He states that over the last 5 years his cough has continued to worsen and has never truly improved. He states that his shortness of breath has also worsened over this time period, as now he can barely make it up the flight of stairs in his home. In this patient, what is the most likely cause of his hemoptysis?

A 40-year-old man comes to the physician because of a 2-year history of gradually worsening shortness of breath. He smoked half a pack of cigarettes daily for 10 years but stopped 8 years ago. His pulse is 72/min, blood pressure is 135/75 mm Hg, and respirations are 20/min. Examination shows an increased anteroposterior diameter of the chest. Diminished breath sounds are heard on auscultation of the chest. An x-ray of the chest shows widened intercostal spaces, a flattened diaphragm, and bilateral hyperlucency of the lung bases. This patient's condition puts him at greatest risk for which of the following conditions?

A 70-year-old man presents to a physician with a cough and difficulty breathing during the last 7 years. He has smoked since his teenage years and regularly inhales tiotropium, formoterol, and budesonide and takes oral theophylline. The number of exacerbations has been increasing over the last 6 months. His temperature is 37.2°C (99°F), the heart rate is 92/min, the blood pressure is 134/88 mm Hg and the respiratory rate is 26/min. On chest auscultation breath sounds are diffusely decreased and bilateral rhonchi are present. Pulse oximetry shows his resting oxygen saturation to be 88%. Chest radiogram shows a flattened diaphragm, hyperlucency of the lungs, and a long, narrow heart shadow. The physician explains this condition to the patient and emphasizes the importance of smoking cessation. In addition to this, which of the following is most likely to reduce the risk of mortality from the condition?