Obstructive lung diseases (emphysema, bronchitis) — MCQs

A 60-year-old man who is a chronic smoker comes to the hospital with the chief complaint of shortness of breath which has worsened over the past 2 days. He also has a productive cough with yellowish sputum. There is no history of hemoptysis, chest pain, fever, palpitations, or leg swelling. He had a viral illness one week ago. He has been using an inhaler for 10 years for his respiratory disease. He sleeps with 2 pillows every night. He received 100 mg of hydrocortisone and antibiotics in the emergency department, and his symptoms have subsided. His FEV1/FVC ratio is < 0.70, and FEV1 is 40% of predicted. What is the most likely finding that can be discovered from the histology of his bronchi?

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 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 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?

An 8-year-old boy presents to his pediatrician accompanied by his father with a complaint of chronic cough. For the past 2 months he has been coughing up yellow, foul-smelling sputum. He has been treated at a local urgent care center for multiple episodes of otitis media, sinusitis, and bronchitis since 2 years of age. His family history is unremarkable. At the pediatrician's office, his temperature is 99.2°F (37.3°C), blood pressure is 110/84 mmHg, pulse is 95/min, and respirations are 20/min. Inspection shows a young boy who coughs occasionally during examination. Pulmonary exam demonstrates diffuse wheezing and crackles bilaterally. Mild clubbing is present on the fingers. The father has brought an electrocardiogram (ECG) from the patient’s last urgent care visit that shows pronounced right axis deviation. Which of the following is the most likely etiology of this patient’s condition?

In which of the following pathological states would the oxygen content of the trachea resemble the oxygen content in the affected alveoli?

A 72-year-old man is brought to the emergency department after an episode of hemoptysis. He has a chronic cough that is productive of copious sputum. Six years ago, he had a stroke that left him with difficulty swallowing. He smoked one pack of cigarettes daily for 40 years, but quit 2 years ago. His respirations are 25/min and labored. Physical examination shows digital clubbing. An x-ray of the chest shows tram track opacities in the lower lung fields. Which of the following is the most likely diagnosis?

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?

A 31-year-old man presents to his primary care physician with shortness of breath. He states that he had a “cold” 2 weeks ago and since then has had a persistent cough and worsening shortness of breath. He denies fever, chills, chest pain, sore throat, or rhinorrhea. His medical history is significant for seasonal allergies. He uses fluticasone nasal spray. He had his tonsils removed when he was 8 years of age. His mother and maternal grandfather have cirrhosis, and his father has depression and hypertension. The patient endorses that he smokes tobacco socially on the weekends and uses marijuana daily. He drinks 1-2 beers after work with his co-workers most evenings. A chest radiograph shows hyperinflation of the lungs and hyperlucency. Routine labs are drawn, as shown below. Serum: Na+: 139 mEq/L Cl-: 105 mEq/L K+: 4.0 mEq/L HCO3-: 26 mEq/L Urea nitrogen: 15 mg/dL Glucose: 100 mg/dL Creatinine: 0.8 mg/dL Alkaline phosphatase: 98 U/L Aspartate aminotransferase (AST, GOT): 46 U/L Alanine aminotransferase (ALT, GPT): 49 U/L Pulmonary function tests are pending. Which of the following is most likely to confirm the patient’s diagnosis?

A 68-year-old man presents to the office with progressive shortness of breath and cough. A chest X-ray shows prominent hilar lymph nodes and scattered nodular infiltrates. Biopsy of the latter reveals noncaseating granulomas. This patient most likely has a history of exposure to which of the following?