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?
AAlveolar macrophages
BCiliated bronchiolar epithelial cells
CElastic fibers in alveolar septa
DType I pneumocytes
EAlveolar septal cells
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?
ADecreased FEV1: FVC and decreased total lung capacity
BNormal FEV1: FVC and decreased total lung capacity
CIncreased FEV1: FVC and decreased total lung capacity
DDecreased FEV1: FVC and increased total lung capacity
EIncreased FEV1: FVC and normal total lung capacity
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?
AIncreased FEV1/FVC ratio
BIncreased diffusing capacity for carbon monoxide
CIncreased pulmonary capillary wedge pressure
DIncreased serum hematocrit
ENormal FEV1
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