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Old 08-18-2011
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Default cough with expectoration

A 45-year-old with a chronic, sputum-producing cough presents to your office for lung measurement tests. He complains that for several years now, he experiences a productive cough thats lasts almost all winter. He reports a 15 year history of smoking 1 pack per day. Physical exam reveals mild cyanosis of the distal extremities and expiratory wheezes. Biopsy of his airways will show:
A. Bronchial smooth muscle hypertrophy with hyalinization of basement membrane
B. Dilation of air spaces with destruction of alveolar walls
C. Small pulmonary vessels with intra-alveolar hyaline membranes
D. Abnormal bronchial dilation with necrosis of bronchial wall
E. Hyperplasia of mucus secreting submucosal gland
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Old 08-18-2011
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Default B)dilation of air spaces with destruction of alveolar walls

Quote:
Originally Posted by ricko335 View Post
A 45-year-old with a chronic, sputum-producing cough presents to your office for lung measurement tests. He complains that for several years now, he experiences a productive cough thats lasts almost all winter. He reports a 15 year history of smoking 1 pack per day. Physical exam reveals mild cyanosis of the distal extremities and expiratory wheezes. Biopsy of his airways will show:
A. Bronchial smooth muscle hypertrophy with hyalinization of basement membrane
B. Dilation of air spaces with destruction of alveolar walls
C. Small pulmonary vessels with intra-alveolar hyaline membranes
D. Abnormal bronchial dilation with necrosis of bronchial wall
E. Hyperplasia of mucus secreting submucosal gland

Dx : emphysema
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Old 08-18-2011
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E. Hyperplasia of mucus secreting submucosal gland
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Old 08-19-2011
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Default

The correct answer is E.
The patient above has symptoms which are defined as chronic bronchitis, which is clinically defined as a productive cough occurring for at least 3 consecutive months over at least 2 consecutive years. Airway biopsy will show hypersecretion of mucus due to hyperplasia of the submucosal glands. By contrast, dilation of air spaces with destruction of alveolar walls and lack of elastic recoil is seen in emphysema. Hyalinization of basement membrane is seen in bronchial asthma; while intra-alveolar hyaline membranes are seen in ARDS. Bronchial dilation with chronic necrosis of bronchial walls is typical of bronchiectasis.
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