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Old 10-01-2011
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Lungs Lung pathology of a smoker with breathing difficulties

A 63-year-old man who is a long-term smoker presents with increasing shortness of breath and dyspnea. He has smoked more than two packs of cigarettes per day for more than 40 years. He denies having a productive cough or any recent infections. Physical examination reveals a thin elderly-appearing man in moderate respiratory distress. While sitting he leans forward slightly and breathes quickly through pursed lips. He is afebrile and his blood pressure is within normal limits. Examination of his chest reveals an increased anteroposterior diameter and his lungs are hyper-resonant to percussion. His respiratory rate is increased, but no clubbing or cyanosis is present. Chest x-ray reveals his heart to be of normal size, but there is hyperinflation of his lungs. Laboratory examination reveals that while breathing room air, his arterial PO2 is decreased but his arterial PCO2 is normal. Which of the following statements is a correct association concerning the pathogenesis of this man's pulmonary disease?

A. Destruction of entire acinus caused panlobular emphysema
B. Destruction of the cilia on the respiratory epithelial cells resulted in bronchiectasis
C. Destruction of the proximal acinus caused centrilobular emphysema
D. Hyperplasia of the respiratory smooth-muscle cells resulted in intrinsic asthma
E. Hyperplasia on the respiratory mucus glands caused chronic bronchitis

Source: Lange Q&A Step 1
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C. Destruction of the proximal acinus caused centrilobular emphysema
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C. Destruction of the proximal acinus caused centrilobular emphysema
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c centrilobular emphysema
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Old 10-04-2011
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The answer is c centrilobar emphysema
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