COPD USMLE Step 1 Practice Question
A 22-year-old woman presents with chronic productive cough producing large volumes of foul-smelling sputum and recurrent pneumonia since childhood. Vital signs: BP 118/76, HR 92, RR 20, Temp 37.2°C, SpO2 94% on room air. Examination reveals coarse crackles at bilateral lung bases; no wheezing noted. Chest X-ray shows bronchial wall thickening. High-resolution CT demonstrates permanently dilated bronchi with bronchus-to-artery ratio >1. Which pathophysiologic mechanism best explains this patient's bronchial abnormality?
Answer choices
- AFibrosis confined to the visceral pleura
- BRepeated inflammation causing destruction of bronchial wall smooth muscle and elastic tissueCorrect answer
- CLoss of alveolar septa from protease excess
- DAcute edema of the epiglottis from Haemophilus influenzae infection
- EDiffuse alveolar damage with hyaline membrane formation
- FPermanent collapse of small airways due to loss of radial traction from surrounding parenchymal fibrosis
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