A 55-year-old man presents to physician with complain of difficulty in breathing for last two weeks. He mentions that he coughs frequently over last five years, but he has ignored the symptom because he thought it was due to smoking. He is a chronic smoker for last fifteen years. There is no history of fever or chest pain. On physical examination, his temperature is 98.8ºF (37.1ºC), respirations are 28/minute, pulse rate is 88/minute, and blood pressure is 124/84 mm Hg. Auscultation of chest reveals wheezing and decreased intensity of breath sounds over suprascapular and supramammary regions bilaterally. Hyperresonance is present over the same areas on percussion. Chest radiogram of the man shows hyperinflation of upper lobes of both the lungs. His pulmonary function testing shows FEV1 82% of predicted and FEV1/FVC 0.65. His total lung capacity is increased and diffusing capacity is reduced. His serum α1-antitrypsin level is normal. Which of the following parts of lower respiratory tract is most likely to be affected maximally in the patient?
B. Terminal bronchioles
C. Respiratory bronchioles
D. Alveolar ducts
E. Alveolar sacs
A 68-year-old man presents to physician with complain of fever, cough, and difficulty in breathing for last three days. He mentions that his expectorations are rust-colored. He has no known medical disorder and is otherwise a healthy man. On physical examination, his temperature is 103.7ºF (39.8ºC), pulse rate is 92/minute, blood pressure is 128/82 mm Hg, and respirations are 24/minute. Auscultation of his chest reveals decreased intensity of breath sounds and presence of crepitations over right infrascapular region. The physician orders his sputum examination, which shows predominant polymorphonuclear neutrophils and a few epithelial cells. Gram staining of sputum confirms presence of Gram-positive cocci in pairs. Chest radiogram of the man shows lobar consolidation in lower zone of the right lung. Which of the following best describes pathological changes in the affected area of the lung?
A. Neutrophil-rich exudate filling bronchi, bronchioles, and adjacent alveoli
B. Widening of alveolar septa and mononuclear inflammatory infiltrate
C. Fibrin strands in alveolar spaces and extravasation of red blood cells
D. Intra-alveolar fluid and vascular engorgement
E. Fibromyxoid masses rich in fibroblasts and macrophages
A 24-year-old woman presents to physician with complain of cough and wheezing for three days. She mentions that she has been experiencing similar episodes for last two years and the episodes are more frequent in winter months as compared to other seasons. Cough is usually non-productive or with scanty expectoration. Use of inhaled salbutamol, as prescribed by his physician one year back, quickly relieves her symptoms. Her mother is a known case of allergic rhinitis. On physical examination, her temperature is 98.4ºF (36.9ºC), pulse rate is 84/minute, blood pressure is 128/80 mm Hg, and respirations are 22/minute. Auscultation of her lungs shows presence of end-expiratory wheezing bilaterally. Her peak expiratory flow rate is 70% of expected for her age, which improves to 90% of expected for her age after use of inhaled salbutamol. The physician suggests her a few laboratory investigations for diagnostic evaluation. Her differential white blood cell count show 9% of eosinophils and microscopic examination of her sputum shows numerous eosinophils and crystals.
Which of the following proteins is most likely to be present in the crystals?
QID # 2311
6. A 48-year-old Japanese man presents to the clinic with multiple skin lesions as seen in the image:
He also complains of unintentional loss of weight even on a good diet and a healthy appetite. He denies smoking or alcohol abuse. On examination, the lesions are flat, velvety, hyperpigmented well defined lesions with a stuck-on appearance. The rest of the physical examination is unremarkable. Which of the following is the best investigation to be considered next in this patient?
A. Biopsy of lesion
B. Chest x-ray
C. Chest CT
D. Abdominal CT