A 59-year-old woman with a 25 pack-year smoking history is diagnosed with chronic obstructive pulmonary disease (COPD). What is the pathophysiology of the emphysema component of this disease process?
Inflammation of the bronchial wall leads to mucosal thickening, epithelial cell desquamation, and denudation of the basement membrane.
An irritant (usually smoking) causes an inflammatory response that leads to destruction of the alveolar air sacs, causing irreversible obstructive airway physiology.
Airway obstruction occurs due to the combination of inflammatory cell infiltration, mucus hypersecretion with mucus plug formation, and smooth muscle contraction.
The inflammatory response initiated by a bacterial infection causes leakage of the alveolar-capillary membrane at the site of inflammation, causing a decrease in lung compliance and shortness of breath.
The Correct Answer is B
Choice A reason: This describes changes more typical of asthma or chronic bronchitis, not emphysema. Emphysema involves destruction of alveolar walls rather than mucosal thickening or epithelial desquamation.
Choice B reason: Emphysema is characterized by permanent enlargement of airspaces distal to the terminal bronchioles due to destruction of alveolar walls. Smoking triggers an inflammatory response that activates proteases like elastase, which degrade alveolar structures, leading to reduced surface area for gas exchange and loss of elastic recoil. This results in irreversible airflow obstruction.
Choice C reason: This describes the pathophysiology of asthma, which involves reversible airway obstruction due to inflammation, mucus plugging, and bronchial smooth muscle contraction. Emphysema does not involve mucus plug formation or reversible obstruction.
Choice D reason: This describes the mechanism of acute respiratory distress syndrome (ARDS), not emphysema. ARDS involves alveolar-capillary membrane damage due to infection or trauma, leading to fluid leakage and decreased lung compliance.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: While mumps can cause inflammation and damage to the testes, there is no strong evidence linking mumps infection directly to an increased incidence of testicular cancer. This choice is misleading and not supported by current pathophysiological understanding.
Choice B reason: Decreased sperm count may occur as a consequence of mumps-related orchitis, but it is not the primary pathophysiological mechanism. The underlying cause is testicular inflammation and atrophy, which subsequently affects spermatogenesis.
Choice C reason: Mumps can lead to orchitis, particularly in post-pubertal males. Orchitis causes inflammation of the testicles, which can result in testicular atrophy and impaired sperm production. This is the most direct and well-established mechanism by which mumps affects male fertility.
Choice D reason: Varicocele is a separate condition involving dilated veins in the scrotum and is not caused by mumps. While varicocele can impair sperm quality, it is unrelated to the viral pathophysiology of mumps.
Correct Answer is B
Explanation
Choice A reason: Nightmare disorder involves vivid, frightening dreams that occur during REM sleep and typically awaken the child, who can recall the dream content. In this case, the child does not fully wake and has no memory of the episode, which is inconsistent with nightmare disorder.
Choice B reason: Sleep terrors, also known as night terrors, are episodes of intense fear, screaming, and autonomic arousal that occur during non-REM sleep, usually within the first few hours of sleep. Children experiencing sleep terrors are difficult to awaken, appear confused, and typically have no memory of the event. This matches the boy’s presentation precisely.
Choice C reason: Insomnia is characterized by difficulty initiating or maintaining sleep, or waking too early. It does not involve screaming, crying, or episodes of confusion during sleep. The boy’s symptoms are not consistent with insomnia.
Choice D reason: REM sleep behavior disorder involves physically acting out dreams due to loss of normal REM atonia. It is more common in older adults and involves purposeful movements rather than screaming or crying. The child’s age and presentation make this diagnosis unlikely.
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