PROBLEMS ON RESPIRATORY SYSTEM

A 48 year old man with no history of major medical illnesses has had gradually worsening dyspnea for the past 13 months. He has no cough or hemoptysis. He is afebrile. He is a non-smoker. He is a corporate attorney. Spirometry reveals a normal FEV1/FVC ratio with decreased FVC. The DLCO is decreased. Sputum cytology shows no atypical cells. The pathologic finding in the lungs most likely to be present in this setting is:

A Honeycombing fibrosis

B Bronchial destruction with dilation

C Apical bullae

D Increased bronchial submucosal glands

E Mucosal eosinophil infiltration

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A 47 year old female develops acute renal failure, and a renal biopsy reveals a crescentic glomerulonephritis. She has an anti-neutrophil cytoplasmic autoantibody test that is positive. A chest radiograph reveals bilateral small nodular infiltrates. A sputum gram stain shows normal flora. A sputum cytology shows no abnormal cells, but numerous hemosiderin-laden macrophages are present. Which of the following pulmonary pathologic findings is most likely to be present:

A Bronchial chronic inflammation

B Recurrent thromboembolism

C Necrotizing vasculitis

D Pleural effusions

E Non-caseating granulomas

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