A 68-year-old man with a 50 pack-year smoking history presents with progressive dyspnea and 12-pound weight loss over three months. Vital signs show BP 142/88, HR 102, RR 22, SpO2 88% on room air. Physical examination reveals barrel chest, pursed-lip breathing, and accessory muscle use. Chest X-ray demonstrates hyperinflation with flattened diaphragms. FEV1/FVC ratio is 0.58. He denies orthopnea. Which lung distribution pattern is most characteristic of smoking-related emphysema?
- A)Bronchial mucus plugging with eosinophilic crystals
- B)Noncaseating granulomas concentrated in hilar nodes
- C)Centriacinar destruction involving the upper lobesGABARITO
- D)Panacinar destruction involving the lower lobes
- E)Diffuse fibrotic change with honeycomb lung
Explicação
Centriacinar destruction involving the upper lobes is correct. Smoking classically causes centriacinar emphysema, which affects respiratory bronchioles most prominently in the upper lobes. Hyperinflation, weight loss, and prolonged expiration fit emphysema. Ver explicação completa e trilha adaptativa →