USMLE Step 1 Question 318

Question:

A 51-year-old man comes to the doctor’s office with shortness of breath and productive cough. The patient has a history of smoking for the past 32 years and in the past was told that he had chronic bronchitis. Which of the following structures is most likely to be altered in this patient’s lungs?

Correct Answer: C.  Bronchial submucosa

The bronchial submucosa (choice C) is enlarged in patients with chronic bronchitis secondary to hyperplasia and hypertrophy of the mucous cells. Also, in the bronchial submucoas there is a greater proportion of mucous cells to serous cells.

The terminal bronchioles (choice D) are destroyed in emphysema leading to exertional dyspnea and nonproductive cough.

The alveoli (choice A) are not altered greatly in chronic bronchitis, but you will see altered alveoli in acute respiratory distress syndrome and acute eosinophilic pneumonia.

The trachea (choice E) and the bronchial arteries (choice B) are not altered in chronic bronchitis.