A 57-Year-Old Man Underwent Lung Transplantation for Severe Emphysema 2

question 19

Multiple Choice

A 57-year-old man underwent lung transplantation for severe emphysema 2 years ago.  Over the last 6 months, he has had increasing exertional dyspnea and dry cough.  The patient has adhered to his medical regimen.  He does not smoke and has no exposure to secondhand smoke.  Physical examination shows scattered bilateral rales and end-expiratory squeaks.  Cardiac auscultation reveals no murmurs or additional sounds.  Spirometry demonstrates markedly decreased FEV1 compared with findings 6 months prior, although the FVC remains largely unchanged.  Chronic lung transplant rejection is suspected, and bronchoscopy with transbronchial biopsy is planned.  Histopathology is most likely to show injury predominantly involving which of the following structures?

• A)Alveolar walls
• B)Large airways
• C)Pleural membranes
• D)Small airways
• E)Small blood vessels