A 65-Year-Old Woman Is Brought to the Physician Due to 6

question 1440

Multiple Choice

A 65-year-old woman is brought to the physician due to 6 months of dry cough and worsening dyspnea.  Her dyspnea has progressed so that she is now able to walk only a few steps.  She has no fever, chest pain, or hemoptysis.  Her only medication is hydrochlorothiazide for hypertension.  The patient is a retired schoolteacher and does not use tobacco or alcohol.  She has no pets and has never traveled abroad.  Temperature is 37.2 C (99 F) , blood pressure is 140/86 mm Hg, pulse is 84/min, and respirations are 18/min.  Chest examination shows dry, late inspiratory crackles and digital clubbing.  There is no peripheral edema.  Serology is negative for antinuclear antibodies and antineutrophil cytoplasmic antibodies.  Chest x-ray shows diffuse reticular opacities.  A high-resolution computed tomography scan is shown below. Which of the following abnormalities is most likely to be present in this patient?

• A)Decreased FEV1/FVC ratio
• B)Increased alveolar-arterial gradient
• C)Increased diffusion capacity of carbon monoxide
• D)Increased PaCO₂
• E)Increased residual volume

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