A 51-year-old male smoker presents with fever and a cough productive of greenish-yellow sputum. The patient states that he has had a morning cough with excessive mucus production for the past 5 years. Which of the following abnormalities would most likely be found in this patient?
Correct Answer: Increased Reid index
Description: This patient presents with symptoms suggestive of acute infection (elevated temperature, greenish-yellow sputum) on a background of chronic bronchitis, which is common in smokers. Hyperplasia and hyperophy of mucous glands in chronic bronchitis causes them to be present at deeper levels in the bronchial wall than usual. The ratio of the gland depth to the total thickness of the bronchial wall is termed the Reid index, which would be increased in this patient. Apical cavitary lesions might be indicative of cavitary tuberculosis. This condition is not associated with excessive mucus production. Hemoptysis and weight loss might also be expected as clinical findings. Curschmann spirals are found in asthmatic patients and represent mucus casts of small airways. This patient does not have the typical episodic history of acute asthmatic attacks with acute dyspnea as the major clinical problem. Elevated sodium chloride levels in sweat are present in cystic fibrosis. This condition has an onset in early life and is associated with excessive production of thick mucus, which predisposes to infection of the airways and permanent damage. Ref: Saavedra M.T., Nick J.A. (2003). Chapter 8. Chronic Bronchiectasis & Cystic Fibrosis. In M.E. Hanley, C.H. Welsh (Eds), CURRENT Diagnosis & Treatment in Pulmonary Medicine.
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