question: Q:A 65-year-old patient comes to the physician because of a 6-month history of persistent dry cough and shortness of breath with mild exertion. He reports feeling too weak to leave the house on most days. He has a history of hypertension and chronic atrial fibrillation. He has smoked a pack of cigarettes daily for 45 years. His medications include warfarin, enalapril, and amiodarone. His temperature is 36.1°C (97°F), pulse is 85/min and irregularly irregular, and blood pressure is 148/82 mm Hg. Physical examination shows enlargement of the fingertips with increased curving of the nail. Inspiratory crackles are heard over both lung bases. Spirometry shows decreased vital capacity. A CT scan of the chest shows clustered air spaces and reticular opacities in the basal parts of the lung. Which of the following is the most likely underlying mechanism of this patient's dyspnea?? 
  {'A': 'Excess collagen deposition in the extracellular matrix of the lung', 'B': 'Chronic airway inflammation', 'C': 'Pleural scarring', 'D': 'Increased pressure in the pulmonary arteries', 'E': 'Peribronchiolar accumulation of Langerhans cells'},