Question:
A 45-year-old man who is a chronic smoker presents with a complaint of cough. The physician takes a biopsy of the airway, shown below. Which of the following cellular changes has happened in this patient?
A 45-year-old man who is a chronic smoker presents with a complaint of cough. The physician takes a biopsy of the airway, shown below. Which of the following cellular changes has happened in this patient?
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One adult epithelium is swapped for a hardier adult epithelium, and it can reverse if the smoker quits.
Updated On: Jun 23, 2026
- Hyperplasia
- Dysplasia
- Metaplasia
- CIN3
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The Correct Option is C
Solution and Explanation
Correct answer: Metaplasia.
Step 1: Cigarette smoke chronically irritates the bronchial lining. The normal pseudostratified ciliated columnar respiratory epithelium is replaced by a tougher stratified squamous epithelium. This swap of one adult cell type for another adult cell type is squamous metaplasia.
Step 2: Metaplasia is reversible: stopping smoking can allow the normal epithelium to return. It is the classic early change in a smoker's airway and frequently coexists with squamous cell lung cancers.
Step 3: Why not the others. Hyperplasia is an increase in cell number, not a change in cell type. Dysplasia is disordered, atypical growth (a step toward malignancy), not seen in simple smoker's metaplasia. CIN3 is a cervical grading term and does not apply to bronchial epithelium.
Note on the recall key: the crowd-recalled key marked Dysplasia (B), but the stem and the cited reference describe replacement of one epithelium by another, which is metaplasia. The medically correct answer is Metaplasia.
Ref: Robbins Basic Pathology, 9th edition.
Step 1: Cigarette smoke chronically irritates the bronchial lining. The normal pseudostratified ciliated columnar respiratory epithelium is replaced by a tougher stratified squamous epithelium. This swap of one adult cell type for another adult cell type is squamous metaplasia.
Step 2: Metaplasia is reversible: stopping smoking can allow the normal epithelium to return. It is the classic early change in a smoker's airway and frequently coexists with squamous cell lung cancers.
Step 3: Why not the others. Hyperplasia is an increase in cell number, not a change in cell type. Dysplasia is disordered, atypical growth (a step toward malignancy), not seen in simple smoker's metaplasia. CIN3 is a cervical grading term and does not apply to bronchial epithelium.
Note on the recall key: the crowd-recalled key marked Dysplasia (B), but the stem and the cited reference describe replacement of one epithelium by another, which is metaplasia. The medically correct answer is Metaplasia.
Ref: Robbins Basic Pathology, 9th edition.
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