USMLE (United States Medical Licensing Examination) Step 1 Practice Exam

The correct choice indicates that expiration becomes difficult primarily due to airway narrowing and reduced elastic recoil associated with obstructive airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD). In these conditions, the airways are narrowed either due to inflammation, bronchoconstriction, or structural changes, which leads to difficulty in expelling air from the lungs. Furthermore, the loss of elastic recoil in the lung tissue can exacerbate this difficulty, resulting in air trapping and reduced airflow during expiration.

Obstructive airway diseases specifically affect the ability to exhale air effectively, as there is increased resistance to airflow, which is a hallmark of these conditions. In contrast, other options such as a right-to-left shunt involve different mechanisms primarily affecting oxygenation rather than airflow obstruction. Restrictive lung disease is characterized by reduced lung volumes, making inhalation challenging rather than expiration. Decreased alveolar ventilation pertains to overall gas exchange inefficiency, which encompasses both inhalation and exhalation but does not specifically highlight the difficulties during expiration caused by airway narrowing.