Deck 26: Interstitial Lung Disease

Question 1

The presence of pleural calcification on the chest film is consistent with what type of interstitial lung disease (ILD)?

A) Asbestosis
B) Coal worker's pneumoconiosis
C) Sarcoidosis
D) Silicosis

Answer 1

A
Explanation: With an appropriate exposure history, the presence of radiographic pleural plaques or rounded atelectasis may indicate that asbestos as the cause of the ILD.

Question 2

What radiographic technique has the ability to better define the specific parenchymal characteristics associated with specific types of interstitial lung disease?

A) Bronchograms
B) High-resolution CT
C) MRI
D) Scans

Answer 2

B
Explanation: The ready availability of high-resolution CT (HRCT) has highlighted significant radiographic differences between diseases that have similar plain chest radiographic patterns.

Question 3

In interstitial lung disease, which of the following mechanisms contributes to impaired gas exchange?
1) Depression of respiratory drive
2) Diffusion defect
3) Shunt
4) Ventilation/perfusion mismatch

A)1 and 4 only
B)2 and 3 only
C)2, 3, and 4 only
D)1, 2, and 4

Answer 3

C

Question 4

What auscultatory finding is most consistent with the diagnosis of interstitial lung disease (ILD)?

A) Coarse inspiratory and expiratory crackles
B) Fine bilateral inspiratory crackles
C) Monophonic expiratory wheezes
D) Polyphonic expiratory wheezes

Question 5

What is the most common cause of interstitial lung disease (ILD)?

A) Asbestosis
B) Berylliosis
C) Pulmonary fibrosis (IPF)
D) Sarcoidosis

Question 6

Which of the following pulmonary function tests is most likely to be normal in the patient with interstitial pulmonary fibrosis?

A) Diffusing capacity of the lungs (DLCO)
B) FEV₁ (forced expiratory volume in 1 second)
C) FEV₁/FVC
D) FVC (forced vital capacity)

Question 7

The disease seen in interstitial lung disease is primarily a/an _____ process.

A) airway constrictive
B) obstructive
C) restrictive
D) supralaryngeal

Question 8

What is the classic radiographic finding present in many end-stage interstitial lung diseases (ILDs)?

A) Cystic pattern called honeycombing
B) Pleural disease uncommon
C) Prominent bibasilar infiltrates
D) Severe hyperinflation

Question 9

The term "asbestos-related pulmonary disease" may be used to encompass which of the following?
1) Asbestosis
2) Coal worker's pneumoconiosis
3) Sarcoidosis
4) Silicosis

A)1, 2, and 4 only
B)1 and 4 only
C)2 only
D)2, 3, and 4 only

Question 10

The classic chest radiographic findings in which of the following interstitial lung disease (ILD) is calcification along the pleura?

A) Asbestosis
B) Berylliosis
C) Idiopathic pulmonary fibrosis (IPF)
D) Sarcoidosis

Question 11

What is the primary pathologic change that occurs in interstitial lung disease?

A) Alveolar-capillary membrane structures replaced by fibrotic tissue
B) Bronchial submucosal gland hypertrophy
C) Bronchoconstriction of medium to small airways
D) Increased sputum production

Question 12

Which of the following is found almost universally in patients with interstitial lung disease (ILD)?

A) Airway dilation
B) Bronchoconstriction
C) Compensatory cytokine release
D) Decreased compliance

Question 13

Among smokers with IPF, normal spirometry and lung volumes with reduced DLCO suggest the presence of coexisting:

A) emphysema.
B) asthma.
C) chronic bronchitis.
D) lung carcinoma.

Question 14

Which group of disorders is categorized together because of similarities in their clinical presentations, plain chest radiographic appearance, and physiologic features?

A) Congestive heart failure
B) Infant respiratory distress syndrome
C) Interstitial lung diseases
D) Sudden acute respiratory syndrome

Question 15

Which of the following interstitial lung diseases (ILDs) is not occupationally related?

A) Asbestosis
B) Berylliosis
C) Sarcoidosis
D) Silicosis

Question 16

For what reason do patients with interstitial lung disease most commonly seek medical care?

A) Excessive mucus production
B) Hacking cough resulting in chest cage pain
C) Progressive exertional dyspnea
D) Severe wheezing and sense of breathlessness

Question 17

What symptoms are most common in the patient with interstitial lung disease?

A) Exertional dyspnea and nonproductive cough
B) Exertional dyspnea and wheezing
C) Nonproductive cough and wheezing
D) Productive cough and increased sputum production

Question 18

What are the typical pulmonary function test results in a patient with interstitial lung disease?
1) Decreased airway resistance
2) Decreased forced expiratory volumes
3) Increased airway resistance
4) Normal to elevated FEV₁/FVC

A)1, 2, and 4 only
B)2 and 4 only
C)3 only
D)2, 3, and 4 only

Question 19

Which of the following physical examination findings could be considered a late manifestation of interstitial lung disease (ILD)?

A) Bronchial wheezing
B) Increased wedge pressure
C) Peripheral cyanosis
D) Pulmonary hypertension

Question 20

It is determined that a patient has silicosis. What profession is he most likely to have worked at?

A) Foundry worker
B) Talc manufacturer employee
C) Carpenter
D) Miller

Question 21

Which of the following indicates the typical chest radiographic findings of a patient with silicosis?

A) Apical nodules
B) Bibasilar reticulogranular appearance
C) Lymphadenopathy
D) Pleural plaque

Question 22

A patient is exposed a second time to an antigen and subsequently seeks medical attention with sudden shortness of breath, chest pain, fever, chills, malaise, and a cough that may be productive of purulent sputum. What is the most likely cause of this pathology?

A) Acute anaphylactic shock
B) Acute hypersensitivity pneumonitis
C) Allergic congestive heart failure
D) Bronchial asthma

Question 23

Which of the interstitial lung diseases will in one-third of patients cause a chylothorax?

A) Alveolar proteinosis
B) Idiopathic pulmonary fibrosis
C) Lymphangioleiomyomatosis
D) Nonspecific interstitial pneumonitis

Question 24

What is the only therapy shown to prolong life in patients with end-stage, particularly fibrotic interstitial lung disease (ILD)?

A) Corticosteroids
B) Lung transplantation
C) Oxygen therapy
D) Pulmonary rehabilitation

Question 25

Exacerbations of silicosis are most often treated with what medication?

A) Aerosolized steroids
B) Antibiotics
C) Diuretics
D) Positive inotropes

Question 26

Which of the following medications has been shown to be useful in the treatment of almost all interstitial lung diseases?

A) Acetaminophen
B) Aspirin
C) Oxytocin
D) Oxygen

Question 27

What is the life expectancy of a patient diagnosed with progressive idiopathic pulmonary fibrosis?

A) Less than 2 years
B) Less than 4 years
C) Less than 6 years
D) Less than 7 years

Question 28

What is the most common radiographic finding in the chest film of a patient with sarcoidosis?

A) Bibasilar parenchymal opacities
B) Bilateral hilar lymphadenopathy
C) Pleural plaque with calcification
D) Upper-lobe distribution of fibrotic cysts

Question 29

Which of the following categories of medications is most closely associated with the onset of interstitial pulmonary fibrosis?

A) Antiarrhythmic drugs
B) Anticoagulants
C) Bronchodilators
D) Vasodilators

Question 30

What disease process is the most common cause of interstitial lung disease (ILD) in the United States?

A) Asbestosis
B) Coal worker's pneumoconiosis
C) Idiopathic pulmonary fibrosis
D) Sarcoidosis

Question 31

A patient is exposed a second time to an antigen and subsequently seeks medical attention with sudden shortness of breath, chest pain, fever, chills, malaise, and a cough that may be productive of purulent sputum. Which of the following is the most likely source for the antigen?

A) Bed
B) Foundry
C) Hay field
D) Mine

Question 32

What treatment is most useful in preventing subsequent right-sided heart failure in a patient with interstitial lung disease?

A) Bronchodilator
B) Digoxin
C) Oxygen
D) Caffeine

Question 33

Scleroderma, rheumatoid arthritis, and systemic lupus erythematosus are all examples of what type of disease group?

A) Asbestos-associated illnesses
B) Connective tissue diseases
C) Hypersensitivity pneumonitis
D) Pneumoconiosis

Question 34

A 65-year-old patient with a history of exposure to metal dust comes in to the emergency department with chronic cough and exertional dyspnea. HRCT shows bibasilar, peripheral reticular abnormalities with focal honeycomb cystic changes. What is the most likely diagnosis?

A) Asbestosis
B) Coal worker's pneumoconiosis
C) Idiopathic pulmonary fibrosis
D) Sarcoidosis

Question 35

What is the most common treatment for patients with idiopathic pulmonary fibrosis (IPF)?

A) Hyperbaric oxygen treatments
B) Lung transplantation
C) Penicillin
D) Prednisone

Question 36

A patient with which of the following diseases will have the longest life expectancy?

A) Alveolar proteinosis
B) Idiopathic pulmonary fibrosis
C) Nonspecific interstitial pneumonitis
D) Sarcoidosis

Question 37

Which of the interstitial lung diseases is directly tied to exposure to first- and secondhand tobacco smoke?

A) Alveolar proteinosis
B) Idiopathic pulmonary fibrosis
C) Nonspecific interstitial pneumonitis
D) Pulmonary Langerhans cell histiocytosis (PLCH)

Question 38

What disease process is associated with much higher risk of tuberculosis?

A) Asbestosis
B) Coal worker's pneumoconiosis
C) Sarcoidosis
D) Silicosis

Question 39

In simple coal worker's pneumoconiosis, a chest radiograph that is characterized by multiple small nodular opacities on the chest x-ray film is most likely to be associated with what clinical presentation?

A) Asymptomatic
B) Cough
C) Crackles
D) Shortness of breath

Question 40

What treatment is recommended by the Centers for Disease Control and Prevention (CDC) guidelines for patients with interstitial lung disease (ILD)?

A) Measles vaccine
B) Mumps vaccine
C) Pneumococcal vaccine
D) Varicella vaccine

Question 41

What use, other than prognostic value, can serial pulmonary function tests provide for the management of interstitial lung disease patients?

A) Determine the degree of refractory hypoxemia.
B) Establish the need for lung transplantation.
C) Guide the type of oxygen therapy delivered.
D) Guide the type of medication therapy delivered.

Question 42

You are called to attend to an ER patient complaining of shortness of breath and severe dyspnea on exertion. Patient history is significant for a 30-year-pack smoking history, dry nonproductive cough, and occasional pedal edema. CXR findings are not remarkable except for mild cardiomegaly. You want to rule out ILD versus obstructive lung disease. Which of the following tests may help you to differentiate the diagnosis on this patient?
1) Sputum culture and sensitivity
2) High-resolution CT
3) Pulmonary function testing
4) Arterial blood gas analysis

A)2, 3, and 4 only
B)1, 3, and 4 only
C)1 and 4 only
D)3 and 4 only

Question 43

You are called to attend to an ER patient complaining of shortness of breath and severe dyspnea on exertion. Patient history is significant for a 30-year-pack smoking history, dry nonproductive cough, and occasional pedal edema. CXR findings are not remarkable except for mild cardiomegaly. You want to rule out ILD versus obstructive lung disease. HRCT shows a diffused ground glass appearance with the presence of centrilobular nodules. Together with the PFT results, HRCT finding indicates the presence of:

A) respiratory bronchiolitis ILD.
B) chronic bronchitis.
C) emphysema.
D) sarcoidosis.

Question 44

A 45 year-old patient with sarcoidosis complaints of being unable to perform his daily house chores due to shortness of breaths despite continued oxygen therapy of 2 L/min via a nasal cannula. You would recommend which of the following to the patient?

A) Increase O₂ to 5 L/min.
B) Nebulized budesonide BID.
C) Pulmonary rehabilitation.
D) Lung transplantation.

Question 45

You are called to attend to an ER patient complaining of shortness of breath and severe dyspnea on exertion. Patient history is significant for a 30-year-pack smoking history, dry nonproductive cough, and occasional pedal edema. CXR findings are not remarkable except for mild cardiomegaly. You want to rule out ILD versus obstructive lung disease. Results for pulmonary function testing are shown below. These results are consistent with:

A) small airway disease.
B) air trapping.
C) severe obstructive disease.
D) loss of alveolar capillary surface.