Deck 24: Interstitial Lung Disease

Question 1

Which of the following physical exam 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

Answer 1

D

Question 2

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

A)asbestosis
B)berylliosis
C)idiopathic pulmonary fibrosis (IPF)
D)sarcoidosis

Answer 2

D

Question 3

In interstitial lung disease, which of the following mechanisms does NOT contribute to impaired gas exchange?

A)depression of respiratory drive
B)diffusion defect
C)shunt
D)ventilation/perfusion $\dot { V } / \dot { Q }$ mismatch

Answer 3

depression of respiratory drive

Question 4

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 5

Your patient with interstitial lung disease (ILD) has hypoxemia during exertion and at rest. This implies the ILD may be in its early stages.

Question 6

The cystic pattern called honeycombing is a feature of end-stage interstitial lung disease (ILD).

Question 7

What are the typical pulmonary function test results in a patient with interstitial lung disease?
I)decreased airway resistance
II)decreased forced expiratory volumes
III)increased airway resistance
IV)normal to elevated FEV₁/FVC

A)I, II, and IV
B)II and IV
C)III only
D)I, II, III, and IV

Question 8

The classic chest radiographic findings in interstitial lung disease (ILD) are considered to be those caused by which of its component diseases?

A)asbestosis
B)berylliosis
C)idiopathic pulmonary fibrosis (IPF)
D)sarcoidosis

Question 9

The development of interstitial lung disease (ILD) in a patient with emphysema can result in normal compliance measurements.

Question 10

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

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

Question 11

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 12

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 13

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 14

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 15

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 16

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

A)asbestosis
B)berylliosis
C)sarcoidosis
D)silicosis

Question 17

Expiratory wheezing is relatively uncommon in uncomplicated interstitial lung disease.

Question 18

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) $\dot { V } / \dot { Q }$ scans

Question 19

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 20

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 21

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 22

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

A)asbestosis
B)coal worker's pneumoconiosis
C)sarcoidosis
D)silicosis

Question 23

Indicate the typical chest radiographic findings of a patient with silicosis.

A)apical nodules
B)bibasilar reticulogranular appearance
C)lymphadenopathy
D)pleural plaque

Question 24

Sarcoidosis is more common among young adults than is idiopathic pulmonary fibrosis (IPF).

Question 25

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 26

Chest radiographs will show hilar lymphadenopathy in most cases of asbestosis.

Question 27

The first line of treatment for patients with hypersensitivity pneumonitis is to avoid the offending agent.

Question 28

In smokers with idiopathic pulmonary fibrosis, normal spirometry and lung volumes with a reduced diffusion capacity suggest emphysema.

Question 29

Spontaneous remission rarely occurs with sarcoidosis.

Question 30

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 31

The term "asbestos-related pulmonary disease" may be used to encompass which of the following?
I)asbestosis
II)coal worker's pneumoconiosis
III)sarcoidosis
IV)silicosis

A)I, II, and IV
B)I and IV
C)II only
D)I, II, III, and IV

Question 32

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 33

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 34

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 of for the antigen?

A)bed
B)foundry
C)hay field
D)mine

Question 35

Most patients with asbestosis have considerable asbestos exposure for many years before manifestation of the disease.

Question 36

Exacerbations of silicosis are most often treated with what medication?

A)aerosolized steroids
B)antibiotics
C)diuretics
D)positive inotropes

Question 37

Patients with simple pneumoconiosis of coal workers are often asymptomatic.

Question 38

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 39

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

Question 40

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 41

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 42

Most patients with cryptogenic organizing pneumonia (COP) will improve if given corticosteroid therapy.

Question 43

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 44

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 45

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 46

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)turbutaline

Question 47

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 48

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

A)<2 years
B)<4 years
C)<6 years
D)<7 years

Question 49

A 65-year-old patient with a history of exposure to metal dust presents in 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 50

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 51

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

A)alveolar proteinosis
B)idiopathic pulmonary fibrosis
C)nonspecific interstitial pneumonitis
D)pulmonary Langerhans cell histiocytosis (PLCH)

Question 52

Idiopathic pulmonary fibrosis (IPF) is most commonly seen in patients during the third decade of life.

Question 53

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

Question 54

The prognosis is much better for nonspecific interstitial pneumonitis (NSIP) than idiopathic pulmonary fibrosis (IPF).