Interstitial Lung Disease – Timotej Vataha

Question 1:
A 65-year-old female, a former smoker, presents with progressive dyspnea and a nonproductive cough over the past 6 months. High-resolution CT shows bilateral reticular opacities and traction bronchiectasis predominantly in the lower lobes. Pulmonary function tests reveal a restrictive pattern. What is the most likely diagnosis?

A) Chronic obstructive pulmonary disease (COPD)
B) Idiopathic pulmonary fibrosis (IPF)
C) Sarcoidosis
D) Lymphangioleiomyomatosis (LAM)
E) Hypersensitivity pneumonitis

Question 2:
A 45-year-old male with a history of scleroderma presents with worsening breathlessness. His chest X-ray shows diffuse interstitial markings. Which of the following serological markers is most commonly associated with scleroderma-related ILD?

A) Anti-Jo-1 antibody
B) Anti-centromere antibody
C) Anti-Scl-70 antibody
D) Rheumatoid factor
E) Anti-Smith antibody

Question 3:
In patients diagnosed with idiopathic pulmonary fibrosis (IPF), which of the following features on high-resolution CT is considered a typical finding?

A) Kerley B lines
B) Honeycombing
C) Batwing opacification
D) Cavitation
E) Pleural effusion

Question 4:
A 70-year-old female with a long history of rheumatoid arthritis presents with a persistent dry cough and exertional dyspnea. Chest CT shows ground-glass opacities and septal thickening. What is the most likely diagnosis?

A) Usual interstitial pneumonia (UIP)
B) Nonspecific interstitial pneumonia (NSIP)
C) Organizing pneumonia
D) Lymphocytic interstitial pneumonia
E) Respiratory bronchiolitis-associated interstitial lung disease

Question 5:
Which of the following is considered a first-line treatment option for idiopathic pulmonary fibrosis?

A) Corticosteroids
B) Nintedanib
C) Cyclophosphamide
D) Methotrexate
E) Azathioprine

Question 6:
A patient with a history of bird keeping presents with malaise, fever, and a dry cough. High-resolution CT of the chest shows diffuse ground-glass opacities. Which diagnosis should be considered?

A) Asbestosis
B) Silicosis
C) Hypersensitivity pneumonitis
D) Pulmonary alveolar proteinosis
E) Idiopathic pulmonary fibrosis

Question 7:
A 55-year-old male, a non-smoker, presents with gradual onset of dyspnea and dry cough. His HRCT scan shows upper lobe predominant fibrosis and subpleural sparing. What is the most likely diagnosis?

A) Chronic hypersensitivity pneumonitis
B) Sarcoidosis
C) Idiopathic pulmonary fibrosis
D) Asbestosis
E) Silicosis

Question 8:
Which pulmonary function test finding is most characteristic of interstitial lung disease?

A) Increased FEV1/FVC ratio
B) Decreased total lung capacity
C) Increased residual volume
D) Increased peak expiratory flow rate
E) Decreased diffusion capacity for carbon monoxide

Question 9:
A 30-year-old female with a history of systemic lupus erythematosus (SLE) presents with progressive dyspnea and a dry cough. A high-resolution CT scan shows ground-glass opacities. Which of the following is the most likely diagnosis?

A) Lupus pneumonitis
B) Usual interstitial pneumonia
C) Cryptogenic organizing pneumonia
D) Lymphocytic interstitial pneumonia
E) Acute respiratory distress syndrome

Question 10:
In the management of sarcoidosis-related interstitial lung disease, which of the following medications is typically considered first-line therapy?

A) Oral corticosteroids
B) Methotrexate
C) Infliximab
D) Cyclophosphamide
E) Nintedanib

Question 11:
A 50-year-old male, a construction worker, presents with dyspnea and a chronic dry cough. His chest X-ray shows small rounded opacities throughout the lung fields. What is the most likely diagnosis?

A) Coal worker’s pneumoconiosis
B) Silicosis
C) Asbestosis
D) Idiopathic pulmonary fibrosis
E) Hypersensitivity pneumonitis

Question 12:
Which of the following is a common early finding in asbestosis on high-resolution CT?

A) Upper lobe fibrosis
B) Honeycombing
C) Pleural plaques
D) Centrilobular nodules
E) Mosaic attenuation

Question 13:
A 35-year-old female, a non-smoker, presents with exertional dyspnea and a history of Raynaud’s phenomenon. High-resolution CT shows ground-glass opacities and traction bronchiectasis. Which of the following conditions is most likely associated with these findings?

A) Systemic sclerosis
B) Rheumatoid arthritis
C) Sjögren’s syndrome
D) Dermatomyositis
E) Systemic lupus erythematosus

Question 14:
In patients with idiopathic pulmonary fibrosis, which of the following factors is associated with a poorer prognosis?

A) Younger age at diagnosis
B) Presence of honeycombing on HRCT
C) Mildly reduced FEV1/FVC ratio
D) Lower blood eosinophil count
E) Absence of clubbing

Question 15:
A 60-year-old woman with a history of chronic gastroesophageal reflux disease (GERD) presents with progressive dyspnea. A lung biopsy shows fibroblastic foci and usual interstitial pneumonia pattern. What is the most likely diagnosis?

A) Aspiration pneumonia
B) Idiopathic pulmonary fibrosis
C) Chronic hypersensitivity pneumonitis
D) Organizing pneumonia
E) Non-specific interstitial pneumonia

Question 16:
A patient with known sarcoidosis develops worsening pulmonary symptoms. A chest CT shows new-onset honeycombing. What does this finding suggest?

A) Typical progression of sarcoidosis
B) Coexisting idiopathic pulmonary fibrosis
C) Development of lung cancer
D) Pulmonary hypertension
E) Infection superimposed on sarcoidosis

Question 17:
Which of the following environmental exposures is most strongly associated with the development of hypersensitivity pneumonitis?

A) Cigarette smoke
B) Asbestos fibers
C) Moldy hay
D) Silica dust
E) Diesel exhaust

Question 18:
A 40-year-old female presents with dyspnea, fatigue, and a persistent dry cough. She has a history of hairdressing. A high-resolution CT scan reveals ground-glass opacities and irregular linear opacities. What is the most likely diagnosis?

A) Occupational asthma
B) Hypersensitivity pneumonitis
C) Idiopathic pulmonary fibrosis
D) Sarcoidosis
E) Chronic obstructive pulmonary disease

Question 19:
In the management of idiopathic pulmonary fibrosis, which of the following is a primary goal of therapy?

A) Complete reversal of fibrosis
B) Prevention of acute exacerbations
C) Normalization of pulmonary function tests
D) Cure of the underlying disease
E) Reduction in cough

Question 20:
A patient diagnosed with rheumatoid arthritis presents with worsening breathlessness and a dry cough. A lung biopsy shows a pattern of usual interstitial pneumonia. Which of the following medications for rheumatoid arthritis is most likely to be associated with this finding?

A) Methotrexate
B) Infliximab
C) Etanercept
D) Leflunomide
E) Hydroxychloroquine

Question 21:
A 55-year-old female presents with progressive dyspnea and a dry cough. High-resolution CT of the chest shows patchy ground-glass opacities with peripheral sparing. Which diagnosis is most likely?

A) Non-specific interstitial pneumonia (NSIP)
B) Usual interstitial pneumonia (UIP)
C) Cryptogenic organizing pneumonia (COP)
D) Acute respiratory distress syndrome (ARDS)
E) Lymphangioleiomyomatosis (LAM)

Question 22:
Which of the following histopathological findings is characteristic of usual interstitial pneumonia (UIP)?

A) Non-caseating granulomas
B) Organizing pneumonia
C) Fibroblastic foci with temporal heterogeneity
D) Lymphoid aggregates with germinal centers
E) Granulomatous vasculitis

Question 23:
A 60-year-old male, with a history of working in shipbuilding, presents with dyspnea on exertion and a chronic cough. His chest X-ray reveals pleural thickening and calcification. Which exposure is most consistent with these findings?

A) Coal dust
B) Silica
C) Asbestos
D) Beryllium
E) Tobacco smoke

Question 24:
In evaluating a patient with suspected drug-induced interstitial lung disease, which of the following drugs is least likely to be implicated?

A) Amiodarone
B) Nitrofurantoin
C) Methotrexate
D) Penicillin
E) Bleomycin

Question 25:
A patient with a recent diagnosis of idiopathic pulmonary fibrosis (IPF) asks about prognosis. Which of the following is a recognized poor prognostic indicator in IPF?

A) Male gender
B) Age above 70
C) Presence of digital clubbing
D) Current non-smoker status
E) Mild exertional dyspnea

Question 26:
A 48-year-old male, a lifelong non-smoker, presents with worsening dyspnea and a dry cough. His pulmonary function tests reveal a restrictive pattern and reduced diffusion capacity. His occupational history includes bird breeding. What is the most likely diagnosis?

A) Hypersensitivity pneumonitis
B) Sarcoidosis
C) Idiopathic pulmonary fibrosis
D) Asbestosis
E) Silicosis

Question 27:
Which of the following is the most common radiographic finding in early sarcoidosis?

A) Pulmonary fibrosis
B) Pleural effusions
C) Bilateral hilar lymphadenopathy
D) Apical bullae
E) Kerley B lines

Question 28:
In a patient with chronic hypersensitivity pneumonitis, which of the following findings would be most likely on a high-resolution CT scan?

A) Upper lobe predominant fibrosis
B) Honeycombing and traction bronchiectasis
C) Centrilobular nodules and ground-glass opacities
D) Mosaic attenuation and air trapping
E) Cystic changes and bronchiectasis

Question 29:
A 40-year-old female with a history of systemic sclerosis presents with increasing dyspnea. High-resolution CT shows extensive ground-glass opacities with esophageal dilatation. What is the most likely associated pulmonary condition?

A) Pulmonary arterial hypertension
B) Interstitial lung disease
C) Pleural effusion
D) Bronchiolitis obliterans
E) Pulmonary embolism

Question 30:
In the management of drug-induced interstitial lung disease, what is the first and most crucial step?

A) High-dose corticosteroid therapy
B) Immediate discontinuation of the offending drug
C) Start antifibrotic therapy
D) Initiate oxygen therapy
E) Perform a lung biopsy

Question 31:
A 58-year-old woman with a history of smoking presents with dyspnea on exertion and a persistent cough. High-resolution CT shows subpleural reticulation and honeycombing. Pulmonary function tests indicate a restrictive pattern. Which of the following is the most likely diagnosis?

A) Chronic obstructive pulmonary disease (COPD)
B) Idiopathic pulmonary fibrosis (IPF)
C) Lymphangioleiomyomatosis (LAM)
D) Sarcoidosis
E) Hypersensitivity pneumonitis

Question 32:
A 40-year-old male, a stone mason, presents with progressive shortness of breath. His chest X-ray shows small rounded opacities predominantly in the upper lobes. What is the most likely diagnosis?

A) Coal worker’s pneumoconiosis
B) Silicosis
C) Asbestosis
D) Idiopathic pulmonary fibrosis
E) Hypersensitivity pneumonitis

Question 33:
In idiopathic pulmonary fibrosis, which of the following findings on high-resolution CT is considered a hallmark?

A) Nodular pattern
B) Honeycombing
C) Cystic changes
D) Miliary pattern
E) Mediastinal lymphadenopathy

Question 34:
A 70-year-old female with a history of rheumatoid arthritis presents with exertional dyspnea and a persistent dry cough. A high-resolution CT scan of the chest shows ground-glass opacities and septal thickening. What is the most likely diagnosis?

Question 35:
What is considered a first-line treatment for idiopathic pulmonary fibrosis?

A) Corticosteroids
B) Nintedanib
C) Cyclophosphamide
D) Methotrexate
E) Azathioprine

Question 36:
A patient with a history of bird keeping presents with malaise, fever, and a dry cough. High-resolution CT of the chest shows diffuse ground-glass opacities. Which diagnosis should be considered?

A) Asbestosis
B) Silicosis
C) Hypersensitivity pneumonitis
D) Pulmonary alveolar proteinosis
E) Idiopathic pulmonary fibrosis

Question 37:
A 55-year-old male, a non-smoker, presents with gradual onset of dyspnea and dry cough. His HRCT scan shows upper lobe predominant fibrosis and subpleural sparing. What is the most likely diagnosis?

A) Chronic hypersensitivity pneumonitis
B) Sarcoidosis
C) Idiopathic pulmonary fibrosis
D) Asbestosis
E) Silicosis

Question 38:
Which pulmonary function test finding is most characteristic of interstitial lung disease?

A) Increased FEV1/FVC ratio
B) Decreased total lung capacity
C) Increased residual volume
D) Increased peak expiratory flow rate
E) Decreased diffusion capacity for carbon monoxide

Question 39:
A 30-year-old female with a history of systemic lupus erythematosus (SLE) presents with progressive dyspnea and a dry cough. High-resolution CT shows ground-glass opacities. Which of the following is the most likely diagnosis?

A) Lupus pneumonitis
B) Usual interstitial pneumonia
C) Cryptogenic organizing pneumonia
D) Lymphocytic interstitial pneumonia
E) Acute respiratory distress syndrome

Question 40:
In the management of sarcoidosis-related interstitial lung disease, which of the following medications is typically considered first-line therapy?

A) Oral corticosteroids
B) Methotrexate
C) Infliximab
D) Cyclophosphamide
E) Nintedanib

Question 41:
A 62-year-old male presents with dyspnea, cough, and fatigue. His occupational history includes exposure to metal dust. High-resolution CT reveals diffuse interstitial fibrosis with upper lobe predominance. What is the most likely diagnosis?

A) Hypersensitivity pneumonitis
B) Sarcoidosis
C) Idiopathic pulmonary fibrosis (IPF)
D) Asbestosis
E) Hard metal pneumoconiosis

Question 42:
Which of the following is a characteristic feature of lymphangioleiomyomatosis (LAM) on high-resolution CT?

A) Pleural plaques
B) Upper lobe fibrosis
C) Cystic changes throughout the lung fields
D) Honeycombing
E) Ground-glass opacities

Question 43:
A 50-year-old female, a bird enthusiast, presents with chronic dyspnea and cough. High-resolution CT shows diffuse ground-glass opacities with centrilobular nodules. Pulmonary function tests indicate a restrictive pattern. What is the most likely diagnosis?

A) Bird fancier’s lung (hypersensitivity pneumonitis)
B) Idiopathic pulmonary fibrosis
C) Sarcoidosis
D) Asbestosis
E) Silicosis

Question 44:
In evaluating a patient with suspected occupational interstitial lung disease, which of the following findings on high-resolution CT would be most suggestive of silicosis?

A) Nodular opacities predominantly in the upper lobes
B) Lower lobe predominant fibrosis
C) Honeycombing and traction bronchiectasis
D) Diffuse ground-glass opacities
E) Bilateral hilar lymphadenopathy

Question 45:
Which of the following is a common early finding in sarcoidosis on high-resolution CT?

A) Apical fibrosis
B) Pleural effusions
C) Bilateral hilar and mediastinal lymphadenopathy
D) Honeycombing
E) Centrilobular nodules

Question 46:
A 68-year-old woman with a history of gastroesophageal reflux disease (GERD) presents with worsening dyspnea. Lung biopsy reveals usual interstitial pneumonia (UIP) pattern. Which condition is most likely associated with these findings?

A) Chronic aspiration pneumonia
B) Idiopathic pulmonary fibrosis (IPF)
C) Drug-induced interstitial lung disease
D) Rheumatoid arthritis-associated interstitial lung disease
E) Non-specific interstitial pneumonia (NSIP)

Question 47:
In a patient diagnosed with idiopathic pulmonary fibrosis, which of the following is a poor prognostic factor?

A) Presence of digital clubbing
B) Young age at diagnosis
C) Absence of honeycombing on HRCT
D) Mildly reduced FEV1/FVC ratio
E) Non-smoker status

Question 48:
A 40-year-old female presents with a history of progressive dyspnea and cough. She has a history of joint pain and Raynaud’s phenomenon. High-resolution CT reveals ground-glass opacities with esophageal dilatation. Which condition is most likely?

A) Systemic sclerosis
B) Sjögren’s syndrome
C) Rheumatoid arthritis
D) Systemic lupus erythematosus
E) Dermatomyositis

Question 49:
Which of the following is the first-line treatment for acute exacerbations of idiopathic pulmonary fibrosis?

A) High-dose corticosteroids
B) Antifibrotic agents
C) Broad-spectrum antibiotics
D) Oxygen therapy
E) Pulmonary rehabilitation

Question 50:
A 55-year-old male with a history of smoking presents with cough and exertional dyspnea. HRCT reveals diffuse parenchymal fibrosis with upper lobe predominance. Spirometry shows a restrictive pattern. What is the most likely diagnosis?

A) Combined pulmonary fibrosis and emphysema (CPFE)
B) Chronic obstructive pulmonary disease (COPD)
C) Asbestosis
D) Sarcoidosis
E) Silicosis

Answers and explanations

Question 1:
Correct Answer: B) Idiopathic pulmonary fibrosis (IPF)
Explanation: The presentation of progressive dyspnea, nonproductive cough, and typical HRCT findings of bilateral reticular opacities and traction bronchiectasis predominantly in the lower lobes, along with a restrictive pattern on PFTs, is characteristic of IPF.
Teaching Point: IPF is a chronic, progressive fibrosing interstitial pneumonia of unknown cause, primarily occurring in older adults and is associated with a histopathologic and/or radiographic pattern of usual interstitial pneumonia (UIP).

Question 2:
Correct Answer: C) Anti-Scl-70 antibody
Explanation: The Anti-Scl-70 antibody (also known as anti-topoisomerase I antibody) is most commonly associated with scleroderma (systemic sclerosis) and is often present in patients with scleroderma-related ILD.
Teaching Point: Screening for specific autoantibodies is essential in patients with connective tissue disease-associated ILD, as they can provide clues about the underlying disease and prognosis.

Question 3:
Correct Answer: B) Honeycombing
Explanation: Honeycombing, which is the presence of cystic air spaces with fibrous walls typically in a subpleural and basal distribution, is a typical finding on HRCT in patients diagnosed with IPF.
Teaching Point: Recognition of honeycombing on HRCT is crucial in the diagnosis of IPF, as it is a key feature of the UIP pattern.

Question 4:
Correct Answer: B) Nonspecific interstitial pneumonia (NSIP)
Explanation: Ground-glass opacities and septal thickening in a patient with a history of rheumatoid arthritis are indicative of NSIP, which is commonly associated with connective tissue diseases.
Teaching Point: NSIP is characterized by varying degrees of inflammation and fibrosis and is often associated with better prognosis and responsiveness to treatment compared to UIP.

Question 5:
Correct Answer: B) Nintedanib
Explanation: Nintedanib, along with pirfenidone, is a first-line treatment option for IPF, shown to slow the progression of the disease.
Teaching Point: Antifibrotic agents like nintedanib and pirfenidone have revolutionized the management of IPF by reducing the rate of decline in lung function.

Question 6:
Correct Answer: C) Hypersensitivity pneumonitis
Explanation: The patient’s history of bird keeping, clinical presentation, and HRCT findings of diffuse ground-glass opacities suggest hypersensitivity pneumonitis, an immune-mediated lung disease due to inhalation of various antigens.
Teaching Point: Identifying and avoiding exposure to the causative antigen is crucial in the management of hypersensitivity pneumonitis.

Question 7:
Correct Answer: A) Chronic hypersensitivity pneumonitis
Explanation: The history, HRCT findings of upper lobe predominant fibrosis, and subpleural sparing are suggestive of chronic hypersensitivity pneumonitis.
Teaching Point: Chronic hypersensitivity pneumonitis can manifest with upper lobe fibrosis, differentiating it from other forms of ILD which typically affect the lower lobes.

Question 8:
Correct Answer: B) Decreased total lung capacity
Explanation: A decreased total lung capacity on pulmonary function tests is characteristic of ILD and indicates a restrictive lung disease pattern.
Teaching Point: Pulmonary function tests in ILD typically show a restrictive pattern with reduced lung volumes (total lung capacity) and a reduced diffusing capacity for carbon monoxide (DLCO).

Question 9:
Correct Answer: A) Lupus pneumonitis
Explanation: The history of SLE, symptoms, and HRCT findings of ground-glass opacities suggest lupus pneumonitis, a rare but serious complication of SLE.
Teaching Point: Lupus pneumonitis should be considered in patients with SLE presenting with respiratory symptoms and ground-glass opacities on imaging.

Question 10:
Correct Answer: A) Oral corticosteroids
Explanation: Oral corticosteroids are typically considered the first-line therapy for sarcoidosis-related interstitial lung disease, especially in patients with progressive or symptomatic disease.
Teaching Point: The use of corticosteroids in sarcoidosis can improve symptoms and lung function but needs to be balanced against potential side effects.

Question 11:
Correct Answer: B) Silicosis
Explanation: The patient’s occupational exposure as a construction worker and radiographic findings of small rounded opacities in the lung fields are characteristic of silicosis, a pneumoconiosis caused by inhalation of silica dust.
Teaching Point: Silicosis is an occupational lung disease, and prevention involves controlling dust exposure in the workplace.

Question 12:
Correct Answer: C) Pleural plaques
Explanation: Pleural plaques are a common early finding in asbestosis and are indicative of prior asbestos exposure, often occurring before the onset of significant fibrosis.
Teaching Point: Asbestos-related lung disease can manifest years after exposure, with pleural plaques being a hallmark finding on imaging.

Question 13:
Correct Answer: A) Systemic sclerosis
Explanation: The combination of Raynaud’s phenomenon, ground-glass opacities, and traction bronchiectasis on HRCT is suggestive of systemic sclerosis, particularly in the context of interstitial lung disease.
Teaching Point: ILD is a common complication of systemic sclerosis and can be a major determinant of prognosis in these patients.

Question 14:
Correct Answer: B) Presence of honeycombing on HRCT
Explanation: The presence of honeycombing on HRCT in patients with IPF is associated with a poorer prognosis, indicating more advanced fibrotic changes.
Teaching Point: The extent and pattern of fibrosis on HRCT, including honeycombing, are important factors in determining prognosis in IPF.

Question 15:
Correct Answer: B) Idiopathic pulmonary fibrosis
Explanation: The patient’s history, HRCT findings of fibroblastic foci and a UIP pattern, and a history of GERD (a potential risk factor for IPF) point towards idiopathic pulmonary fibrosis.
Teaching Point: IPF can be associated with GERD, and treatment of GERD is often recommended in the management of IPF.

Question 16:
Correct Answer: B) Coexisting idiopathic pulmonary fibrosis
Explanation: The development of honeycombing in a patient with sarcoidosis suggests the coexistence of IPF, a separate and distinct entity from sarcoidosis.
Teaching Point: The coexistence of IPF and sarcoidosis is rare but can significantly alter the prognosis and management strategy.

Question 17:
Correct Answer: C) Moldy hay
Explanation: Exposure to moldy hay is strongly associated with the development of hypersensitivity pneumonitis, particularly in the form of ‘farmer’s lung.’
Teaching Point: Identifying the antigen exposure is critical in the diagnosis and management of hypersensitivity pneumonitis.

Question 18:
Correct Answer: B) Hypersensitivity pneumonitis
Explanation: Occupational exposure in hairdressing and the HRCT findings suggest hypersensitivity pneumonitis, which can be caused by exposure to certain chemicals used in hairdressing.
Teaching Point: Hypersensitivity pneumonitis can result from exposure to a variety of organic and inorganic antigens in different occupational settings.

Question 19:
Correct Answer: B) Prevention of acute exacerbations
Explanation: The primary goal of therapy in IPF is to prevent acute exacerbations, which are associated with significant morbidity and mortality.
Teaching Point: Acute exacerbations of IPF can significantly worsen the disease course and are a major cause of deterioration and death in these patients.

Question 20:
Correct Answer: A) Methotrexate
Explanation: Methotrexate, commonly used in rheumatoid arthritis, can be associated with drug-induced ILD and a UIP pattern on biopsy.
Teaching Point: Drug-induced ILD is an important consideration in patients with rheumatoid arthritis who develop pulmonary symptoms while on disease-modifying antirheumatic drugs (DMARDs).

Question 21:
Correct Answer: A) Non-specific interstitial pneumonia (NSIP)
Explanation: The presentation of progressive dyspnea, dry cough, and HRCT findings of patchy ground-glass opacities with peripheral sparing are characteristic of NSIP, a form of ILD.
Teaching Point: NSIP is often associated with connective tissue diseases and typically presents a more uniform appearance on HRCT compared to other forms of ILD.

Question 22:
Correct Answer: C) Fibroblastic foci with temporal heterogeneity
Explanation: Fibroblastic foci with temporal heterogeneity is a hallmark histopathological feature of usual interstitial pneumonia (UIP), which is the pattern seen in IPF.
Teaching Point: Histopathologic examination in UIP reveals a patchwork of fibrotic and less affected areas, which is key to its diagnosis.

Question 23:
Correct Answer: C) Asbestos
Explanation: The history of working in shipbuilding, combined with radiographic findings of pleural thickening and calcification, suggests asbestos exposure, which is associated with asbestosis and pleural disease.
Teaching Point: Occupational history is vital in diagnosing asbestos-related lung disease, which can manifest many years after exposure.

Question 24:
Correct Answer: D) Penicillin
Explanation: While many drugs can cause ILD, penicillin is less commonly implicated compared to drugs like amiodarone, nitrofurantoin, methotrexate, and bleomycin.
Teaching Point: Drug-induced ILD should be considered in patients presenting with new-onset respiratory symptoms and a history of relevant drug exposure.

Question 25:
Correct Answer: C) Presence of digital clubbing
Explanation: The presence of digital clubbing in IPF is a recognized poor prognostic indicator, often associated with more advanced disease.
Teaching Point: Physical examination findings such as digital clubbing can provide important prognostic information in patients with IPF.

Question 26:
Correct Answer: A) Hypersensitivity pneumonitis
Explanation: The history of bird breeding, clinical presentation, and restrictive pattern on PFTs suggest hypersensitivity pneumonitis, a condition caused by inhalation of organic dusts.
Teaching Point: Hypersensitivity pneumonitis is an immune-mediated lung disease, and avoidance of the offending antigen is crucial in management.

Question 27:
Correct Answer: C) Bilateral hilar lymphadenopathy
Explanation: Bilateral hilar lymphadenopathy is a common early radiographic finding in sarcoidosis and can be seen even before the onset of lung parenchymal involvement.
Teaching Point: Sarcoidosis is a multi-system granulomatous disorder, and hilar lymphadenopathy is often its hallmark feature on imaging.

Question 28:
Correct Answer: C) Centrilobular nodules and ground-glass opacities
Explanation: In chronic hypersensitivity pneumonitis, HRCT typically shows a combination of centrilobular nodules and ground-glass opacities, often with upper lobe predominance.
Teaching Point: Recognition of the HRCT patterns in hypersensitivity pneumonitis can aid in distinguishing it from other forms of ILD.

Question 29:
Correct Answer: B) Interstitial lung disease
Explanation: The presence of extensive ground-glass opacities on HRCT in a patient with systemic sclerosis is suggestive of interstitial lung disease, a common pulmonary manifestation of this condition.
Teaching Point: Interstitial lung disease is a significant cause of morbidity and mortality in systemic sclerosis and requires careful monitoring.

Question 30:
Correct Answer: B) Immediate discontinuation of the offending drug
Explanation: The first and most crucial step in managing drug-induced ILD is the immediate discontinuation of the suspected offending drug.
Teaching Point: Early identification and cessation of the causative drug are key to improving outcomes in drug-induced ILD.

Question 31:
Correct Answer: B) Idiopathic pulmonary fibrosis (IPF)
Explanation: The presentation of a smoker with dyspnea, cough, restrictive pattern on PFTs, and HRCT showing subpleural reticulation and honeycombing is characteristic of IPF.
Teaching Point: IPF is a diagnosis of exclusion, often considered in older adults, especially those with a history of smoking, presenting with unexplained chronic dyspnea and a UIP pattern on HRCT.

Question 32:
Correct Answer: B) Silicosis
Explanation: The patient’s occupation as a stone mason and the radiographic findings of small rounded opacities in the upper lobes suggest silicosis, an occupational lung disease caused by inhalation of silica dust.
Teaching Point: Regular health monitoring and protective measures in the workplace are essential for preventing silicosis in at-risk occupations.

Question 33:
Correct Answer: B) Honeycombing
Explanation: Honeycombing on HRCT is a hallmark finding in idiopathic pulmonary fibrosis, indicative of advanced fibrotic changes.
Teaching Point: Honeycombing, characterized by clustered cystic air spaces with fibrous walls, is a key radiographic feature that helps in diagnosing IPF.

Question 34:
Correct Answer: B) Nonspecific interstitial pneumonia (NSIP)
Explanation: Ground-glass opacities and septal thickening in a patient with rheumatoid arthritis suggest NSIP, a pattern of ILD often associated with connective tissue diseases.
Teaching Point: NSIP is generally more responsive to immunosuppressive therapy compared to UIP and often has a better prognosis.

Question 35:
Correct Answer: B) Nintedanib
Explanation: Nintedanib, an antifibrotic agent, is a first-line treatment for idiopathic pulmonary fibrosis, shown to slow the progression of lung function decline.
Teaching Point: Management of IPF has evolved with the use of antifibrotic agents like nintedanib and pirfenidone, which can reduce the rate of decline in lung function.

Question 36:
Correct Answer: C) Hypersensitivity pneumonitis
Explanation: The history of bird keeping, along with clinical and radiographic findings, is consistent with hypersensitivity pneumonitis, an immune-mediated lung disease caused by inhalation of various antigens like bird proteins.
Teaching Point: Identifying the causative antigen and avoiding further exposure are key to managing hypersensitivity pneumonitis.

Question 37:
Correct Answer: A) Chronic hypersensitivity pneumonitis
Explanation: Upper lobe predominant fibrosis and subpleural sparing on HRCT, along with the patient’s symptoms, suggest chronic hypersensitivity pneumonitis.
Teaching Point: Chronic hypersensitivity pneumonitis can present with insidious onset of respiratory symptoms and is often associated with exposures to specific antigens.

Question 38:
Correct Answer: B) Decreased total lung capacity
Explanation: A decreased total lung capacity on pulmonary function tests is indicative of a restrictive lung disease pattern, which is characteristic of interstitial lung diseases.
Teaching Point: In ILD, restrictive lung disease is demonstrated by reduced lung volumes and a decreased diffusing capacity for carbon monoxide (DLCO).

Question 39:
Correct Answer: A) Lupus pneumonitis
Explanation: The patient’s history of systemic lupus erythematosus (SLE), progressive dyspnea, dry cough, and HRCT findings of ground-glass opacities suggest lupus pneumonitis.
Teaching Point: Lupus pneumonitis is an uncommon but serious complication of SLE, characterized by acute or subacute respiratory symptoms and radiographic abnormalities.

Question 40:
Correct Answer: A) Oral corticosteroids
Explanation: Oral corticosteroids are typically the first-line therapy for sarcoidosis-related interstitial lung disease, especially in patients with progressive or symptomatic disease.
Teaching Point: Corticosteroids can improve symptoms and lung function in sarcoidosis, but long-term treatment requires monitoring for side effects.

Question 41:
Correct Answer: E) Hard metal pneumoconiosis
Explanation: The patient’s history of exposure to metal dust and the HRCT findings of diffuse interstitial fibrosis with upper lobe predominance suggest hard metal pneumoconiosis, an occupational lung disease associated with inhalation of metal dust particles.
Teaching Point: Occupational history is critical in diagnosing ILDs, especially in cases like hard metal pneumoconiosis, where specific exposures are implicated.

Question 42:
Correct Answer: C) Cystic changes throughout the lung fields
Explanation: Cystic changes throughout the lung fields on HRCT are characteristic of lymphangioleiomyomatosis (LAM), a rare lung disease that typically affects women of childbearing age.
Teaching Point: LAM is characterized by cystic lung destruction and can be associated with tuberous sclerosis complex.

Question 43:
Correct Answer: A) Bird fancier’s lung (hypersensitivity pneumonitis)
Explanation: The patient’s occupation as a bird enthusiast, combined with HRCT findings of ground-glass opacities and centrilobular nodules, is indicative of bird fancier’s lung, a form of hypersensitivity pneumonitis.
Teaching Point: Hypersensitivity pneumonitis results from repeated inhalation of organic antigens, and identifying the source of exposure is crucial for management.

Question 44:
Correct Answer: A) Nodular opacities predominantly in the upper lobes
Explanation: Nodular opacities predominantly in the upper lobes on HRCT are suggestive of silicosis, particularly in patients with relevant occupational exposure such as mining or stone cutting.
Teaching Point: Silicosis, a form of pneumoconiosis, results from inhalation of crystalline silica particles, leading to lung fibrosis.

Question 45:
Correct Answer: C) Bilateral hilar and mediastinal lymphadenopathy
Explanation: Bilateral hilar and mediastinal lymphadenopathy are common early findings in sarcoidosis on HRCT and can precede lung parenchymal involvement.
Teaching Point: Sarcoidosis is a multisystem granulomatous disorder, and hilar lymphadenopathy is a hallmark feature on chest imaging.

Question 46:
Correct Answer: B) Idiopathic pulmonary fibrosis (IPF)
Explanation: The patient’s history of GERD, a potential risk factor for IPF, combined with a UIP pattern on lung biopsy, strongly suggests idiopathic pulmonary fibrosis.
Teaching Point: IPF often presents with a UIP pattern on histology or HRCT and can be associated with risk factors such as smoking and GERD.

Question 47:
Correct Answer: A) Presence of digital clubbing
Explanation: The presence of digital clubbing in patients with IPF is a recognized poor prognostic factor, often associated with more advanced disease.
Teaching Point: Digital clubbing, along with the extent of fibrosis on imaging and lung function parameters, can provide prognostic information in IPF.

Question 48:
Correct Answer: A) Systemic sclerosis
Explanation: The patient’s history of joint pain and Raynaud’s phenomenon, along with HRCT findings of ground-glass opacities and esophageal dilatation, are suggestive of systemic sclerosis, which commonly involves the lungs.
Teaching Point: Lung involvement, including interstitial lung disease and pulmonary arterial hypertension, is a major cause of morbidity and mortality in systemic sclerosis.

Question 49:
Correct Answer: A) High-dose corticosteroids
Explanation: High-dose corticosteroids are often used as first-line treatment for acute exacerbations of idiopathic pulmonary fibrosis, although their efficacy is uncertain.
Teaching Point: Management of acute exacerbations of IPF is challenging, and corticosteroids are used despite limited evidence of benefit, highlighting the need for further research.

Question 50:
Correct Answer: A) Combined pulmonary fibrosis and emphysema (CPFE)
Explanation: The combination of diffuse parenchymal fibrosis with upper lobe predominance and a restrictive pattern on spirometry in a smoker is indicative of combined pulmonary fibrosis and emphysema (CPFE).
Teaching Point: CPFE is characterized by the coexistence of emphysema and pulmonary fibrosis, particularly in smokers, and presents with distinct clinical and radiological features.