Week 18
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Quiz 18 Context:
A 60-year-old female presents for evaluation of exercise related dyspnea and chronic dry cough. The symptoms have been present and progressive for several months. There have been no associated fevers or chills. The patient reports a previous history of smoking. There is no history of environmental exposure, cardiac disease, connective tissue disease, or exposure to medications or drugs with these adverse effects. A recent evaluation found no infectious or cardiac explanation for these symptoms.
Physical examination reveals a patient in no distress. Vital signs are normal. The exam is notable for dry rales at the bases of the lung fields as well as clubbing.
A previously
obtained chest radiograph was abnormal; as a result a CT of the
chest is obtained and shown above.
Sorry, that is not the most likely answer. Try Again.
e. Excellent!
This image reveals predominantly subpleural fibrosis with honeycombing and traction bronchiectasis, consistent with idiopathic pulmonary fibrosis.
You have correctly identified this week's Image of the Week. Now test your knowledge of other aspects of idiopathic interstitial lung disease. Do you know…
…The typical age at which patients with usual interstitial pneumonia (UIP), nonspecific interstitial pneumonitis (NSIP), respiratory bronchiolitis associated lung disease (RB-ILD), and desquamative interstitial pneumonitis (DIP) present?
…the significance of a history of tobacco use in each of the above disorders? And the expected response to an empiric trial of steroids for each?
…the role of bronchoscopy in the diagnostic work-up of a patient suspected of having idiopathic interstitial lung disease?
The answers to these questions, and a concise review of the pathogenesis, diagnosis, and treatment of idiopathic interstitial lung disease, can be found here within The Cleveland Clinic Disease Management Project.
The history, exam, and chest CT are most consistent with which of the following?
- Pericardial effusion
- Emphysema
- Tuberculosis
- Pneumonia, community acquired
- Idiopathic
pulmonary fibrosis
