A 65-year-old male retired teacher is evaluated because of a dry cough and dyspnea on exertion that began 15 months ago and has gradually progressed to the point that he is unable to perform his usual activities. He has never smoked and has had no known exposure to environmental respiratory hazards. Pulmonary function testing shows a restrictive pattern with a forced vital capacity (FVC) 52% of predicted and a carbon monoxide diffusing capacity (DLCO) 42% of predicated. He has clubbing. Mild cyanosis, and fine basal end-inspiratory crackles. A chest radiograph shows diffuse linear opacities with basal predominance What of the following disorders is the most likely?
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الإجابة: B. Idiopathic pulmonary fibrosis
Slowly progressive dry cough and exertional dyspnoea with a restrictive PFT pattern and low DLCO, clubbing and fine end-inspiratory basal crackles with basal reticular opacities in an older non-smoker is idiopathic pulmonary fibrosis. IPF is the prototype interstitial lung disease, which thickens the respiratory membrane and reduces DLCO. Asbestosis looks similar but needs an occupational exposure, which he denies; pneumonia, heart failure and PE do not cause a 15-month restrictive picture with clubbing.
ليش كل خيار صح أو غلط
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A
ليش غلط
Community-acquired bacterial pneumonia presents acutely with high fever, rigors, productive cough and pleuritic pain; this man has a 15-month dry cough.
✓ view-material.pdf · p. 80 -
B
ليش صح
Fine end-inspiratory crackles are typical of interstitial lung disease or idiopathic lung fibrosis, which also fits the restrictive PFT and low DLCO.
✓ Pulmonology 🫁.pdf · p. 38 -
C
ليش غلط
Left ventricular failure gives medium crackles (pulmonary edema), not the fine end-inspiratory crackles of fibrosis.
✓ Pulmonology 🫁.pdf · p. 38 -
D
ليش غلط
In PE the chest X-ray is usually normal; this patient has diffuse linear basal opacities.
✓ 12• Venous Thromboembolism [Notes].pdf · p. 7
- المصدر
- Pulmonology 🫁.pdf · p. 38
6• Pulmonary Function Tests [Notes].pdf · p. 1
Pulmonology 🫁.pdf · p. 35 - المحاضرة
- Other Lung Diseases (ILD, Bronchiectasis, Lung Cancer) · Pulmonology · Module B
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