Kacmarek: Egan's Fundamentals of Respiratory Care, 10th Edition

Chapter 24: Interstitial Lung Disease

Test Bank

MULTIPLE CHOICE

1. 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

ANS: C
The term interstitial lung disease (ILD) refers to a broad category of lung diseases rather than
to a specific disease entity. It includes a variety of illnesses with diverse causes, treatments,
and prognoses. These disorders are grouped together because of similarities in their clinical
presentations, plain chest radiographic appearance, and physiologic features.

DIF: Recall REF: p. 547 OBJ: 1

2. Which of the following interstitial lung diseases (ILDs) is NOT occupationally related?
a. asbestosis
b. berylliosis
c. sarcoidosis
d. silicosis

ANS: C
Sarcoidosis is not an occupationally related ILD (see Figure 24-1).

DIF: Recall REF: p. 554 OBJ: 1

3. 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

ANS: A
The lung must respond to the damage and repair itself. If the exposure to the causative agent
persists or if the repair process is imperfect, the lung may be permanently damaged with
increased interstitial tissue replacing the normal capillaries, alveoli, and healthy interstitium.

DIF: Recall REF: p. 548 OBJ: 2

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 Test bank 24-2

4. 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 mismatch

ANS: A
Gas exchange is impaired owing to mismatching, shunt, and decreased diffusion across
the abnormal interstitium.

DIF: Recall REF: p. 551 OBJ: 1

5. 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

ANS: A
Exertional breathlessness (dyspnea) and a nonproductive cough are the most common reasons
patients seek medical attention.

DIF: Recall REF: p. 554 OBJ: 2

6. 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

ANS: C
Exertional breathlessness (dyspnea) and a nonproductive cough are the most common reasons
patients seek medical attention.

DIF: Recall REF: p. 548 OBJ: 2

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

ANS: B
Exertional breathlessness (dyspnea) and a nonproductive cough are the most common reasons
patients seek medical attention and does not occur in the early stages.

DIF: Recall REF: p. 548 OBJ: 2

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 Test bank 24-3

8. 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

ANS: B
Most patients with ILD have bilateral inspiratory, fine crackles, which usually are most
prominent at the lung bases.

DIF: Recall REF: p. 559 OBJ: 2

9. Expiratory wheezing is relatively uncommon in uncomplicated interstitial lung disease.

a. True
b. False

ANS: A
Expiratory wheezing is relatively uncommon, and its presence suggests either airway
involvement as part of the primary disease process or accompanying airways disease such as
emphysema or asthma.

DIF: Recall REF: p. 548 OBJ: 2

10. 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

ANS: D
Signs of pulmonary arterial hypertension with right ventricular dysfunction, such as lower-
extremity edema or jugular venous distention, may occur late in the course of any ILD and are
not helpful in the diagnosis of a specific ILD.

DIF: Recall REF: p. 548 OBJ: 2

11. 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

ANS: B
The ready availability of high-resolution CT (HRCT) has highlighted significant radiographic
differences between diseases that have similar plain chest radiographic patterns.
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DIF: Recall REF: p. 549 OBJ: 2

12. What is the most common cause of interstitial lung disease (ILD)?
a. asbestosis
b. berylliosis
c. idiopathic pulmonary fibrosis (IPF)
d. sarcoidosis

ANS: C
The plain chest radiographic and HRCT features of IPF often are considered the classic ILD
pattern, primarily because, next to sarcoidosis, IPF is the most common ILD and because
several other ILDs have a similar appearance.

DIF: Recall REF: p. 556 OBJ: 3

13. 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

ANS: C
The plain chest radiographic and HRCT features of IPF often are considered the classic ILD
pattern, primarily because, next to sarcoidosis, IPF is the most common ILD and because
several other ILDs have a similar appearance.

DIF: Recall REF: p. 549 OBJ: 3

14. 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

ANS: A
This cystic pattern, called honeycombing, reflects end-stage fibrosis and is a feature of many
end-stage ILDs.

DIF: Recall REF: p. 550 OBJ: 1

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

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 Test bank 24-5

ANS: A
This cystic pattern, called honeycombing, reflects end-stage fibrosis and is a feature of many
end-stage ILDs.

DIF: Recall REF: p. 550 OBJ: 1

16. The disease seen in interstitial lung disease is primarily a/an _____ process.
a. airway constrictive
b. obstructive
c. restrictive
d. supralaryngeal

ANS: C
A restrictive physiologic impairment is the common finding in ILD.

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17. 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
b. 2 and 4
c. 3
d. 1, 2, 3, and 4

ANS: B
In ILD both forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) are
diminished, while the FEV1/FVC ratio is preserved or even supranormal.

DIF: Recall REF: p. 554 OBJ: 2

18. 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)

ANS: C
In ILDs the FEV1/FVC ratio is preserved or even supranormal.

DIF: Recall REF: p. 551 OBJ: 2

19. Which of the following is found almost universally in patients with interstitial lung disease
(ILD)?
a. airway dilation
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 Test bank 24-6

b. bronchoconstriction
c. compensatory cytokine release
d. decreased compliance

ANS: D
In almost all of the ILDs, the lungs have reduced compliance and require supranormal
transpleural pressures to ventilate (Figure 24-4). This lack of compliance results in small lung
volumes and increased work of breathing.

DIF: Recall REF: p. 551 OBJ: 2

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

ANS: A
If ILD develops in a patient with significant emphysema, the opposing physiologic effects of
the two diseases may result in deceptively normal spirometry and lung volume measurements,
as well as apparently normally compliant lungs.

DIF: Recall REF: p. 551 OBJ: 2

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

ANS: A
If ILD develops in a patient with significant emphysema, the opposing physiologic effects of
the two diseases may result in deceptively normal spirometry and lung volume measurements,
as well as apparently normally compliant lungs. Because both emphysema and interstitial lung
disease result in impaired gas exchange, the DLCO is significantly decreased.

DIF: Recall REF: p. 551 OBJ: 2

22. 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
b. 1 and 4
c. 2 only
d. 1, 2, 3, and 4

ANS: A
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 Test bank 24-7

The three most common types of occupational interstitial lung disease are asbestosis, chronic
silicosis, and coal worker’s pneumoconiosis. Predictable clinical and radiographic
abnormalities occur in susceptible patients who have been exposed to asbestos. These
abnormalities include pleural changes (plaques, fibrosis, effusions, atelectasis, and
mesothelioma) as well as parenchymal scarring and lung cancer. The term “asbestos-related
pulmonary disease” may be used to encompass all of these entities.

DIF: Recall REF: p. 554 OBJ: 3

23. 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

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

DIF: Recall REF: p. 554 OBJ: 3

24. Most patients with asbestosis have considerable asbestos exposure for many years before
manifestation of the disease.
a. True
b. False

ANS: A
Unfortunately, severe impairment typically occurs 30 to 40 years after exposure, making
almost all patients ineligible for lung transplantation because of age.

DIF: Recall REF: p. 554 OBJ: 3

25. 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

ANS: A
Occupations that commonly involve exposure to silica include mining, tunneling,
sandblasting, and foundry work.

DIF: Recall REF: p. 554 OBJ: 3

26. Indicate the typical chest radiographic findings of a patient with silicosis.
a. apical nodules
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 Test bank 24-8

b. bibasilar reticulogranular appearance

c. lymphadenopathy
d. pleural plaque

ANS: A
The chest radiograph commonly shows upper-lung-zone predominant abnormalities
characterized by multiple small nodular opacities in the central lung tissue.

DIF: Recall REF: p. 554 OBJ: 3

27. What disease process is associated with much higher risk of tuberculosis?
a. asbestosis
b. coal worker’s pneumoconiosis
c. sarcoidosis
d. silicosis

ANS: D
It is important to recognize the association of silicosis with lung cancer and active
tuberculosis. Silicosis patients develop active tuberculosis 2- to 30-fold more frequently than
do coworkers without silicosis.

DIF: Recall REF: p. 554 OBJ: 3

28. 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

ANS: A
Simple coal worker’s pneumoconiosis, characterized by multiple small nodular opacities on
the chest x-ray film, is asymptomatic.

DIF: Recall REF: p. 555 OBJ: 3

29. Patients with simple pneumoconiosis of coal workers are often asymptomatic.
a. True
b. False

ANS: A
Simple coal worker’s pneumoconiosis, characterized by multiple small nodular opacities on
the chest radiographic film, is asymptomatic.

DIF: Recall REF: p. 555 OBJ: 3

30. Exacerbations of silicosis are most often treated with what medication?
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 Test bank 24-9

a. aerosolized steroids
b. antibiotics
c. diuretics
d. positive inotropes

ANS: B
Exacerbations can be frequent and are treated with antibiotics and systemic corticosteroids.

DIF: Recall REF: p. 555 OBJ: 4

31. 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

ANS: A
Drugs from many different therapeutic classes can cause interstitial lung disease, including
chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents
(see Box 24-1).

DIF: Recall REF: p. 552 OBJ: 3

32. 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

ANS: B
Initial exposure to the antigen ramps up the immune system, Subsequent exposure to the
antigen results in the hypersensitivity response. Patients with acute hypersensitivity
pneumonitis usually present to medical attention with sudden shortness of breath, chest pain,
fever, chills, malaise, and a cough that may be productive of purulent sputum.

DIF: Application REF: p. 553 OBJ: 3

33. 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
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 Test bank 24-10

ANS: C
Common organic antigens known to cause hypersensitivity pneumonitis include bacteria and
fungi, which may be found in moldy hay (farmer’s lung) or in the home environment,
particularly in association with central humidification systems (humidifier lung), indoor hot
tubs, and animal proteins (e.g., bird breeder’s lung).

DIF: Application REF: p. 553 OBJ: 3

34. The first line of treatment for patients with hypersensitivity pneumonitis is to avoid the
offending agent.
a. True
b. False

ANS: A
Specific therapies for hypersensitivity pneumonitis are strict antigen avoidance and
immunosuppression with corticosteroids in patients with symptomatic or physiologically
impairing disease.

DIF: Recall REF: p. 553 OBJ: 4

35. 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

ANS: B
Interstitial lung disease is a well-known complication of various connective tissue diseases.
The most commonly implicated disorders are scleroderma, rheumatoid arthritis, Sjögren’s
syndrome, polymyositis/dermatomyositis, and systemic lupus erythematosus.

DIF: Recall REF: p. 555 OBJ: 3

36. 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

ANS: D
Sarcoidosis is an idiopathic multisystem inflammatory disorder that commonly involves the
lung. In fact, it is the most common of the ILD in the United States.

DIF: Recall REF: p. 555 OBJ: 3

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37. Sarcoidosis is more common among young adults than is idiopathic pulmonary fibrosis (IPF).
a. True
b. False

ANS: A
Unlike IPF, sarcoidosis is more common among young adults than it is among older persons.

DIF: Recall REF: p. 555 OBJ: 3

38. Spontaneous remission rarely occurs with sarcoidosis.

a. True
b. False

ANS: B
Sarcoidosis often follows a benign course without symptoms or long-term consequences and
may spontaneously resolve.

DIF: Recall REF: p. 555 OBJ: 3

39. 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

ANS: B
The most common manifestation of sarcoidosis is asymptomatic hilar adenopathy. Less
frequently, the chest radiograph demonstrates parenchymal opacities in the mid lung zone,
which may be nodular, reticulonodular, or alveolar.

DIF: Recall REF: p. 555 OBJ: 3

40. Idiopathic pulmonary fibrosis (IPF) is most commonly seen in patients during the third decade
of life.
a. True
b. False

ANS: B
Most patients are greater than 60 years of age, and IPF is extremely unusual in persons
younger than age 40.

DIF: Recall REF: p. 556 OBJ: 3

41. 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
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 Test bank 24-12

b. coal worker’s pneumoconiosis

c. idiopathic pulmonary fibrosis
d. sarcoidosis

ANS: C
Risk factors for development of idiopathic pulmonary fibrosis include exposure to smoke,
metal dust, farming dust, and hairdressing chemicals. Patients present with chronic cough and
exertional dyspnea with HRCT demonstrating bibasilar, peripheral reticular abnormalities
with focal honeycomb cystic change.

DIF: Application REF: p. 556 OBJ: 3

42. 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

ANS: B
Most patients die of progressive fibrotic lung disease within 4 years of diagnosis.

DIF: Recall REF: p. 556 OBJ: 3

43. What is the most common treatment for patients with idiopathic pulmonary fibrosis (IPF)?
a. hyperbaric oxygen treatments
b. lung transplantation
c. penicillin
d. prednisone

ANS: D
No medical therapy has proven beneficial for IPF. Immunosuppression with oral
corticosteroids and cytotoxic agents such as azathioprine are most commonly used, although
they appear to benefit only a minority of patients.

DIF: Recall REF: p. 559 OBJ: 4

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

ANS: D
Although the prognosis for NSIP is better than IPF the life expectancy is still only 7-10 years.
Sarcoidosis often follows a benign course without symptoms or long-term consequences, and
may spontaneously resolve.

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DIF: Recall REF: p. 556 OBJ: 3

45. The prognosis is much better for nonspecific interstitial pneumonitis (NSIP) than idiopathic
pulmonary fibrosis (IPF).
a. True
b. False

ANS: A
The prognosis is much better for NSIP than is that for IPF, with most patients surviving 7 to
10 years.

DIF: Recall REF: p. 557 OBJ: 3

46. Most patients with organizing pneumonia (OP) will improve if given corticosteroid therapy.
a. True
b. False

ANS: A
OP is the revised nomenclature for bronchiolitis obliterans organizing pneumonia (BOOP).
Patients are younger than those with idiopathic pulmonary fibrosis and present with acute or
subacute dyspnea and cough. Most patients improve with oral corticosteroids (0.5 to 1.0
mg/kg for 6 to 12 weeks).

DIF: Recall REF: p. 557 OBJ: 3

47. 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

ANS: C
Lymphangioleiomyomatosis (LAM) is a rare disorder of abnormal smooth muscle tissue
proliferating around small airways leading to severe obstruction and destruction of alveoli
with resultant thin-walled cyst formation. Unilateral or less commonly bilateral chylothorax is
seen in about one third of patients. This results from lymphatic obstruction by abnormal
smooth muscle tissue.

DIF: Recall REF: p. 556 OBJ: 3

48. 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)

ANS: D
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 Test bank 24-14

PLCH is an interstitial lung disease found in adult smokers. Patients usually have a significant
smoking history and develop cough and progressive dyspnea on exertion.

DIF: Recall REF: p. 558 OBJ: 3

49. 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

ANS: D
Although studies are limited, supplemental oxygen delivered via nasal cannula can prevent
resting hypoxemia and allow greater exertion before desaturation. These benefits may
improve quality of life and potentially ward off development of pulmonary arterial
hypertension, although further studies are needed.

DIF: Recall REF: p. 558 OBJ: 4

50. 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

ANS: C
Although studies are limited, supplemental oxygen delivered via nasal cannula can prevent
resting hypoxemia and allow greater exertion before desaturation. These benefits may
improve quality of life and potentially ward off development of pulmonary arterial
hypertension, although further studies are needed.

DIF: Recall REF: p. 558 OBJ: 4

51. 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

ANS: C
Patients with ILD should receive a pneumococcal vaccine per CDC guidelines and a yearly
influenza virus vaccine.

DIF: Recall REF: p. 559 OBJ: 4

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52. 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

ANS: B
The only therapy shown to prolong life in patients with end-stage, particularly fibrotic ILD, is
lung transplantation.

DIF: Recall REF: p. 559 OBJ: 4

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

ANS: B
Changes in lung function over time help determine whether to continue therapy or to refer
eligible patients for lung transplantation.

DIF: Recall REF: p. 559 OBJ: 4

54. 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 lpm N/C. You would
recommend which of the following to the patient:
a. increase O2 to 5 lpm
b. nebulized budesonide BID
c. pulmonary rehabilitation
d. lung transplantation

ANS: C DIF: Application REF: p. 559 OBJ: 4

55. 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
non-productive cough and occasional pedal edema. CXR findings are not remarkable except
for mild cardiomegaly. You want to rule out ILD vs. 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
5. magnetic resolution imaging
a. 2, 3 and 4 only
b. 2, 3, 4 and 5 only
c. 1, 2, 3, 4 and 5
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d. 3 and 4 only

ANS: A
Obtaining HRCT images allows non-invasive evaluation of the ILDs and is a key element in
making a confident diagnosis in the management of ILD. An ABG is useful to assess gas
exchange. The presence of significant V/Q mismatching, shunt, and decreased diffusion
across the abnormal interstitium is a hallmark of IDLs. Both FEV1 FVC are diminished, and
the FEV1/FVC ratio is preserved or even supranormal . Lung volumes are reduced, as is the
diffusing capacity of the lung for carbon monoxide (DLCO). This reduction in diffusing
capacity reflects a pathological disturbance of the alveolus-capillary interface.

DIF: Application REF: p. 554 OBJ: 3

56. 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
non-productive cough and occasional pedal edema. CXR findings are not remarkable except
for mild cardiomegaly. You want to rule out ILD vs. obstructive lung disease. Results for
pulmonary function testing are shown below.
Spirometry Value %Predicted
FVC (liters) 2.79 63
SVC (liters) 2.61 59
FEV1(liters) 2.12 67
FEV1/FVC (%) 80
FEF 25-75% (l/min) 4.11 98
Lung Volume
RV (liters) 1.20 100
TLC (liters) 3.99 60
DLCO (ml/min/mm 11.35 28
Hg)

These results are consistent with:

a. small airway disease
b. air-trapping
c. severe obstructive disease
d. loss of alveolar capillary surface

ANS: D
The DLCO indicates a loss of alveolar capillary surface area and strongly suggests that lung
destruction is occurring at the level of the alveolar-capillary membrane.

DIF: Analysis REF: p. 554 OBJ: 3

57. 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
non-productive cough and occasional pedal edema. CXR findings are not remarkable except
for mild cardiomegaly. You want to rule out ILD vs. 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:
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Test bank 24-17

a. respiratory bronchiolitis ILD

b. chronic bronchitis
c. emphysema
d. sarcoidosis

ANS: A
The presence of diffused ground glass appearance with the presence of centrilobular nodules
in the HRTC are consistent with respiratory bronchiolitis ILD caused by tobacco exposure.
Moreover, PFT results supports this conclusion by showing a restrictive process with loss of
alveolar-capillary surface area.

DIF: Analysis REF: p. 555 OBJ: 3

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