Egan’s Chapter 24 Practice Questions:

1. Asbestosis: Restrictive lung disease caused by prolonged exposure to asbestos fibers. Associated with a high incidence of malignant lung tumors and pleural abnormalities.

2. Connective Tissue Disease: Group of acquired disorders that have in common diffuse immunologic and inflammatory changes in small blood vessels and connective tissue. The cause of most of these diseases is unknown.

3. Hypersensitivity Pneumonitis (H.P.): an Inflammatory form of interstitial pneumonia that results from an immunologic reaction in a hypersensitive person. The reaction may be provoked by various inhaled organic dust, often containing fungal spores. The disease can be prevented by avoiding contact with causative agents, also called extrinsic allergic alveolitis.

4. Idiopathic Pulmonary Fibrosis (I.P.F.): Formation of scar tissue in the connective tissue of the lungs without known cause resulting in severe chronic restrictive lung disease.

5. Interstitial Lung Disease (I.L.D.): a Respiratory disorder characterized by a dry, unproductive cough and dyspnea on exertion. The chest radiograph usually shows fibrotic infiltrates in the lung tissue, usually in lower lobe.

6. Lymphangioleiomyomatosis (L.A.M.): Lung abnormality most commonly observed in women and characterized by abnormal proliferation of smooth muscle cells in the interstitium, dyspnea, abnormal radiographic findings, and commonly pneumothorax.

7. Occupational I.L.D.: Interstitial lung disease resulting from an occupational exposure. Asbestosis is a common example.

8. Organizing Pneumonia (O.P.): Is the new term for bronchiolitis obliterans organizing pneumonia, that generally occurs in the setting of connective tissue disease.

9. Pulmonary Langerhans Cell Histiocytosis (P.L.C.H.): Condition characterized by abnormal proliferation of Langerhans cells, accompanied by interstitial markings on the chest film and dyspnea.

10. Silicosis: Lung disorder caused by continued, long-term exposure to the dust of an inorganic compound, silicon dioxide, which is found in sands, quartzes and many other stones. Chronic silicosis is marked by widespread fibrotic nodular lesions in both lungs.



11. Which of the following are considered part of the lungs’ interstitium? I. Alveolar walls and lumens; II. Cilia; III. Fibroblasts

I and II

I and III

II and III

I, II and III

Reason: The interstitium of the lung comprises the alveolar walls and lumens, pulmonary microvasculature, interstitial macrophages, fibroblasts, myofibroblasts, and matrix components of the lungs.

12. Which of the following is required in most cases in order to make a definitive diagnosis of interstitial lung disease (ILD)?

Clinical presentation

Lung biopsy

Pulmonary function testing

Radiographic findings

Reason: To make a diagnosis of interstitial lung disease (ILD) physicians must consider the patient’s clinical presentation, radiographic findings, pulmonary function test results, laboratory values, and lung biopsy findings. In order to make a definitive diagnosis of which of the more than 200 interstitial lung diseases the patient has, a lung biopsy is usually required.

13. Which of the following are key diagnostic features of interstitial lung disease (ILD)? I. Dyspnea at rest and/or with exertion; II. Unilateral diffuse interstitial infiltrates on the chest radiograph.; III. Histopathologic features of inflammation and/or fibrosis of the pulmonary parenchyma.

I and II

I and III

II and III

I, II and III

Reason: The key diagnostic features of interstitial lung disease (ILD) include dyspnea at rest and/or with exertion, bilateral diffuse interstitial infiltrates on the chest radiograph, physiologic abnormalities of a restrictive lung defect, and histopathologic features of inflammation or fibrosis of the pulmonary parenchyma.

14. Which of the following interstitial lung diseases has an unknown cause?

Bordetella pertussis

HIV/AIDS

Sarcoidosis

Silicosis

Reason: Of all the choices, only sarcoidosis has an unknown cause.

15. Which of the following is the most important tool in the identification of the etiology of interstitial lung disease (ILD)?

Lung biopsy

Bronchoscopy

Medical history

Pulmonary function testing

Reason: Physicians perform many different tests to determine whether the patient has interstitial lung disease (ILD). However, the patient’s medical history is most valuable in determining the type and etiology of a specific patient’s ILD.

16. A physician is examining a patient whom she suspects has a form of interstitial lung disease (ILD). The patient is a smoker and presents with dyspnea, cough, fever, chills, and night sweats. The physical exam reveals digital clubbing. Which of the following diseases might the patient have?

Amyloidosis

Eosinophilic granuloma

Idiopathic pulmonary fibrosis

Sarcoidosis

Reason: Patients with interstitial lung disease present with many different symptoms. The most likely diagnosis is idiopathic pulmonary fibrosis (IPF).

17. A physician is examining the chest radiograph of a patient she suspects has a form of interstitial lung disease (ILD). The radiograph shows eggshell calcification. Which of the following diseases might the patient have?

Berylliosis

Eosinophilic granuloma

Silicosis

Tuberculosis

Reason: All of the choices are interstitial lung diseases (ILD). The appearance of eggshell calcification on a chest radiograph is almost unique to silicosis.

18. Which of the following are indications for surgical lung biopsy for patients in whom physicians suspect interstitial lung disease (ILD)? I. Patient younger than 65 years; II. No history of pneumothorax; III. Normal chest radiograph despite clinical signs

I and II

I and III

II and III

I, II and III

Reason: Indications for surgical lung biopsy include a patient younger than 65 years; a history of fevers, weight loss, and sweats; a history of hemoptysis; symptoms and signs of peripheral vasculitis; a history of pneumothorax; a normal chest radiograph; and rapidly progressing disease.

19. Which of the following tests can help physicians determine the needed biopsy sites for patients with suspected interstitial lung disease (ILD)?

Bronchoscopy

Chest radiography

High-resolution computed tomography

Histology

Reason: Physicians use high-resolution computed tomography (HCRT) to help them determine the best sites to biopsy in patients they suspect have interstitial lung disease (ILD).

20. Which of the following is the primary objective of therapy in patients with interstitial lung disease (ILD)?

Comfort care

Identifying the agent of injury

Removing the agent of injury

Suppressing inflammation

Reason: The most important tenet of therapy for patients with interstitial lung disease (ILD) is to remove the agent of injury, if possible. If the agent cannot be found and removed, suppressing inflammatory and cellular immune responses is the next priority.