[MCQ] Interstitial Lung Diseases- Part 1

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Interstitial Lung Diseases- Part 1

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Question 1

ILDs involves which of the following in lung parenchyma ?

A	Capillary endothelium
B	Perivascular tissues
C	Lymphatic tissues
D	All of the above

Question 1 Explanation:

ILDs involve parenchyma of lung - alveoli, alveolar epithelium, capillary endothelium, & spaces between these structures, as well as perivascular & lymphatic tissues

Question 2

Lung response is alveolitis, interstitial inflammation and fibrosis in all of the following ILDs except ?

A	Hypersensitivity pneumonitis
B	Goodpasture’s syndrome
C	Idiopathic pulmonary hemosiderosis
D	Asbestosis

Question 2 Explanation:

ILDs are groups in two based on the major underlying histopathology i.e. they are either associated with predominant inflammation and fibrosis or they have predominantly granulomatous reaction in interstitial or vascular areas. Hypersensitivity pneumonitis belongs to the later group

Question 3

Etiology of which of the following interstitial lung diseases is known ?

A	Sarcoidosis
B	Idiopathic pulmonary fibrosis (IPF)
C	Pulmonary fibrosis associated with CTDs
D	None of the above

Question 3 Explanation:

Sarcoidosis, IPF and pulmonary fibrosis associated with connective tissue diseases (CTD) are the most common ILDs of unknown etiology. Among the ILDs of known cause, the largest group includes occupational & environmental exposures

Question 4

Which of the following statements about ILDs is false ?

A	Non-malignant disorders
B	Not caused by identified infectious agents
C	May have granulomatous or inflammatory/fibrosis pattern
D	None of the above

Question 4 Explanation:

ILDs are nonmalignant disorders not caused by identified infectious agents. Two major histopathologic patterns are granulomatous or inflammation & fibrosis

Question 5

Granulomas in granulomatous lung disease consists of ?

A	T lymphocytes
B	Macrophages
C	Epithelioid cells
D	All of the above

Question 5 Explanation:

Granulomas in granulomatous lung disease consists of T lymphocytes, macrophages, and epithelioid cells organized into discrete structures in the lung parenchyma. Granulomatous lesions can progress to fibrosis. Sarcoidosis and hypersensitivity pneumonitis are prime examples.

Question 6

The initial insult leading to inflammation and fibrosis in ILD is to ?

A	Vascular endothelium
B	Epithelial surface
C	Perivascular tissues
D	Lymphatic tissues

Question 6 Explanation:

The initial insult is an injury to the epithelial surface that causes inflammation in the air spaces and alveolar walls. Inflammation spreads to adjacent portions of interstitium and vasculature and eventually causes interstitial fibrosis

Question 7

Myofibroblasts produce which of the following ?

A	Angiotensinogen
B	Gelatinases
C	Collagens
D	All of the above

Question 8

Patients with idiopathic pulmonary fibrosis typically have all the following features except ?

A	Exertional dyspnea
B	Productive cough
C	Fine bibasilar inspiratory crackles
D	An abnormal chest radiograph on presentation

Question 9

Which of the following initial features is most frequent in ILD patients ?

A	Wheezing
B	Chest pain
C	Progressive exertional dyspnea
D	Hemoptysis

Question 9 Explanation:

Patients with ILDs seek medical attention mainly due to progressive exertional dyspnea or a persistent, nonproductive cough. Hemoptysis, wheezing, and chest pain may be present.

Question 10

ILDs with symptoms and signs form a chronic presentation include all except ?

A	Sarcoidosis
B	Pulmonary Langerhans cell histiocytosis (PLCH)
C	Churg-Strauss syndrome
D	IPF

Question 10 Explanation:

ILDs with s/s as a chronic presentation (months to years) include IPF, sarcoidosis, pulmonary Langerhans cell histiocytosis (PLCH), pneumoconioses, and CTDs

Question 11

ILDs with acute presentation include all except ?

A	Sarcoidosis
B	Eosinophilic pneumonia
C	Hypersensitivity pneumonitis
D	Churg-Strauss syndrome

Question 11 Explanation:

Acute presentation (days to weeks) occurs with allergy (drugs, fungi, helminths), acute interstitial pneumonia (AIP), eosinophilic pneumonia, & hypersensitivity pneumonitis. Episodic presentations include eosinophilic pneumonia, hypersensitivity pneumonitis, COP, vasculitides, pulmonary hemorrhage, and Churg-Strauss syndrome

Question 12

ILDs that present at age < 50 years include all except ?

A	IPF
B	Lymphangioleiomyomatosis (LAM)
C	PLCH
D	Sarcoidosis

Question 12 Explanation:

Most patients with sarcoidosis, ILD associated with CTD, lymphangio-leiomyomatosis (LAM), PLCH, and inherited forms of ILD (familial IPF, Gaucher’s disease, Hermansky-Pudlak syndrome) present between the ages of 20 and 40 years. Most patients with IPF are older than 50 years

Question 13

Interstitial lung disease in which of these conditions is more common in men ?

A	Lymphangioleiomyomatosis (LAM
B	Tuberous sclerosis
C	Hermansky-Pudlak syndrome
D	Rheumatoid arthritis

Question 13 Explanation:

LAM & pulmonary involvement in tuberous sclerosis occur exclusively in premenopausal women. ILD in Hermansky-Pudlak syndrome & in CTDs is more common in women. ILD in rheumatoid arthritis (RA) is more common in men

Question 14

Familial lung fibrosis is associated with mutation in ?

A	Surfactant protein C gene
B	Surfactant protein A2 gene
C	ATP-binding cassette transporter A3 gene
D	All of the above

Question 14 Explanation:

Familial lung fibrosis is associated with mutations in surfactant protein C gene, surfactant protein A2 gene and ATP-binding cassette transporter A3 gene

Question 15

Autosomal recessive pattern of inheritance occurs in all except ?

A	Niemann-Pick disease
B	Gaucher’s disease
C	Neurofibromatosis
D	Hermansky-Pudlak syndrome

Question 15 Explanation:

Family associations (with an autosomal dominant pattern) occur in tuberous sclerosis and neurofibromatosis. An autosomal recessive pattern of inheritance occurs in Niemann-Pick disease, Gaucher’s disease, and the Hermansky-Pudlak syndrome

Question 16

Patients with all of the following are almost always current or former smokers except ?

A	Pulmonary Langerhans cell histiocytosis (PLCH)
B	Lymphangioleiomyomatosis (LAM)
C	Desquamative interstitial pneumonia (DIP)
D	Goodpasture’s syndrome

Question 16 Explanation:

Patients with PLCH, desquamative interstitial pneumonia (DIP), Goodpasture’s syndrome, respiratory bronchiolitis, and pulmonary alveolar proteinosis are almost always current or former smokers. Twothirds to 75% of patients with IPF have a history of smoking.

Question 17

Which of the following is usually not a clinical feature of sarcoidosis ?

A	Dyspnea
B	Wheezing
C	Hemoptysis
D	Substernal chest pain

Question 17 Explanation:

Dyspnea is a common and prominent complaint in patients with ILD, especially sarcoidosis. Wheezing and clinically significant chest pain, though uncommon in ILD, is noted in patients with sarcoidosis. Frank hemoptysis rarely a presenting manifestations of sarcoidosis.

Question 18

Differential diagnosis of sudden worsening of dyspnea with acute chest pain due to spontaneous pneumothorax in a case of ILD includes ?

A	PLCH
B	Tuberous sclerosis
C	LAM
D	All of the above

Question 18 Explanation:

Sudden worsening of dyspnea, especially if associated with acute chest pain, may indicate a spontaneous pneumothorax, which occurs in PLCH, tuberous sclerosis, LAM & neurofibromatosis

Question 19

Frank hemoptysis in ILD suggests the possibility which of the following ILDs?

A	Diffuse alveolar hemorrhage (DAH) syndromes
B	Lymphangioleiomyomatosis (LAM)
C	Tuberous sclerosis
D	Any of the above

Question 19 Explanation:

Frank hemoptysis and blood-streaked sputum are rarely presenting manifestations of ILD but can be seen in the diffuse alveolar hemorrhage (DAH) syndromes, LAM, tuberous sclerosis, and the granulomatous vasculitides

Question 20

Which of the following is a nonspecific finding common to ILDs ?

A	Raised LDH
B	Antinuclear antibodies
C	Anti-immunoglobulin antibodies (rheumatoid factors)
D	Circulating immune complexes

Question 20 Explanation:

Antinuclear antibodies, anti-immunoglobulin antibodies (rheumatoid factors), and circulating immune complexes are identified in some patients, even in the absence of a defined CTD. A raised LDH is a nonspecific finding common to ILDs.

Question 21

Which of the following laboratory abnormality is common in sarcoidosis ?

A	Elevated serum angiotensin-converting enzyme level
B	Presence of serum precipitins
C	Antineutrophil cytoplasmic antibodies
D	Anti-basement membrane antibodies

Question 21 Explanation:

Elevation of serum ACE level is common in sarcoidosis.

Question 22

In which of the following ILDs, nodular opacities in upper lung zones is frequent ?

A	Sarcoidosis
B	PLCH
C	Chronic hypersensitivity pneumonitis
D	All of the above

Question 22 Explanation:

ILDs that show nodular opacities with a predilection for the upper lung zones include sarcoidosis, PLCH, chronic hypersensitivity pneumonitis, silicosis, berylliosis, RA (necrobiotic nodular form), and ankylosing spondylitis

Question 23

Which of the following chest x-ray findings is indicative of a poor prognosis in a case of ILD ?

A	Bibasilar reticular pattern
B	Honeycombing
C	Nodular pattern of alveolar filling
D	Mixed pattern of alveolar filling

Question 23 Explanation:

Most common chest radiograph abnormality in ILD is a bibasilar reticular pattern. Radiographic finding of honeycombing suggests small cystic spaces & progressive fibrosis which carry a poor prognosis

Question 24

Pathologic changes that characterize idiopathic pulmonary fibrosis are all except ?

A	Predilection for peripheral subpleural parenchyma
B	Fibrotic zones with associated honeycombing alternate with areas of relatively unaffected lung tissue
C	Fibrotic areas vary in age and activity
D	“Fibroblast foci” occur at sites of chronic lung injury

Question 24 Explanation:

“Fibroblast foci” occur at sites of acute lung injury

Question 25

HRCT in idiopathic pulmonary fibrosis shows all except ?

A	Bibasal peripheral lower lobe reticular opacities
B	Peripheral “honeycombing”
C	Traction bronchiectasis
D	Pleural thickening

Question 25 Explanation:

HRCT lung scans in IPF show patchy, predominantly basilar, subpleural reticular opacities, with traction bronchiectasis and honeycombing

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See all quizzes of Obstructive Pulmonary Disease at here:

1.ILDs involves which of the following in lung parenchyma ?
A. Capillary endothelium
B. Perivascular tissues
C. Lymphatic tissues
D. All of the above

2. Lung response is alveolitis, interstitial inflammation and fibrosis in all of the following ILDs except ?
A. Hypersensitivity pneumonitis
B. Goodpasture’s syndrome
C. Idiopathic pulmonary hemosiderosis
D. Asbestosis

3. Etiology of which of the following interstitial lung diseases is known ?
A. Sarcoidosis
B. Idiopathic pulmonary fibrosis (IPF)
C. Pulmonary fibrosis associated with CTDs
D. None of the above

4. Which of the following statements about ILDs is false ?
A. Non-malignant disorders
B. Not caused by identified infectious agents
C. May have granulomatous or inflammatory/fibrosis pattern
D. None of the above

5. Granulomas in granulomatous lung disease consists of ?
A. T lymphocytes
B. Macrophages
C. Epithelioid cells
D. All of the above

6. The initial insult leading to inflammation and fibrosis in ILD is to ?
A. Vascular endothelium
B. Epithelial surface
C. Perivascular tissues
D. Lymphatic tissues

7. Myofibroblasts produce which of the following ?
A. Angiotensinogen
B. Gelatinases
C. Collagens
D. All of the above
8. Patients with idiopathic pulmonary fibrosis typically have all the following features except ?
A. Exertional dyspnea
B. Productive cough
C. Fine bibasilar inspiratory crackles
D. An abnormal chest radiograph on presentation
9. Which of the following initial features is most frequent in ILD patients ?
A. Wheezing
B. Chest pain
C. Progressive exertional dyspnea
D. Hemoptysis

10. ILDs with symptoms and signs form a chronic presentation include all except ?
A. Sarcoidosis
B. Pulmonary Langerhans cell histiocytosis (PLCH)
C. Churg-Strauss syndrome
D. IPF

11. ILDs with acute presentation include all except ?
A. Sarcoidosis
B. Eosinophilic pneumonia
C. Hypersensitivity pneumonitis
D. Churg-Strauss syndrome

12. ILDs that present at age < 50 years include all except ?
A. IPF
B. Lymphangioleiomyomatosis (LAM)
C. PLCH
D. Sarcoidosis

13. Interstitial lung disease in which of these conditions is more common in men ?
A. Lymphangioleiomyomatosis (LAM)
B. Tuberous sclerosis
C. Hermansky-Pudlak syndrome
D. Rheumatoid arthritis

14. Familial lung fibrosis is associated with mutation in ?
A. Surfactant protein C gene
B. Surfactant protein A2 gene
C. ATP-binding cassette transporter A3 gene
D. All of the above

15. Autosomal recessive pattern of inheritance occurs in all except ?
A. Niemann-Pick disease
B. Gaucher’s disease
C. Neurofibromatosis
D. Hermansky-Pudlak syndrome

16. Patients with all of the following are almost always current or former smokers except ?
A. Pulmonary Langerhans cell histiocytosis (PLCH)
B. Lymphangioleiomyomatosis (LAM)
C. Desquamative interstitial pneumonia (DIP)

D. Goodpasture’s syndrome

17. Which of the following is usually not a clinical feature of sarcoidosis ?
A. Dyspnea
B. Wheezing
C. Hemoptysis
D. Substernal chest pain

18. Differential diagnosis of sudden worsening of dyspnea with acute chest pain due to spontaneous pneumothorax in a case of ILD includes ?
A. PLCH
B. Tuberous sclerosis
C. LAM
D. All of the above

19. Frank hemoptysis in ILD suggests the possibility which of the following ILDs?
A. Diffuse alveolar hemorrhage (DAH) syndromes
B. Lymphangioleiomyomatosis (LAM)
C. Tuberous sclerosis
D. Any of the above

20. Which of the following is a nonspecific finding common to ILDs ?
A. Raised LDH
B. Antinuclear antibodies
C. Anti-immunoglobulin antibodies (rheumatoid factors)
D. Circulating immune complexes

21. Which of the following laboratory abnormality is common in sarcoidosis ?
A. Elevated serum angiotensin-converting enzyme level
B. Presence of serum precipitins
C. Antineutrophil cytoplasmic antibodies
D. Anti-basement membrane antibodies

22. In which of the following ILDs, nodular opacities in upper lung zones is frequent ?
A. Sarcoidosis
B. PLCH
C. Chronic hypersensitivity pneumonitis
D. All of the above

23. Which of the following chest x-ray findings is indicative of a poor prognosis in a case of ILD ?
A. Bibasilar reticular pattern
B. Honeycombing
C. Nodular pattern of alveolar filling
D. Mixed pattern of alveolar filling

24. Pathologic changes that characterize idiopathic pulmonary fibrosis are all except ?
A. Predilection for peripheral subpleural parenchyma
B. Fibrotic zones with associated honeycombing alternate
with areas of relatively unaffected lung tissue
C. Fibrotic areas vary in age and activity
D. “Fibroblast foci” occur at sites of chronic lung injury
“Fibroblast foci” occur at sites of acute lung injury.
25. HRCT in idiopathic pulmonary fibrosis shows all except ?
A. Bibasal peripheral lower lobe reticular opacities
B. Peripheral “honeycombing”
C. Traction bronchiectasis
D. Pleural thickening

Interstitial Lung Diseases

[MCQ] Interstitial Lung Diseases- Part 1

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Interstitial Lung Diseases- Part 1

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