These are actual cases to: –Stimulate your reading –Test your knowledge of the material Look for the sound icon (usually in the upper right hand corner of the slide)

58 year old female increasing exertional dyspnea x 8 months. nonsmoker. History is otherwise unremarkable FI: unremarkable Physical exam: –bilateral crackles from the mid lung zones to the bases. –Mild clubbing –Needing 5 lpm oxygen Bloodwork: unremarkable CXR is shown on the next slide.

Q1: Interpret the CXR. Answer (Q1)

Q2: Interpret the PFT’s. Answer (Q2)

Q3: Given the clinical features, radiographs, and PFT’s, what are the diagnostic possibilities and your most likely clinical diagnosis? Answer (Q3)

Q4: What would you do next? a)Bronchoscopy with BAL b)Bronchoscopy with BAL and transbronchial biopsy c)Open Lung Biopsy d)Empiric Treatment with Steroids Answer (Q4)

UIP pattern Idiopathic Pulmonary Fibrosis Connective Tissue Disease Drug Induced Pneumoconiosis Chronic Hypersensitivity Pneumonitis You ascertain the cause

Patient listed for lung transplant Gradual deterioration over 6 months 3 day worsening of dyspnea and hypoxemia superimposed on chronic decline Physical Exam: –HR 110, BP stable –Tachypneic –Bilateral pedal edema Q5 :List 4 possible reasons why this patient might have deteriorated. Answers on next slide

Answer (Q5): Causes for acute deterioration in IPF –Heart failure with pulmonary edema –Pulmonary embolism –Lower respiratory tract infection –Exacerbation of IPF (NEJM 2002;347(26): )

Direct questions or constructive criticism to: Dr. Lawrence Cheung – 2E4.34 WMC