[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]”This patient has presented to the acute medical unit on account of shortness of breath worsening over several months. Please examine their respiratory system to identify why then tell the examiners what signs you find and discuss your proposed management”[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191692″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row]
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This patient is clubbed and has fine bibasal crepitations in his lower zones in keeping with interstitial lung disease. This combination should prompt consideration of idiopathic pulmonary fibrosis as an underlying pathology.
A patient with interstitial lung disease (ILD) presents with the complaint of shortness of breath. This may not only occur on exertion, but also while doing activities that would not normally require excessive energy such as climbing the stairs and changing clothes. Patients also complain of a non-productive and persistent cough. There is also associated weight loss, easy fatigability, muscle pain, joint pain and fever. While most people are unaware of the fact that there are finger and toe-nail changes in lung disease, clubbing is an indicator of interstitial lung disease.
On auscultation there will be fine, late inspiratory crackles at the bases which, unlike atelectasis, do not clear upon coughing.
Steps towards diagnosis include a thorough history and complete chest examination. Chest X ray changes are often diagnostic with a distinct pattern of honeycomb lung tissue. High resolution-CT imaging is then also carried out to further evaluate lung condition along with spirometry, which demonstrates a restrictive lung pattern, and is used in monitoring progression. A lung biopsy may be required in some cases if the diagnosis is in doubt.
The term interstitial lung disease (ILD) covers around 200 different lung conditions but the most common among them is idiopathic pulmonary fibrosis. In ILD, there is pathology in the interstitial component of the lung which is a network of connective tissue present around the alveoli for their support. An injury to the lung that results in an abnormal inflammatory response results in an abnormal healing process. This causes the tissue around the alveoli to undergo scarring. When the interstitium becomes fibrosed and thickened, the lungs then have difficulty in expanding during inspiration and hence hypoxia develops.
Idiopathic lung disease does not have a specifically known aetiology, but there are a number of conditions within the spectrum that are caused by recognized insults:
• Auto-immune conditions such as rheumatoid arthritis, systemic sclerosis and psoriatic arthropathy
• Medications such as amiodarone, nitrfuorantoin, quinine, bleomycin, azothioprine, interferons, gold and methotrexate
• Occupational exposure such as asbestos, coal and silicon based industrial products
Since ILD has variable conditions, treatment of all of them is different from each other. General approaches of management of a patient with ILD include pulmonary rehabilitation, stopping any offending causes such as methotrexate, oxygen therapy for symptomatic relief and in severe cases, a lung transplant can be considered. For years, patients with IPF were treated with corticosteroids despite a lack of trial evidence to support this practice. Eventually, when tested, this strategy was found to be harmful. However more recently two new drugs have been launched – nintedanib and pirfenidone.
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Question 1 of 9
1. Question1 point(s)Category: Respiratory
What sign is depicted in the patient’s hands?CorrectIncorrect
Question 2 of 9
2. Question1 point(s)Category: Respiratory
How would you describe the patient’s chest expansion?CorrectIncorrect
Question 3 of 9
3. Question1 point(s)Category: Respiratory
What clinical signs can be heard in the patient’s chest?CorrectIncorrect
Question 4 of 9
4. Question1 point(s)Category: Respiratory
What is the diagnosis?CorrectIncorrect
Question 5 of 9
5. Question1 point(s)Category: Respiratory
What tests would you arrange to confirm a diagnosis of interstitial lung disease?CorrectIncorrect
Question 6 of 9
6. Question1 point(s)Category: Respiratory
What types of idiopathic pulmonary fibrosis can you name?
Question 7 of 9
7. Question1 point(s)Category: Respiratory
Out of NSIP and UIP, which has the better prognosis?CorrectIncorrect
Question 8 of 9
8. Question1 point(s)Category: Respiratory
Name two new drugs for IPF?
Question 9 of 9
9. Question1 point(s)Category: Respiratory
Which of the following are the most common symptoms of Pulmonary Fibrosis?CorrectIncorrect