Common pulmonary fibrosis exam questions for medical finals, OSCEs and MRCP PACES
Question 1. Causes of clubbing
What are the respiratory causes of clubbing?
- Fibrosis (and TB)
- Chronic suppurative lung disease (bronchiectasis; empyema; chronic abscess)
- Lung cancel (not small cell: progresses too quickly)
Question 2. Causes of fibrosis
What are the causes of upper and lower zone fibrosis?
- Upper lobe (‘A TEA SHOP’)
- Exrinsic allergic alveolitis
- Ankylosing spondylosis
- Berylliosis, silicosis
- Lower (‘BRAD’)
- RA (and other connective tissue disease)
Question 3. Fibrosis exacerbations
What is an exacerbation of fibrosis?
- An unexplained worsening or development of dyspnoea within 30 days with new radiological infiltrates on HRCT
- Poor prognosis
- Treatment is iv steroid as 1st line and other immunosuppressant (e.g. cyclophosphamide) as 2nd line
Question 4. Histiocytosis
What is histiocytosis?
- A multi-system disease with abnormal proliferation of histiocytes. Commonly affects young people.
- Mixed obstructive and restrictive pattern
- Low KCO, low FEV1/FVC ratio
- Renal damage
- 1-5mm papules
- Radiolucent skull lesions
- Marrow invasion