WorksheetsInterstitial Lung & Pleural Disease
Total questions: 30
Worksheet time: 28mins
Define Interstitial Lung Disease (ILD) based on the introductory description.
A group of lung disorders involving inflammation and fibrosis of the lung parenchyma
A single infection that targets only the bronchi and bronchioles
A vascular condition limited to pulmonary arteries without parenchymal involvement
A neuromuscular disease that weakens respiratory muscles without affecting lungs
Recall the major categories of Interstitial Lung Diseases listed in the lesson. Which option correctly includes only conditions identified as major ILDs?
Idiopathic Pulmonary Fibrosis, Sarcoidosis, Pneumoconiosis, Hypersensitivity Pneumonitis, Connective tissue–related ILDs
Asthma, Chronic bronchitis, Emphysema, Cystic fibrosis
Pulmonary embolism, Pneumothorax, Pleural effusion, Bronchiectasis
Tuberculosis, Lung cancer, Pneumonia, Acute respiratory distress syndrome
A 62-year-old presents with progressive exertional dyspnea, a persistent dry cough, and fine inspiratory crackles described as 'Velcro rales.' Which diagnosis is most consistent with these hallmark ILD features?
Idiopathic Pulmonary Fibrosis
Asthma exacerbation
Acute bacterial pneumonia
Pulmonary embolism
Match each diagnostic modality with the key ILD finding described.
Chest X-ray
Reticulonodular pattern
HRCT
Honeycombing and ground-glass opacities
Pulmonary function tests (PFTs)
Restrictive pattern with reduced TLC and VC; reduced DLCO
Bronchoscopy/biopsy
May be needed for definitive diagnosis
A patient’s HRCT shows honeycombing with ground-glass opacities. Based on the provided material, which diagnosis pathway step does this support most directly?
It confirms airway hyperreactivity requiring bronchodilator trial
It suggests ILD features on HRCT imaging
It rules out interstitial processes in favor of infection
It indicates pulmonary embolism as the primary concern
Outline a comprehensive management plan for a patient with advanced ILD incorporating supportive, pharmacologic, and definitive strategies described in the material. Provide rationale for each component.
A 55-year-old man has progressive exertional dyspnea and a dry cough. On exam you hear fine inspiratory crackles, and the chest radiograph shows a reticulonodular pattern. Pulmonary function testing shows decreased total lung capacity (TLC) and decreased diffusing capacity for carbon monoxide (DLCO). Based on this presentation, what is the most likely diagnosis?
Chronic obstructive pulmonary disease
Idiopathic Pulmonary Fibrosis
Asthma with acute exacerbation
Pulmonary embolism
Which pulmonary function test finding is typical of interstitial lung disease? Choose the best single answer.
Increased TLC
Decreased FEV1/FVC ratio
Decreased DLCO
Increased RV
For a patient with idiopathic pulmonary fibrosis (IPF), which medication has evidence for slowing disease progression?
Pirfenidone
Albuterol
Dornase alfa
Ipratropium
Light’s criteria are used to differentiate pleural effusions. According to the diagram, an effusion is exudative if at least one of which thresholds is met?
Pleural protein to serum protein ratio > 0.5; Pleural LDH to serum LDH ratio > 0.6; Pleural LDH > 2/3 upper limit of normal serum LDH
Pleural protein to serum protein ratio > 0.6; Pleural LDH absolute value > 200; Pleural cholesterol > 45 mg/dL
Pleural triglycerides > 110 mg/dL; Pleural pH < 7.2; Pleural glucose < 60 mg/dL
Serum-pleural albumin gradient > 1.2 g/dL; Serum LDH < 2/3 upper limit of normal
Match each pleural effusion category with a representative etiology shown in the diagram.
Transudative
Congestive heart failure
Exudative (common)
Infection or cancer
Exudative—right-sided secondary
Meigs’ syndrome or endometriosis
Exudative—left-sided secondary
Pancreatitis or esophageal rupture
Which diagnostic modalities are listed for evaluating pleural effusion?
Chest X-ray, ultrasound, thoracentesis
Spirometry, bronchoscopy, V/Q scan
CT angiography, echocardiography, ABG
D-dimer, treadmill test, pulse oximetry
Strategic Thinking: A patient arrives with chest pain, severe dyspnea, hypotension, and tracheal deviation on exam. Outline the immediate procedural management and justify it based on the condition described in the summary.
In the same patient with suspected tension pneumothorax, what is the correct first treatment step before definitive tube placement?
Endotracheal intubation with positive-pressure ventilation
Immediate chest tube insertion without needle
High-flow oxygen only
Immediate needle decompression
According to the practice items, which finding supports an exudative pleural effusion by Light’s criteria?
Pleural fluid protein/serum protein ratio less than 0.5
Pleural fluid LDH/serum LDH ratio greater than 0.6
Congestive heart failure–related effusion
Cirrhosis-related effusion
Which list best represents major ILDs highlighted in the wrap-up?
COPD, asthma, bronchiectasis, cystic fibrosis
IPF, sarcoidosis, pneumoconiosis, hypersensitivity pneumonitis
Bronchiolitis obliterans, emphysema, chronic bronchitis
ARDS, pneumonia, acute bronchitis
Identify the group that correctly lists pleural diseases emphasized in the takeaways.
Pleural effusion, pneumothorax, empyema, hemothorax
Atelectasis, asthma, pulmonary embolism, edema
Bronchiectasis, bronchiolitis, COPD, asthma
Interstitial pneumonia, sarcoidosis, IPF, pneumoconiosis
Which statement about tension pneumothorax aligns with the key takeaways?
It is typically self-limited and resolves without treatment
It is a medical emergency requiring immediate action
It is best managed with antibiotic therapy alone
It is defined by transudative fluid meeting Light’s criteria
A patient presents with restrictive physiology on PFTs and impaired gas exchange. Based on the wrap-up, which diagnostic category is most consistent?
Obstructive airway disease
Interstitial lung disease
Primary pleural disease without parenchymal involvement
Upper airway disorder
Which comparison best differentiates ILD from pleural disease as prompted in the reflection?
ILD affects airways only; pleural disease affects alveoli only
ILD is parenchymal with fibrosis; pleural disease involves the pleural space
ILD presents with exudative effusions; pleural disease always causes obstructive PFTs
ILD is always acute; pleural disease is always chronic
According to the key takeaways, which statement about gas exchange in ILDs is correct?
Gas exchange is improved due to increased alveolar surface area
Gas exchange is impaired, commonly due to fibrosis
Gas exchange remains normal unless pneumothorax occurs
Gas exchange is only affected during exercise testing
Match each pleural pathology to its defining feature based on the summary list.
Pleural effusion
Abnormal fluid collection in the pleural space
Pneumothorax
Air in the pleural space causing lung collapse risk
Empyema
Pus in the pleural space due to infection
Open response: Summarize the major ILD categories and state one shared physiologic effect.
In the reflection prompt, students are asked to differentiate conditions. Which two domains are specified for comparison?
Radiographic staging and histology
Clinical features and pulmonary function tests (PFTs)
Arterial blood gas analysis and bronchoscopy findings
Genetic markers and immunologic assays
Based on the summary, which statement about pleural diseases is accurate?
They are parenchymal disorders causing interstitial fibrosis
They include effusion, pneumothorax, empyema, and hemothorax
They are defined solely by obstructive spirometry
They are synonymous with hypersensitivity pneumonitis
In terms of physiologic pattern, ILDs most consistently produce which PFT result?
Reduced FEV1/FVC with hyperinflation
Normal lung volumes with increased diffusion capacity
Reduced lung volumes consistent with restriction
Variable obstruction with bronchodilator response
Open response: Provide a brief rationale for why tension pneumothorax requires immediate intervention.
Match each disease space to an example from the summary.
Parenchymal interstitial processes
IPF and sarcoidosis
Pleural space processes
Effusion and pneumothorax
Diagnostic criteria set
Light’s criteria
Which selection lists only pleural diseases mentioned in the summary?
Empyema, hemothorax, pneumothorax, pleural effusion
IPF, sarcoidosis, pneumoconiosis, hypersensitivity pneumonitis
Asthma, COPD, bronchiectasis, bronchiolitis
ARDS, pneumonia, pulmonary edema, PE
Open response: Contrast the core pathophysiology of ILD with that of pleural effusion as highlighted in the wrap-up.
