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NBME 21 Answers

nbme21/Block 1/Question#32

A 50-year-old man has had progressive dyspnea on ...

Usual interstitial pneumonitis

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 +14  upvote downvote
submitted by notadoctor(66),

Usual interstitial pneumonitis is the histological definition of Idiopathic pulmonary fibrosis. We know that this patient has pulmonary fibrosis because the question states that there is fibrous thickening of the alveolar septa. This question was just testing that we knew the other names for Pulmonary Fibrosis.

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 +6  upvote downvote
submitted by gabstep(10),

found this in robbins: the radiologic and histologic pattern of fibrosis is referred to as usual interstitial pneumonia, which is required for the diagnosis of IPF.





Ifall else fails: note that other answer choices are COPD types

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 +2  upvote downvote
submitted by neonem(278),

Pathoma says that interstitial (atypical) pneumonia is characterized by diffuse interstitial infiltrates, presents w/ relatively mild upper resp symptoms (minimal sputum & low fever), and is most often caused by viruses, but can be bacterial. However, this question is presenting a chronic case, so I'm assuming that the previous interstitial pneumonia caused a fibrotic response in the lung.





 +0  upvote downvote
submitted by niboonsh(90),

my understanding of this is from pathoma - Interstitial (atypical) pneumonia - caused by diffuse interstitial infiltrates. Can be caused by Mycoplasma pneumo, RSV, chlamydia pneumo, influenza, coxiella burentii





 +0  upvote downvote
submitted by sweetmed(44),

Usual interstitial pneumonia (UIP) is a form of lung disease characterized by progressive scarring of both lungs.[1] The scarring (fibrosis) involves the supporting framework (interstitium) of the lung. UIP is thus classified as a form of interstitial lung disease. The term "usual" refers to the fact that UIP is the most common form of interstitial fibrosis. "Pneumonia" indicates "lung abnormality", which includes fibrosis and inflammation. A term previously used for UIP in the British literature is cryptogenic fibrosing alveolitis (CFA), a term that has fallen out of favor since the basic underlying pathology is now thought to be fibrosis, not inflammation. The term usual interstitial pneumonitis (UIP) has also often been used, but again, the -itis part of that name may overemphasize inflammation. Both UIP and CFA have been described as synonymous with idiopathic pulmonary fibrosis.