Interstitial Lung Disease — Clinical

A 58-year-old man from Mumbai presents with progressive dyspnea on exertion for 8 months and a dry cough. He is a retired stonemason with 35 years of occupational exposure. On examination, he has bilateral fine crackles at the lung bases. High-resolution CT chest shows bilateral lower-lobe predominant reticular opacities with traction bronchiectasis and honeycombing. Pulmonary function tests reveal FVC 62% predicted, FEV₁/FVC ratio 0.78, and DLCO 45% predicted. What is the most likely diagnosis?

A 52-year-old woman from Delhi presents with progressive dyspnea, dry cough, and constitutional symptoms (fever, fatigue, weight loss) for 3 months. She has a history of sarcoidosis diagnosed 5 years ago. On examination, she has bilateral fine crackles at the lung bases and erythema nodosum on the shins. Chest X-ray shows bilateral hilar lymphadenopathy with reticular opacities. Serum calcium is 11.2 mg/dL (normal 8.5–10.5), and ACE level is elevated. Pulmonary function tests show FVC 68% predicted and DLCO 52% predicted. What is the most likely diagnosis?

Which of the following is the most common histopathological pattern seen in idiopathic pulmonary fibrosis (IPF)?

A 52-year-old woman with a 2-year history of progressive dyspnea, polyarthralgia, and erythema nodosum presents to the pulmonary clinic. Chest X-ray shows bilateral hilar lymphadenopathy with right paratracheal involvement. High-resolution CT confirms mediastinal lymphadenopathy without pulmonary parenchymal disease. Serum calcium is 11.2 mg/dL (normal 8.5–10.5), and 24-hour urinary calcium is elevated at 320 mg/day. ACE level is 85 U/L (normal <40), and serum angiotensin-converting enzyme inhibitor-responsive hypercalcemia is confirmed. Transbronchial lung biopsy shows non-caseating granulomas. What is the most appropriate next step in management?

A 58-year-old male farmer from Punjab presents with progressive dyspnea on exertion and dry cough for 8 months. He has a 30-year history of exposure to organic dusts. On examination, fine end-inspiratory crackles are heard bilaterally at the lung bases. High-resolution CT chest shows bilateral lower lobe predominant reticular opacities with traction bronchiectasis. Pulmonary function tests reveal FVC 65% predicted, FEV₁/FVC ratio 0.82, and DLCO 48% predicted. Serum precipitating antibodies against thermophilic actinomycetes are positive. What is the most likely diagnosis?