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NBME 21 Answers

nbme21/Block 1/Question#32 (reveal difficulty score)
A 50-year-old man has had progressive dyspnea ...
Usual interstitial pneumonitis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +35  upvote downvote
submitted by โˆ—notadoctor(175)
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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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aneurysmclip  Nbme back at it again +37
pg32  Is it still considered idiopathic pulmonary fibrosis is it appears to have been caused by an atypical pneumonia? +1
zevvyt  Why not Sarcoidosis? Wouldn't Sarcodosis also be a chronic inflamation with fibrous thickening? +2
swagcabana  UIP is a better answer. Sarcoid is a leap in logic, usual interstitial pneumonitis is textbook histological definition of idiopathic pulmonary fibrosis. The biopsy has no mention of noncaseating granulomas and the clinical picture is not consistent with an inflammatory process. You have to focus on the better answers, try not to get caught up in the "why nots?" Calling this sarcoidosis is like someone coming in with prototypical asthma and jumping to eosinophilic granulomatous with polyangiitis. Sure its a possibility but its definitely not likely. +7
mangotango  I picked โ€œdiffuse alveolar damageโ€ with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/ +5
zevvyt  thank you swagcabana! Very good explanation and strategy! +



 +9  upvote downvote
submitted by gabstep(15)
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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.

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drdoom  pneumonitis* +
drdoom  ^nevermind! +



 +4  upvote downvote
submitted by โˆ—sweetmed(157)
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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.

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 +4  upvote downvote
submitted by โˆ—neonem(629)
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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.

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 +4  upvote downvote
submitted by โˆ—usmleuser007(464)
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Ifall else fails: note that other answer choices are COPD types

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dragon3  (except sarcoidosis) +2
leaf_house  I got hung up on why this couldn't be sarcoid, and I think no lymphadenopathy is one of the reasons you wouldn't pick it here. (Though it seems like it can cause alveolar septal thickening: https://pubs.rsna.org/doi/full/10.1148/rg.306105512) +
lovebug  Restrictive VS Obstructive ! very good point! THX! +
schep  if it were sarcoid, wouldn't the biopsy show noncaseating granulomas? +1



 +0  upvote downvote
submitted by โˆ—niboonsh(409)
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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

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athenathefirst  Yeah but how does that help you choose Usual interstital pneumonia? +



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