1. Transbronchial biopsy is the least invasive approach to obtain a histologic diagnosis for a 60-year-old man with shortness of breath, a history of smoking, and basilar crackles. Objective parameters like 6MWT, DLCO, FVC, and HRCT can assess progression of the disease. Lung transplantation is the best curative treatment. 2. A 50-year-old current smoker with shortness of breath and cough showing findings on HRCT and PFTs would be diagnosed with RB-ILD based on surgical lung biopsy findings. 3. A 40-year-old man with rapid deterioration and bilateral infiltrates on CXR would be diagnosed with acute eosin

1. Board Review 2017 Jeddah
DPLD and Rare ILD
Dr Nahid Ali Sherbini
1- 60 y oldman complainingof shortnessof breathonexertion.Notedtohave AFinER,
Cardioversiondonebyamiodarone.He hada35 pack –yearhistoryof smoking.His
physical examinationwasunremarkableexceptforbasal crepitationandirregular
irregularheartbeat.HisLaboratory testswasunremarkable.CTchest
What is the least invasive approach to obtain the histologic diagnosis?
a. Surgical lung biopsy
b. BAL
c. Transbronchial biopsy
d. None
What Objective parameters would you use to assess the progression of the disease?
a. 6MWT ,DLCO ,FVC ,HRCT
b. DLCO
c. SERIAL CXR
d. SERIAL HRCT
e. FEVFVC ,FEV1
What are the best curative treatment?
a. Start NIntidanib or pirfenidone
b. Start oral prednisolone and DMARDS as needed
c. Start N-acetyl Cysteine

2. Board Review 2017 Jeddah
DPLD and Rare ILD
Dr Nahid Ali Sherbini
d. Lung Transplantation
2- 50 y oldman, 30 pack-yearsandcurrent smoker, complaining of shortness of breath on
exertion and dry cough for 3 month. He has normal examination except for bilateral
basal crackles. HRCTV show bilateral patchy ground glass opacities and centrilobular
nodules. PFT show Restrictive pattern and low DLCO.
Surgical lung biopsy show brownish pigmented macrophage in the respiratory
bronchioles .What is the diagnosis?
a. Chronic HP
b. RB-ILD
c. LIP
d. IPF
e. NSIP
3- 40 y old man, presented with dyspnea for 2 weeks, not known to have any previous
medical illness. He had a history of smoking. Rapidly deteriorated admitted to ICU,
Intubated and mechanically ventilated. His Labs were normal and CXR show bilateral
lung infiltrate.
a. Chronic eosinophilic Pneumonia
b. Acute eosinophilic Pneumonia
c. IPF
d. ABPA
e. HP
4- Which of the following is a manifestation of drug induced ILD?
a. Chronic HP
b. UIP
c. OP
d. Non cardiogenic pulmonary oedema
e. All of the above
5- 43 y old lady presented with dyspnea for 2 days. Smoker, Previous admission with
pneumothorax. Her examination is normal except for diminished breaths sounds.
Hypoxic. PFT Obstructive pattern. Echo show pulmonary hypertension.
CT shown below

3. Board Review 2017 Jeddah
DPLD and Rare ILD
Dr Nahid Ali Sherbini
Which of the following statement is true about this case?
a. Lung cyst is the hallmark of the disease
b. The diagnosis require histological examination
c. All patients need lung transplantation
d. Sirolimus is not approved for these cases.
e. All of the above
6- Indications of systemic steroids in sarcoidosis include
a. Bilateral hilar adenopathy
b. Bilateral lung infiltrate
c. Ocular involvement
d. Cardiac involvement
e. Hypocalcemia
7- 40 y old female, was completely healthy .Presented with progressive shortness of
breath. CT is shown
What you will do next for diagnosis?

4. Board Review 2017 Jeddah
DPLD and Rare ILD
Dr Nahid Ali Sherbini
a. Open Lung biopsy
b. Bronchoalveolar Lavage
c. Pulmonary Function Tests
d. Bronchoscopy and Trans bronchial biopsy
e. CT guided biopsy
8- Which of the following is true regarding nonspecific interstitial pneumonia (NSIP)?
a. NSIP is a specific disease entity.
b. Prognosis associated with NSIP and UIP are similar.
c. NSIP is commonly associated with connective tissue diseases.
d. NSIP commonly manifests as cystic lung lesions on HRCT.
e. NSIP can be only diagnosed by radiological appearance
9- 45 year oldman knowncase of PM/DM , presentedwiththree weekshistoryof dyspnea
on exertion ,progressive andassociatedwithdrycough,weightloss and loss of appetite
He has a history of Raynaud’s. Physical Examination show ankle joint swelling, HRCT
show bilateral interstitial infiltrate diffuse predominantly upper lobes with traction
bronchiectasis ILD.
What is true about this disease?
a. 2-5 % of PMDMpatients will have it
b. UIP pattern is the commonest to be found in HRCT
c. Anti –jo antibodies positive
d. Obstructive ventilatory defect in PFT
e. None of the above
10- 22 y oldfemale known case of SLE presented with acute shortness of breath, dry cough
and fever, admitted to ICU, intubated and ventilated. CT chest done- shown below
.Bronchoscopy andbronchoalveolarlavage performed, the fluid is sequentially bloody.
Which of the following statements is true about this condition?
a. Survival more than 70%

5. Board Review 2017 Jeddah
DPLD and Rare ILD
Dr Nahid Ali Sherbini
b. IV Methylprednisolone 40 mg TID should be given for 3 days
c. No need for antibiotics for this case
d. Active lupus nephritis is commonly associated
e. None of the above
Key
1 D ,A ,D
2 B
3 B
4 E
5 A
6 D
7 B
8 C
9 C
10 D