Correct!
4. 1 and 3
Exposure to birds might suggest hypersensitivity pneumonitis. Distinguishing between usual interstitial pneumonia and hypersensitivity pneumonitis can be difficult. Of course, old chest x-rays or CT scans can reveal a chronic process while normal prior radiography suggests an acute change. Thirty-six patients with idiopathic pulmonary fibrosis and 27 patients with hypersensitivity pneumonitis were studied. All diagnoses were confirmed or supported by open lung biopsy (3). A diagnosis of idiopathic pulmonary fibrosis was considered more likely in patients with honeycombing and peripheral or lower lung zone predominance of disease. In contrast, patients with micronodules but without honeycombing, were considered more likely to have chronic hypersensitivity pneumonitis (3). A CT diagnosis could be made with a high level of confidence in 39 (62%) of 63 patients. In these patients, the CT diagnosis was correct in 35 cases (90%): 23 of 26 patients with a CT diagnosis of idiopathic pulmonary fibrosis and 12 of 13 patients with a CT diagnosis of hypersensitivity pneumonitis.
A painful skin rash could suggest ILD especially disease secondary to dermatomyositis (4).
What laboratory evaluation might confirm a diagnosis of dermatomyositis-associated ILD? (Click on the best answer to be directed to the sixth of seven pages)