Rosh Internal Medicine Boost Practice Exam

What is the most likely diagnosis for an 80-year-old woman with increasing dyspnea, clubbed digits, and honeycombing of the lung parenchyma?

1. Bronchiectasis

2. Chronic obstructive pulmonary disease

3. Idiopathic pulmonary fibrosis

4. Sarcoidosis

The correct answer is: Idiopathic pulmonary fibrosis

The presence of increasing dyspnea, clubbed digits, and honeycombing of the lung parenchyma suggests a specific pulmonary condition, with idiopathic pulmonary fibrosis being the most likely diagnosis. Idiopathic pulmonary fibrosis (IPF) is characterized by progressive dyspnea and dry cough, which are often the initial symptoms. The clubbing of digits indicates the presence of chronic hypoxia typically associated with interstitial lung disease, and honeycombing on imaging is a classic radiological finding that suggests a specific pattern of lung injury consistent with IPF. This condition is thought to involve repeated cycles of lung injury and repair leading to fibrosis, ultimately affecting respiratory function. The other conditions listed can involve lung symptoms but do not typically exhibit the combination of symptoms described as distinctively as IPF. For instance, bronchiectasis usually presents with a productive cough and has a more chronic history rather than the acute respiratory deterioration noted here. Chronic obstructive pulmonary disease (COPD) is often related to a history of smoking and presents with different lung changes in imaging and symptoms. Sarcoidosis can involve dyspnea and clubbing but often presents with other systemic symptoms and does not typically show honeycombing as a predominant feature. Given this combination of findings