Dorothy is a 55-year-old woman, who was well until about a year ago, when she first noticed some dyspnea carrying groceries up the front steps. This has progressed to where she now notes dyspnea even walking on level ground with her friends or at work. She recently had a hernia repair, and the preoperative chest xray showed increased interstitial markings. She was told to follow up with her physician, which is why she came into see you today. She denies cough and is a lifelong nonsmoker. She has no chest pain or any history of heart disease. She works as an accountant in Manhattan. She states that her office is old and dusty but knows of no mold problems at work or at home. She has no pets. She notes some back and neck arthritis but has no history of joint swelling, dry eyes or mouth, skin rashes, muscle pain, or change in color of digits in cold. Her only medications are an ACE inhibitor for hypertension, and occasional ibuprofen.
1. What possibilities are you considering for her shortness of breath and her radiographic findings?
A. Idiopathic pulmonary fibrosis (IPF)
B. Interstitial lung disease (ILD) associated with connective tissue disease
C. Hypersensitivity pneumonitis
D. ILD associated with medications
E. ILD associated with occupational exposure (pneumoconiosis)
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