Restrictive Lung Disease USMLE Step 1 Practice Question
A 62-year-old man with a history of stage IB seminoma treated with chemotherapy (including bleomycin and etoposide) 3 months ago presents to clinic with progressive dyspnea on exertion and nonproductive cough for 6 weeks. He denies fever, night sweats, or recent travel. Vital signs are notable for respiratory rate 22/min and oxygen saturation 92% on room air. Physical examination reveals fine bilateral crackles at the lung bases. Pulmonary function testing shows: TLC 65% predicted, FVC 68% predicted, FEV1 78% predicted, with FEV1/FVC ratio of 83%. Chest X-ray demonstrates bilateral fine reticular opacities predominantly in the lower lobes. Which of the following is the most likely diagnosis?
Answer choices
- AAcute interstitial pneumonia from opportunistic infection
- BChemotherapy-induced pulmonary fibrosisCorrect answer
- CRadiation pneumonitis
- DPulmonary edema from chemotherapy-related cardiomyopathy
- ERecurrent/metastatic malignancy with lymphangitic carcinomatosis
- FChronic obstructive pulmonary disease with acute exacerbation
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