Restrictive Lung Disease USMLE Step 1 Practice Question
A 68-year-old male former shipyard worker presents to clinic with a 2-year history of progressive dyspnea on exertion and persistent nonproductive cough. He worked in naval shipbuilding for 35 years, primarily in insulation and pipe-wrapping. Vital signs are notable for RR 22 and SpO2 88% on room air. Physical examination reveals bibasilar end-inspiratory crackles without wheezing. High-resolution CT chest demonstrates bilateral lower lobe pleural thickening with calcified pleural plaques, along with interstitial reticular opacities. Pulmonary function tests show FVC 65% predicted, FEV1/FVC ratio 78%, and DLCO 52% predicted. Which of the following occupational exposures best explains his clinical presentation?
Answer choices
- ASilica dust from stone/concrete cutting
- BBeryllium from aerospace manufacturing
- COrganic grain dust from agricultural work
- DAsbestos from insulation and shipbuilding materialsCorrect answer
- ETalc from mining and processing
- FCoal dust from underground mining
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