Idiopathic Pulmonary Fibrosis: The Daily PANCE Blueprint

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Idiopathic Pulmonary Fibrosis: The Daily PANCE Blueprint

A 68-year-old man with a history of smoking presents with a 6-month history of progressive dyspnea on exertion and a dry cough. He has no past medical history of asthma or COPD. Physical examination reveals bibasilar inspiratory crackles. High-resolution CT shows reticular opacities and honeycombing without evidence of emphysema. Which of the following best describes the pulmonary function test (PFT) results in a patient with idiopathic pulmonary fibrosis?

A. Increased Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1)
B. Normal lung volumes and normal gas exchange
C. Increased residual volume (RV) and normal diffusing capacity for carbon monoxide (DLCO)
D. Reduced FVC, normal FEV1/FVC ratio, and reduced DLCO
E. Increased total lung capacity (TLC) and airflow obstruction

Answer and topic summary

The answer is D. Reduced FVC, normal FEV1/FVC ratio, and reduced DLCO

Pulmonary function tests in a patient with idiopathic pulmonary fibrosis typically show a restrictive pattern. This is characterized by a reduced forced vital capacity (FVC) due to the decreased lung compliance from fibrosis. Despite the reduction in FVC, the FEV1/FVC ratio is preserved or even increased because both FEV1 (forced expiratory volume in the first second) and FVC are proportionally reduced. Additionally, the diffusing capacity for carbon monoxide (DLCO) is decreased, reflecting impaired gas exchange across the fibrotic lung tissue. This pattern of findings is indicative of restrictive lung disease, such as idiopathic pulmonary fibrosis.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Pulmonary ⇒ Restrictive Pulmonary Disease (PEARLS) ⇒ Idiopathic pulmonary fibrosis

Also covered as part of the Internal Medicine Rotation topic lists