Syndromes of Bronchiolitis Sat Sharma, MD Dr. Sharma is professor and head, Section of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, MB. The questions below are based on the article “Syndromes of Bronchiolitis”. Choose the single best answer for each question.
	1. A 48-year-old man presented with cough and worsening exertional shortness of breath over a 2-month period. Symptoms included fever, malaise, and anorexia and weight loss. A chest radiograph showed patchy pulmonary infiltrates and irregular nodular opacities in both lungs. Bilateral patchy ground-glass opacities with a triangular area of consolidation with the base along the pleural surface were evident on high-resolution computed tomography (HRCT). Pneumonia was ruled out based on findings from bronchoscopy with bronchoalveolar lavage (BAL). What is the most likely presumptive diagnosis of this patient’s pulmonary disease? Bronchiolitis obliterans organizing pneumonia (BOOP) Diffuse alveolar damage Hypersensitivity pneumonitis Nonspecific interstitial pneumonitis Usual interstitial pneumonitis Click here to compare your answer. 2. Which of the following investigations is necessary to make a definitive diagnosis of cryptogenic organizing pneumonia (idiopathic BOOP)? Bronchoscopy and BAL Gallium scan Positron emission tomography Surgical lung biopsy Transbronchial lung biopsy Click here to compare your answer. 3. Which of the following is a common sign and symptom of cryptogenic organizing pneumonia? Cough associated with sputum production Hemoptysis Pleuritic chest pain Shortness of breath Wheezing Click here to compare your answer. 4. BOOP should be considered as a causative factor in which of the following patients admitted to the hospital with respiratory failure? A diabetic patient with chronic renal failure An elderly man with hypertension and coronary artery disease A multiple-trauma victim with systemic inflammatory response syndrome A patient with exacerbation of longstanding cystic fibrosis A transplant recipient with acute-onset shortness of breath Click here to compare your answer.		5. What radiographic finding is the most common and suggestive of BOOP? Airway hyperinflation Triangle-shaped densities along the pleural edges Diffuse interstitial infiltrates Multiple lung nodules Pleural effusion Click here to compare your answer. 6. The following radiographic findings are commonly seen in bronchiolitis obliterans EXCEPT Airspace opacities Hyperinflation or reticulonodular pattern Ill-defined centrilobular nodules on HRCT Mosaic perfusion on HRCT Normal chest radiograph Click here to compare your answer. 7. Which of the following is the mainstay treatment for BOOP? Anti-infective agents Inhaled corticosteroids Inhaled cytotoxic drugs Macrolide medications Oral prednisone Click here to compare your answer. 8. Once successful treatment for BOOP has been started, relapse occurs in approximately what percentage of patients? Less than 10% 10% to 20% 10% to 40% 40% to 60% 60% Click here to compare your answer.
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