Respiratory: usual interstitial pneumonia: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Respiratory: usual interstitial pneumonia

Sample item

A 65-year-old man has progressive breathlessness, dry cough, finger clubbing and fine bibasal crackles. HRCT shows subpleural basal honeycombing with traction bronchiectasis. Which histological pattern and feature are expected?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Usual interstitial pneumonia with patchy fibrosis of varying age and fibroblast foci

Idiopathic pulmonary fibrosis shows the pattern of usual interstitial pneumonia: patchy subpleural and paraseptal fibrosis alternating with normal lung (temporal heterogeneity), honeycombing and fibroblast foci of active fibrosis. HRCT alone is often diagnostic in the right setting. Antifibrotics such as pirfenidone and nintedanib slow decline.

Option by option

  • A. Non-specific interstitial pneumonia with uniform temporal inflammation

    Non-specific interstitial pneumonia shows uniform, temporally homogeneous inflammation and fibrosis.

  • B. Bronchiolocentric non-necrotising granulomas with lymphocytes

    Bronchiolocentric granulomas suggest hypersensitivity pneumonitis, which has a different imaging pattern.

  • C. Usual interstitial pneumonia with patchy fibrosis of varying age and fibroblast foci (correct)

    Correct. Patchy fibrosis of varying age with fibroblast foci defines usual interstitial pneumonia.

  • D. Diffuse alveolar damage with hyaline membranes

    Hyaline membranes with diffuse alveolar damage describe acute respiratory distress syndrome.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Usual interstitial pneumonia with patchy fibrosis of varying age and fibroblast foci. Idiopathic pulmonary fibrosis shows the pattern of usual interstitial pneumonia: patchy subpleural and paraseptal fibrosis alternating with normal lung (temporal heterogeneity), honeycombing and fibroblast foci of active fibrosis.

Why is "Non-specific interstitial pneumonia with uniform temporal inflammation" not the answer?

Non-specific interstitial pneumonia shows uniform, temporally homogeneous inflammation and fibrosis.

Why is "Bronchiolocentric non-necrotising granulomas with lymphocytes" not the answer?

Bronchiolocentric granulomas suggest hypersensitivity pneumonitis, which has a different imaging pattern.

Why is "Diffuse alveolar damage with hyaline membranes" not the answer?

Hyaline membranes with diffuse alveolar damage describe acute respiratory distress syndrome.

What concept does this question test?

It tests Respiratory: usual interstitial pneumonia in Pathology. HRCT alone is often diagnostic in the right setting. Antifibrotics such as pirfenidone and nintedanib slow decline.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory: usual interstitial pneumonia?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.