Module 3 Assessment
There are 7 questions in this module. Please click send after you choose your answer. You will proceed to the next page if you answer correctly.
Start Assessement
Based on this initial CT scan, which radiographic features are present that would be concerning for ILAs?
A 67-year-old former smoker with a 30-pack-year history presents for routine lung cancer screening. She is asymptomatic with no reported cough, dyspnea, or functional limitation. She denies occupational exposures or known family history of interstitial lung disease. Pulmonary Function Testing (PFTs): FVC: 95% predicted DLCO: 87% predicted No oxygen desaturation on six-minute walk test CT Scan #1 (Year 0) Findings: Bilateral ground-glass opacities and reticular changes located in the subpleural and basilar regions. No evidence of traction bronchiectasis, honeycombing, or lung distortion.
Centrilobular nodules with upper lobe predominance and traction bronchiectasis, suggesting respiratory bronchiolitis or hypersensitivity pneumonitis.
Ground-glass opacities and reticular changes in the subpleural and basilar regions, consistent with possible early interstitial lung abnormality.
Honeycombing with peripheral and basal distribution, indicating advanced fibrotic changes typical of usual interstitial pneumonia pattern.
Great Job!
Correct Answer: B) Ground-glass opacities and reticular changes in the subpleural and basilar regions, consistent with possible early interstitial lung abnormality. Rationale: The CT scan demonstrates reticular opacities and ground-glass opacities in a subpleural and basilar distribution, which are key radiographic features concerning for interstitial lung abnormalities. The scan does not show centrilobular nodules, honeycombing, or traction bronchiectasis.
How would you classify this patient's ILA subtype?
A 67-year-old former smoker with a 30-pack-year history presents for routine lung cancer screening. She is asymptomatic with no reported cough, dyspnea, or functional limitation. She denies occupational exposures or known family history of interstitial lung disease. Pulmonary Function Testing (PFTs): FVC: 95% predicted DLCO: 87% predicted No oxygen desaturation on six-minute walk test CT Scan #1 (Year 0) Findings: Bilateral ground-glass opacities and reticular changes located in the subpleural and basilar regions. No evidence of traction bronchiectasis, honeycombing, or lung distortion.
Classify as subpleural fibrotic ILA due to the presence of reticular changes in a subpleural distribution, which indicates established fibrosis requiring immediate pulmonary consultation.
Categorize as indeterminate for ILA since the patient is asymptomatic with normal pulmonary function tests, suggesting these findings likely represent age-related changes.
Classify as subpleural non-fibrotic ILA due to ground-glass opacities and reticular changes in subpleural distribution without evidence of traction bronchiectasis or honeycombing.
Great Job!
Correct Answer: B) Ground-glass opacities and reticular changes in the subpleural and basilar regions, consistent with possible early interstitial lung abnormality. Rationale: The CT scan demonstrates reticular opacities and ground-glass opacities in a subpleural and basilar distribution, which are key radiographic features concerning for interstitial lung abnormalities. The scan does not show centrilobular nodules, honeycombing, or traction bronchiectasis.
Based on the updated CT findings and PFT changes, what is the appropriate classification according to the UIP criteria?
1 year later the same 67-year-old former smoker with a 30-pack-year history presents for routine lung cancer screening. She is asymptomatic with no reported cough, dyspnea, or functional limitation. She denies occupational exposures or known family history of interstitial lung disease. Pulmonary Function Testing (PFTs): FVC dropped from 95% to 80% predicted, DLCO dropped from 87% to 70% predicted CT Scan #2 (1 Year Later) Findings:
- Increased subpleural reticulation and architectural distortion
- Development of traction bronchiectasis
- Still no honeycombing
- Findings remain subpleural and basilar in distribution
Classify as probable UIP pattern due to increased subpleural reticulation with architectural distortion and traction bronchiectasis, but without honeycombing, in a subpleural and basilar distribution.
Classify as typical UIP pattern due to the progression of fibrotic changes with traction bronchiectasis and declining pulmonary function tests, indicating established fibrosis.
Classify as indeterminate for UIP pattern since the absence of honeycombing and the relatively preserved pulmonary function suggest these changes could represent an alternative diagnosis.
Great Job!
Correct Answer: A) Classify as probable UIP pattern due to increased subpleural reticulation with architectural distortion and traction bronchiectasis, but without honeycombing, in a subpleural and basilar distribution. Rationale: The development of traction bronchiectasis with subpleural and basilar predominant distribution of reticulation meets criteria for probable UIP. The absence of honeycombing prevents classification as typical UIP, while the presence of traction bronchiectasis excludes indeterminate UIP or alternative diagnosis categories.
How would you classify this patient's risk for progression to clinically significant ILD?
1 year later the same 67-year-old former smoker with a 30-pack-year history presents for routine lung cancer screening. She is asymptomatic with no reported cough, dyspnea, or functional limitation. She denies occupational exposures or known family history of interstitial lung disease. Pulmonary Function Testing (PFTs): FVC dropped from 95% to 80% predicted, DLCO dropped from 87% to 70% predicted CT Scan #2 (1 Year Later) Findings:
- Increased subpleural reticulation and architectural distortion
- Development of traction bronchiectasis
- Still no honeycombing
- Findings remain subpleural and basilar in distribution
Classify as low risk for progression to ILD since the patient remains asymptomatic despite the radiographic changes, suggesting a stable non-progressive process.
Classify as moderate risk for progression to ILD due to some worsening of radiographic findings but with relatively preserved pulmonary function tests.
Classify as high risk for progression to ILD due to the development of traction bronchiectasis, increasing architectural distortion, and decline in both FVC and DLCO within one year.
Great Job!
Correct Answer: C) Classify as high risk for progression to ILD due to the development of traction bronchiectasis, increasing architectural distortion, and decline in both FVC and DLCO within one year.Rationale: The patient demonstrates several high-risk features for progression to clinically significant ILD: development of traction bronchiectasis (a fibrotic feature), progression of radiographic abnormalities over a short time period (1 year), and significant decline in pulmonary function (15% drop in FVC and 17% drop in DLCO). These features collectively indicate a high risk for continued progression to clinically significant ILD.
What is the most appropriate next step in management?
1 year later the same 67-year-old former smoker with a 30-pack-year history presents for routine lung cancer screening. She is asymptomatic with no reported cough, dyspnea, or functional limitation. She denies occupational exposures or known family history of interstitial lung disease. Pulmonary Function Testing (PFTs): FVC dropped from 95% to 80% predicted, DLCO dropped from 87% to 70% predicted CT Scan #2 (1 Year Later) Findings:
- Increased subpleural reticulation and architectural distortion
- Development of traction bronchiectasis
- Still no honeycombing
- Findings remain subpleural and basilar in distribution
Schedule routine follow-up imaging in 12 months with repeat pulmonary function testing, as the patient remains asymptomatic despite radiographic changes.
Present the case at a multidisciplinary discussion (MDD) for comprehensive ILD evaluation, given the progression of radiographic findings and decline in pulmonary function tests.
Initiate empiric antifibrotic therapy without further evaluation since the probable UIP pattern and declining pulmonary function tests indicate progressive fibrotic lung disease.
Great Work! You completed Module 3.
Incorrect, Please try again
An indeterminate UIP pattern is used when CT findings are too subtle, nonspecific, or incomplete to confidently place the patient within the UIP spectrum. However, this follow-up CT shows progressive fibrotic changes, including traction bronchiectasis and architectural distortion—both key features that move the pattern firmly into the UIP category.
The absence of honeycombing does not make the pattern indeterminate, and the decline in PFTs supports disease progression rather than an alternative explanation. For these reasons, classifying this case as indeterminate for UIP is incorrect.
Incorrect, Please try again
Normal pulmonary function tests and the absence of symptoms do not change the radiologic classification of an interstitial lung abnormality. ILA subtypes are determined entirely by the CT appearance, not by PFT results or clinical symptoms. In this case, the scan clearly shows subpleural ground-glass opacities and reticular changes, which meet the definition of an ILA. These findings are not considered age-related changes and should not be dismissed or labeled as indeterminate.
It is also important not to confuse this with an indeterminate UIP pattern, which is a separate CT descriptor used in fibrotic ILD and will be learned about in the second module. For ILA classification, this scan is not indeterminate for ILA — the findings support subpleural non-fibrotic ILA, making this answer incorrect.
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Waiting another 12 months for routine follow-up would be inappropriate given the degree of progression seen in both imaging and pulmonary function. The patient now has traction bronchiectasis, increasing architectural distortion, and a meaningful decline in FVC and DLCO—all markers of active, evolving fibrotic ILD. Even though he is still asymptomatic, symptoms are not required to trigger escalated evaluation. A routine 12-month interval would risk delaying needed diagnostic clarification and potential treatment. For these reasons, this option is incorrect.
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Although this patient now demonstrates clear progression—with increased reticulation, architectural distortion, and new traction bronchiectasis—he still does not have honeycombing. Honeycombing is a required feature for classifying a scan as typical UIP according to ATS/Fleischner 2018 guidelines. Without it, the pattern cannot be upgraded beyond “probable UIP.” Therefore, calling this pattern typical UIP is incorrect.
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You must answer the question correctly to get to the next page.
Incorrect, Please try again.
Although this patient shows concerning progression, initiating antifibrotic therapy without a multidisciplinary evaluation would skip a critical diagnostic step. Antifibrotics are not started based solely on a probable UIP pattern; treatment decisions depend on confirming the diagnosis, assessing alternative causes, and aligning management across pulmonology, radiology, and sometimes pathology. A comprehensive MDD ensures accuracy before committing the patient to long-term therapy. Starting treatment empirically at this stage would be premature, making this answer incorrect.
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Moderate risk would apply to a patient with mild radiographic progression or stable lung function, but that is not the case here. This patient shows multiple high-risk markers, including new traction bronchiectasis, more pronounced architectural distortion, and a substantial one-year decline in both FVC and DLCO. These changes exceed what would be expected in a moderate-risk category. For that reason, calling him moderate risk underestimates the seriousness of his progression.
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This option suggests advanced fibrosis, specifically a usual interstitial pneumonia (UIP) pattern. However, the CT report clearly states that there is no honeycombing and no lung distortion. The findings described — subpleural ground-glass changes and reticulation without traction bronchiectasis or honeycombing — are far earlier in the disease spectrum and more consistent with possible interstitial lung abnormality, not advanced fibrotic ILD. Because honeycombing is not present, this option is incorrect.
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Labeling this patient as low risk would significantly underestimate the severity of the changes seen on follow-up. Although he remains asymptomatic, symptoms are not required to define risk. What matters here is the clear progression of fibrosis on CT—traction bronchiectasis and increasing architectural distortion—along with measurable declines in both FVC and DLCO. These features are not compatible with a “stable” or “non-progressive” process, so classifying him as low risk is incorrect.
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This option doesn’t match the CT findings described. Centrilobular nodules and upper-lobe–predominant disease are more typical of smoking-related bronchiolitis or hypersensitivity pneumonitis, not interstitial lung abnormality. The patient’s scan shows ground-glass opacities and reticulation in the subpleural and basilar regions, and there is no traction bronchiectasis. Because none of the features listed in this option are present, this is not the correct answer.
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This option overcalls fibrosis. While the CT scan does show subpleural reticulation and ground-glass opacities, there is no evidence of traction bronchiectasis, honeycombing, or architectural distortion—the key features required to label an ILA as fibrotic. Reticulation alone is not enough to classify fibrosis. Because the radiographic findings lack these hallmark fibrotic features, this cannot be categorized as subpleural fibrotic ILA.
Module 3 Assessment
B4 Symptoms
Created on October 3, 2025
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Transcript
Module 3 Assessment
There are 7 questions in this module. Please click send after you choose your answer. You will proceed to the next page if you answer correctly.
Start Assessement
Based on this initial CT scan, which radiographic features are present that would be concerning for ILAs?
A 67-year-old former smoker with a 30-pack-year history presents for routine lung cancer screening. She is asymptomatic with no reported cough, dyspnea, or functional limitation. She denies occupational exposures or known family history of interstitial lung disease. Pulmonary Function Testing (PFTs): FVC: 95% predicted DLCO: 87% predicted No oxygen desaturation on six-minute walk test CT Scan #1 (Year 0) Findings: Bilateral ground-glass opacities and reticular changes located in the subpleural and basilar regions. No evidence of traction bronchiectasis, honeycombing, or lung distortion.
Centrilobular nodules with upper lobe predominance and traction bronchiectasis, suggesting respiratory bronchiolitis or hypersensitivity pneumonitis.
Ground-glass opacities and reticular changes in the subpleural and basilar regions, consistent with possible early interstitial lung abnormality.
Honeycombing with peripheral and basal distribution, indicating advanced fibrotic changes typical of usual interstitial pneumonia pattern.
Great Job!
Correct Answer: B) Ground-glass opacities and reticular changes in the subpleural and basilar regions, consistent with possible early interstitial lung abnormality. Rationale: The CT scan demonstrates reticular opacities and ground-glass opacities in a subpleural and basilar distribution, which are key radiographic features concerning for interstitial lung abnormalities. The scan does not show centrilobular nodules, honeycombing, or traction bronchiectasis.
How would you classify this patient's ILA subtype?
A 67-year-old former smoker with a 30-pack-year history presents for routine lung cancer screening. She is asymptomatic with no reported cough, dyspnea, or functional limitation. She denies occupational exposures or known family history of interstitial lung disease. Pulmonary Function Testing (PFTs): FVC: 95% predicted DLCO: 87% predicted No oxygen desaturation on six-minute walk test CT Scan #1 (Year 0) Findings: Bilateral ground-glass opacities and reticular changes located in the subpleural and basilar regions. No evidence of traction bronchiectasis, honeycombing, or lung distortion.
Classify as subpleural fibrotic ILA due to the presence of reticular changes in a subpleural distribution, which indicates established fibrosis requiring immediate pulmonary consultation.
Categorize as indeterminate for ILA since the patient is asymptomatic with normal pulmonary function tests, suggesting these findings likely represent age-related changes.
Classify as subpleural non-fibrotic ILA due to ground-glass opacities and reticular changes in subpleural distribution without evidence of traction bronchiectasis or honeycombing.
Great Job!
Correct Answer: B) Ground-glass opacities and reticular changes in the subpleural and basilar regions, consistent with possible early interstitial lung abnormality. Rationale: The CT scan demonstrates reticular opacities and ground-glass opacities in a subpleural and basilar distribution, which are key radiographic features concerning for interstitial lung abnormalities. The scan does not show centrilobular nodules, honeycombing, or traction bronchiectasis.
Based on the updated CT findings and PFT changes, what is the appropriate classification according to the UIP criteria?
1 year later the same 67-year-old former smoker with a 30-pack-year history presents for routine lung cancer screening. She is asymptomatic with no reported cough, dyspnea, or functional limitation. She denies occupational exposures or known family history of interstitial lung disease. Pulmonary Function Testing (PFTs): FVC dropped from 95% to 80% predicted, DLCO dropped from 87% to 70% predicted CT Scan #2 (1 Year Later) Findings:
Classify as probable UIP pattern due to increased subpleural reticulation with architectural distortion and traction bronchiectasis, but without honeycombing, in a subpleural and basilar distribution.
Classify as typical UIP pattern due to the progression of fibrotic changes with traction bronchiectasis and declining pulmonary function tests, indicating established fibrosis.
Classify as indeterminate for UIP pattern since the absence of honeycombing and the relatively preserved pulmonary function suggest these changes could represent an alternative diagnosis.
Great Job!
Correct Answer: A) Classify as probable UIP pattern due to increased subpleural reticulation with architectural distortion and traction bronchiectasis, but without honeycombing, in a subpleural and basilar distribution. Rationale: The development of traction bronchiectasis with subpleural and basilar predominant distribution of reticulation meets criteria for probable UIP. The absence of honeycombing prevents classification as typical UIP, while the presence of traction bronchiectasis excludes indeterminate UIP or alternative diagnosis categories.
How would you classify this patient's risk for progression to clinically significant ILD?
1 year later the same 67-year-old former smoker with a 30-pack-year history presents for routine lung cancer screening. She is asymptomatic with no reported cough, dyspnea, or functional limitation. She denies occupational exposures or known family history of interstitial lung disease. Pulmonary Function Testing (PFTs): FVC dropped from 95% to 80% predicted, DLCO dropped from 87% to 70% predicted CT Scan #2 (1 Year Later) Findings:
Classify as low risk for progression to ILD since the patient remains asymptomatic despite the radiographic changes, suggesting a stable non-progressive process.
Classify as moderate risk for progression to ILD due to some worsening of radiographic findings but with relatively preserved pulmonary function tests.
Classify as high risk for progression to ILD due to the development of traction bronchiectasis, increasing architectural distortion, and decline in both FVC and DLCO within one year.
Great Job!
Correct Answer: C) Classify as high risk for progression to ILD due to the development of traction bronchiectasis, increasing architectural distortion, and decline in both FVC and DLCO within one year.Rationale: The patient demonstrates several high-risk features for progression to clinically significant ILD: development of traction bronchiectasis (a fibrotic feature), progression of radiographic abnormalities over a short time period (1 year), and significant decline in pulmonary function (15% drop in FVC and 17% drop in DLCO). These features collectively indicate a high risk for continued progression to clinically significant ILD.
What is the most appropriate next step in management?
1 year later the same 67-year-old former smoker with a 30-pack-year history presents for routine lung cancer screening. She is asymptomatic with no reported cough, dyspnea, or functional limitation. She denies occupational exposures or known family history of interstitial lung disease. Pulmonary Function Testing (PFTs): FVC dropped from 95% to 80% predicted, DLCO dropped from 87% to 70% predicted CT Scan #2 (1 Year Later) Findings:
Schedule routine follow-up imaging in 12 months with repeat pulmonary function testing, as the patient remains asymptomatic despite radiographic changes.
Present the case at a multidisciplinary discussion (MDD) for comprehensive ILD evaluation, given the progression of radiographic findings and decline in pulmonary function tests.
Initiate empiric antifibrotic therapy without further evaluation since the probable UIP pattern and declining pulmonary function tests indicate progressive fibrotic lung disease.
Great Work! You completed Module 3.
Incorrect, Please try again
An indeterminate UIP pattern is used when CT findings are too subtle, nonspecific, or incomplete to confidently place the patient within the UIP spectrum. However, this follow-up CT shows progressive fibrotic changes, including traction bronchiectasis and architectural distortion—both key features that move the pattern firmly into the UIP category. The absence of honeycombing does not make the pattern indeterminate, and the decline in PFTs supports disease progression rather than an alternative explanation. For these reasons, classifying this case as indeterminate for UIP is incorrect.
Incorrect, Please try again
Normal pulmonary function tests and the absence of symptoms do not change the radiologic classification of an interstitial lung abnormality. ILA subtypes are determined entirely by the CT appearance, not by PFT results or clinical symptoms. In this case, the scan clearly shows subpleural ground-glass opacities and reticular changes, which meet the definition of an ILA. These findings are not considered age-related changes and should not be dismissed or labeled as indeterminate. It is also important not to confuse this with an indeterminate UIP pattern, which is a separate CT descriptor used in fibrotic ILD and will be learned about in the second module. For ILA classification, this scan is not indeterminate for ILA — the findings support subpleural non-fibrotic ILA, making this answer incorrect.
Incorrect. Try Again.
You must answer the question correctly to get to the next page.
Incorrect, Please try again
Waiting another 12 months for routine follow-up would be inappropriate given the degree of progression seen in both imaging and pulmonary function. The patient now has traction bronchiectasis, increasing architectural distortion, and a meaningful decline in FVC and DLCO—all markers of active, evolving fibrotic ILD. Even though he is still asymptomatic, symptoms are not required to trigger escalated evaluation. A routine 12-month interval would risk delaying needed diagnostic clarification and potential treatment. For these reasons, this option is incorrect.
Incorrect, Please try again.
Although this patient now demonstrates clear progression—with increased reticulation, architectural distortion, and new traction bronchiectasis—he still does not have honeycombing. Honeycombing is a required feature for classifying a scan as typical UIP according to ATS/Fleischner 2018 guidelines. Without it, the pattern cannot be upgraded beyond “probable UIP.” Therefore, calling this pattern typical UIP is incorrect.
Incorrect. Try Again.
You must answer the question correctly to get to the next page.
Incorrect, Please try again.
Although this patient shows concerning progression, initiating antifibrotic therapy without a multidisciplinary evaluation would skip a critical diagnostic step. Antifibrotics are not started based solely on a probable UIP pattern; treatment decisions depend on confirming the diagnosis, assessing alternative causes, and aligning management across pulmonology, radiology, and sometimes pathology. A comprehensive MDD ensures accuracy before committing the patient to long-term therapy. Starting treatment empirically at this stage would be premature, making this answer incorrect.
Incorrect, Please try again
Moderate risk would apply to a patient with mild radiographic progression or stable lung function, but that is not the case here. This patient shows multiple high-risk markers, including new traction bronchiectasis, more pronounced architectural distortion, and a substantial one-year decline in both FVC and DLCO. These changes exceed what would be expected in a moderate-risk category. For that reason, calling him moderate risk underestimates the seriousness of his progression.
Incorrect. Try Again.
This option suggests advanced fibrosis, specifically a usual interstitial pneumonia (UIP) pattern. However, the CT report clearly states that there is no honeycombing and no lung distortion. The findings described — subpleural ground-glass changes and reticulation without traction bronchiectasis or honeycombing — are far earlier in the disease spectrum and more consistent with possible interstitial lung abnormality, not advanced fibrotic ILD. Because honeycombing is not present, this option is incorrect.
Incorrect, Please try again.
Labeling this patient as low risk would significantly underestimate the severity of the changes seen on follow-up. Although he remains asymptomatic, symptoms are not required to define risk. What matters here is the clear progression of fibrosis on CT—traction bronchiectasis and increasing architectural distortion—along with measurable declines in both FVC and DLCO. These features are not compatible with a “stable” or “non-progressive” process, so classifying him as low risk is incorrect.
Incorrect. Try Again.
This option doesn’t match the CT findings described. Centrilobular nodules and upper-lobe–predominant disease are more typical of smoking-related bronchiolitis or hypersensitivity pneumonitis, not interstitial lung abnormality. The patient’s scan shows ground-glass opacities and reticulation in the subpleural and basilar regions, and there is no traction bronchiectasis. Because none of the features listed in this option are present, this is not the correct answer.
Incorrect, Please try again.
This option overcalls fibrosis. While the CT scan does show subpleural reticulation and ground-glass opacities, there is no evidence of traction bronchiectasis, honeycombing, or architectural distortion—the key features required to label an ILA as fibrotic. Reticulation alone is not enough to classify fibrosis. Because the radiographic findings lack these hallmark fibrotic features, this cannot be categorized as subpleural fibrotic ILA.