Interstitial Lung Diseases and Occupational Disorders — WACS Viva & Clinical Scenarios (Respiratory Medicine)

Exam-style interstitial lung diseases and occupational disorders viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 64-year-old retired artisan presents with a 14-month history of insidious, progressive exertional breathlessness and an intractable non-productive cough. Physical examination reveals bilateral grade 3 digital clubbing and dry, velcro-like end-inspiratory crackles over the lower lung zones. Outline your structured diagnostic workup, discuss the high-resolution computed tomography (HRCT) criteria required to establish a Usual Interstitial Pneumonia (UIP) pattern, and formulate a long-term management strategy including specific antifibrotic agents and supportive care.
• SCENARIO 2: A 32-year-old woman presents with low-grade fever, bilateral ankle swelling with tender erythematous pretibial nodules, anterior uveitis, and a persistent dry cough. A plain chest radiograph reveals bilateral symmetrical hilar lymphadenopathy without parenchymal infiltration. Critically evaluate the differential diagnosis with particular emphasis on distinguishing pulmonary sarcoidosis from tuberculosis in endemic West African settings, outline the diagnostic confirmation pathway, and define the absolute indications for systemic pharmacological intervention.
• SCENARIO 3: A 48-year-old artisanal gold miner presents with worsening exertional dyspnoea, drenching night sweats, productive cough, and a 6 kg weight loss over two months. Chest radiography demonstrates bilateral upper lobe nodular opacities with hilar eggshell calcification and a new right upper zone cavitary lesion. Explain the pathophysiological mechanisms underlying silica-induced alveolar injury, detail the clinical evaluation for silicotuberculosis, and outline the therapeutic and occupational health management protocols.
• SCENARIO 4: A 42-year-old pigeon breeder presents with recurrent episodes of acute dyspnoea, chills, and dry cough occurring 4 to 8 hours following loft cleaning, which have now progressed to persistent exertional breathlessness. Detail the immunopathological mechanisms of hypersensitivity pneumonitis, describe the characteristic HRCT features differentiating acute from chronic/fibrotic disease, and discuss the primary management and preventive measures.
• SCENARIO 5: A 38-year-old woman with known systemic sclerosis (diffuse cutaneous subtype) complains of insidious onset of exercise intolerance and chest tightness. Physical examination reveals sclerodactyly, telangiectasias, and fine bibasilar crackles. Explain the screening algorithm for connective tissue disease-associated interstitial lung disease (CTD-ILD), compare the HRCT features of non-specific interstitial pneumonia (NSIP) versus UIP, and describe the evidence-based immunosuppressive treatment options.