Correct!
4. 1 and 3

His referring pulmonologist was not sure of the diagnosis and so the diagnosis is not firmly established. Therefore, beginning pirfenidone or nintedanib is premature. His CBC showed a hemoglobin of 17.8 g/dL and his white blood cell count was WBC 10 X 109 cell/liter with a normal differential. Rheumatoid factor was elevated at 506 IU/mL (normal <15 IU/mL). Serum cyclic citrullinated peptide (CCP) antibodies were normal at < 15.6 U.

Pulmonary function testing is shown in Figure 1.

Figure 1. Pulmonary function testing.

Thoracic CT scan is show in figure 2.

Figure 2. Representative axial images from thoracic CT scan in lung windows.

Which of the following are true? (Click on the correct answer to proceed to the third of five pages)

1. The history and physical and laboratory testing is compatible with advanced rheumatoid arthritis
2. The pulmonary function testing is compatible with advanced usual interstitial pneumonia (UIP)
3. The thoracic CT scan is not typical of usual interstitial pneumonitis (UIP)
4. 1 and 3
5. All of the above

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