MCQs: Lymphocytic Interstitial Pneumonia (LIP)
1. What is the most common autoimmune disease associated with lymphocytic interstitial pneumonia (LIP)?
A. Systemic lupus erythematosus (SLE)
B. Sjögren syndrome
C. Rheumatoid arthritis
D. Hashimoto thyroiditis
Answer: B. Sjögren syndrome
Comment: LIP is most frequently associated with Sjögren syndrome, a condition characterized by lymphocytic infiltration of exocrine glands and other tissues.
?LIP is strongly linked to Sjögren syndrome, presenting with diffuse lymphoid proliferation in the lung interstitium.?
Reference: Radiopaedia: Lymphocytic Interstitial Pneumonia
2. Which imaging finding is most characteristic of LIP on high-resolution CT (HRCT)?
A. Centrilobular nodules and tree-in-bud pattern
B. Diffuse ground-glass opacities with thin-walled cysts
C. Subpleural honeycombing and traction bronchiectasis
D. Random nodules with pleural thickening
Answer: B. Diffuse ground-glass opacities with thin-walled cysts
Comment: The hallmark of LIP on HRCT includes diffuse ground-glass opacities, reticulonodular patterns, and the presence of thin-walled cysts.
?CT imaging of LIP typically shows ground-glass opacities with scattered thin-walled cysts, often distributed perilymphatically.?
Reference: Radiographics: Lymphoid Disorders
3. Which immunodeficiency syndrome is most commonly associated with LIP?
A. Severe combined immunodeficiency (SCID)
B. Common variable immunodeficiency (CVID)
C. DiGeorge syndrome
D. IgA deficiency
Answer: B. Common variable immunodeficiency (CVID)
Comment: CVID is a primary immunodeficiency frequently associated with LIP due to chronic antigenic stimulation and lymphoid hyperplasia.
?LIP is frequently observed in patients with common variable immunodeficiency, presenting as diffuse interstitial lymphoid proliferation.?
Reference: PubMed: CVID and Pulmonary Manifestations
4. What histologic feature is diagnostic of LIP?
A. Caseating granulomas
B. Interstitial lymphocytic infiltration with germinal centers
C. Eosinophilic infiltration of alveoli
D. Necrotizing vasculitis
Answer: B. Interstitial lymphocytic infiltration with germinal centers
Comment: Histology of LIP shows dense lymphocytic infiltration of alveolar septa, often with lymphoid aggregates and germinal centers.
?LIP is characterized by diffuse lymphocytic infiltration of alveolar septa and the presence of lymphoid follicles with germinal centers.?
Reference: Radiopaedia: Lymphocytic Interstitial Pneumonia
5. What is the most common complication of untreated LIP?
A. Progression to pulmonary fibrosis
B. Pneumothorax due to cyst rupture
C. Pulmonary embolism
D. Transformation to lymphoma
Answer: D. Transformation to lymphoma
Comment: Untreated LIP, particularly in immunodeficient or autoimmune patients, carries a risk of progression to lymphoma, often MALT lymphoma.
?LIP is associated with an increased risk of transformation to lymphoma, particularly in patients with Sjögren syndrome or immunodeficiency.?
Reference: Radiographics: Lymphoid Disorders
6. Which of the following is a distinguishing feature of LIP compared to other interstitial lung diseases?
A. Presence of thin-walled cysts on imaging
B. Subpleural honeycombing
C. Severe traction bronchiectasis
D. Centrilobular nodules
Answer: A. Presence of thin-walled cysts on imaging
Comment: Thin-walled cysts are a key feature of LIP, resulting from lymphoid hyperplasia and bronchiolar obstruction.
?The presence of thin-walled cysts, along with diffuse ground-glass opacities, is highly characteristic of LIP.?
Reference: Radiopaedia: Lymphocytic Interstitial Pneumonia
7. Which pulmonary function test (PFT) abnormality is most commonly seen in LIP?
A. Obstructive pattern with decreased FEV1/FVC ratio
B. Restrictive pattern with reduced lung volumes
C. Mixed obstructive and restrictive pattern
D. Normal PFTs
Answer: B. Restrictive pattern with reduced lung volumes
Comment: LIP typically presents with a restrictive ventilatory defect due to interstitial involvement.
?Pulmonary function tests in LIP often reveal a restrictive pattern with reduced total lung capacity and diffusion capacity.?
Reference: Radiopaedia: Lymphocytic Interstitial Pneumonia
8. Which virus is strongly associated with pediatric cases of LIP?
A. Epstein?Barr virus (EBV)
B. Human immunodeficiency virus (HIV)
C. Cytomegalovirus (CMV)
D. Hepatitis B virus (HBV)
Answer: B. Human immunodeficiency virus (HIV)
Comment: Pediatric LIP is strongly associated with HIV infection, often presenting with lymphoid proliferation in the lungs.
?LIP is a common pulmonary manifestation in children with HIV, reflecting chronic lymphoid proliferation in response to antigenic stimulation.?
Reference: PubMed: HIV and Lymphocytic Interstitial Pneumonia
9. Which treatment is most commonly used for LIP in autoimmune diseases?
A. Antifungal therapy
B. Corticosteroids
C. Chemotherapy
D. Antiviral agents
Answer: B. Corticosteroids
Comment: Corticosteroids are the mainstay of treatment for LIP associated with autoimmune diseases to reduce inflammation and lymphoid proliferation.
?Treatment of LIP typically involves corticosteroids, particularly in cases linked to autoimmune conditions like Sjögren syndrome.?
Reference: Radiopaedia: Lymphocytic Interstitial Pneumonia
10. Which autoimmune disease is least likely to be associated with LIP?
A. Sjögren syndrome
B. Systemic lupus erythematosus (SLE)
C. Rheumatoid arthritis
D. Hashimoto thyroiditis
Answer: D. Hashimoto thyroiditis
Comment: While LIP is strongly associated with Sjögren syndrome, SLE, and RA, it is rarely linked to Hashimoto thyroiditis.
?LIP is most frequently associated with Sjögren syndrome and other autoimmune diseases, though connections to Hashimoto thyroiditis are rare.?
Reference: Radiographics: Lymphoid Disorders