Respiratory manifestations of systemic disease — structured oral (viva)

Branch 1 — The concern and first thought

Examiner: "What concerns you most about this girl, and what is your leading diagnosis?" Candidate: What concerns me most is progressive exertional breathlessness with a dry cough, fine bibasal crackles, and early clubbing in a child with juvenile dermatomyositis, because that combination points to interstitial lung disease rather than deconditioning. In juvenile dermatomyositis the lung can be affected out of proportion to the skin and muscle, so her currently mild rash and weakness do not reassure me. My leading diagnosis is connective tissue disease-associated interstitial lung disease, and I would treat this as a lung complication of her systemic disease. ^[1]