Respiratory Investigation — Viva Defence

Opening statement (SASPOP, delivered aloud)

"Mrs Marsh is a 63-year-old never-smoker with 14 months of progressive exertional dyspnoea, dry cough, Velcro crackles and early clubbing — a presentation I would frame as suspected fibrotic interstitial lung disease until proven otherwise. My problems are: first, confirming and staging the physiological severity of what is likely a restrictive, gas-transfer-impaired lung disease; second, establishing the radiological and, if needed, histological pattern, because pattern determines treatment; third, hunting an underlying cause — connective tissue disease, drug or exposure-related; and fourth, doing all of this through the least invasive sequence that still answers each question. I would like to begin with full pulmonary function tests and an HRCT, then bring her to a multidisciplinary discussion before any tissue diagnosis is considered." [1]