Restrictive Lung Disease & Pneumoconiosis: Step 1 review notes and self-test
Notes for the Restrictive Lung Disease & Pneumoconiosis rapid review: the clue that separates each of its 4 confusion pairs, with timestamps and a self-test.
October 21, 2026
This video covers restrictive lung disease and pneumoconiosis through four confusion pairs. Watch the video, then use these notes to test yourself on the clue that separates each pair.
Idiopathic pulmonary fibrosis vs Hypersensitivity pneumonitis
You separate idiopathic pulmonary fibrosis by its idiopathic basilar subpleural honeycombing from hypersensitivity pneumonitis, which follows repeated inhaled antigen exposure and has bronchiolocentric small-airway clues. Fibrotic hypersensitivity pneumonitis can mimic idiopathic pulmonary fibrosis, so you must check for a repeatable exposure to birds, mold, farming, hot tubs, or occupational antigens.
Idiopathic pulmonary fibrosis vs Hypersensitivity pneumonitis IPF is idiopathic basilar subpleural honeycombing; hypersensitivity pneumonitis is exposure-linked immune ILD with bronchiolocentric small-airway clues. Open the comparison and video →Sarcoidosis vs Berylliosis / histoplasmosis
You identify sarcoidosis by compatible multisystem noncaseating granulomas after excluding beryllium exposure and fungal infection. Noncaseating granulomas are not automatically sarcoidosis because beryllium exposure or bird or bat droppings in endemic areas can point to another cause.
Sarcoidosis vs Berylliosis / histoplasmosis Sarcoidosis is a diagnosis of compatible multisystem granulomas after excluding beryllium exposure and fungal infection. Open the comparison and video →Upper-lobe pneumoconiosis vs Lower-lobe pneumoconiosis
You separate these pneumoconioses by location and associated findings. Silicosis, coal worker pneumoconiosis, and berylliosis affect the upper lobes, while asbestosis causes lower-lobe interstitial fibrosis with pleural plaques and ferruginous bodies. Dust exposure alone is not enough, so you must use the job, lobe, pleura, and node calcification.
Upper-lobe pneumoconiosis vs Lower-lobe pneumoconiosis Upper-lobe pneumoconioses: silicosis, coal workers, berylliosis; lower-lobe pneumoconiosis: asbestosis with calcified pleural plaques. Open the comparison and video →Asbestosis vs Malignant mesothelioma
You separate asbestosis from malignant mesothelioma by deciding whether the dominant process is interstitial fibrosis or a pleural tumor. Asbestosis causes lower-lobe interstitial fibrosis with pleural plaques and ferruginous bodies, while malignant mesothelioma causes pleural thickening or a mass encasing the lung with recurrent pleural effusion. Asbestos exposure and pleural findings can occur in both.
Asbestosis vs Malignant mesothelioma Asbestosis: interstitial fibrosis with calcified pleural plaques and ferruginous bodies; mesothelioma: pleural malignancy with hemorrhagic effusion. Open the comparison and video →Quick self-test
Name the diagnosis from the clue, then tap to check.
Older adult with progressive dry cough, exertional dyspnea, restrictive physiology, bibasilar crackles, and basilar subpleural honeycombing without an exposure trigger.
Idiopathic pulmonary fibrosis · Idiopathic pulmonary fibrosis vs Hypersensitivity pneumonitis
Multisystem noncaseating granulomatous disease with bilateral hilar lymphadenopathy, uveitis, erythema nodosum, hypercalcemia, and no better exposure or infectious cause.
Sarcoidosis · Sarcoidosis vs Berylliosis / histoplasmosis
Asbestos-related lower-lobe interstitial fibrosis with pleural plaques, restrictive physiology, and ferruginous asbestos bodies.
Asbestosis · Asbestosis vs Malignant mesothelioma
Immune lung disease after repeated inhaled antigen exposure, with symptoms tied to birds, mold, farming, hot tubs, or occupational antigens and CT small-airway clues.
Hypersensitivity pneumonitis · Idiopathic pulmonary fibrosis vs Hypersensitivity pneumonitis
Keep going
Every pair in this review has a free page in the library with a side-by-side comparison and a practice question. Work through the ones you missed in the self-test first.