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50 year old Indian man who presents with gradually and steadily…

- - - - Raynaud phenomenon, persistent and inspiratory velcro crackles (heard in 80 percent of patients) that do not clear with cough or deep inspiration and persistent reticular or alveolar abnormalities on chest radiographs. Clubbing is present in 25 to 50 percent of patients with idiopathic pulmonary fibrosis. Amyloidosis, connective tissue diseases, neurofibromatosis, sarcoidosis, or tuberous sclerosis
      - history of connective tissue disease, inflammatory bowel disease, or malignancy. Smoking hx, family hx, Prior medication use and irradiation - over-the-counter medications, oily nose drops or petroleum products, and amino acid supplements. Dry cough, hemoptysis
  - - - triggers (eg, allergen, exercise, viral infection) and resolve with trigger avoidance or asthma medication is typical of asthma., Intermittent breathlessness; Pale, swollen membranes on examination of the nasal cavities with an otoscope and a cobblestone appearance to the posterior pharyngeal wall suggest associated allergic rhinitis; nasal polyps; prolonged expiration; Atopic dermatitis with typical lichenified plaques in a flexural distribution
        ●Wheeze (high-pitched whistling sound, usually upon exhalation)
        ●Cough (often worse at night)
        ●Shortness of breath or difficulty breathing
        Family hx, symptoms as a child
    - - chronic productive cough, chronic sputum production, progressive and persistent dyspnea that is exacerbated by respiratory infections, and exposure to risk factors (primarily smoking and occupational dust), may experience weight gain (due to activity limitations), weight loss (possibly due to dyspnea while eating)
      - barrel chest (common)
        hyper-resonance on percussion (common)
        distant breath sounds on auscultation (common)
        poor air movement on auscultation (common)
        wheezing on auscultation (common)
        coarse crackles (common)
        The use of "accessory" muscles, such as the neck muscles, during quiet breathing.
        Breathing through pursed lips.
        The inability to complete full sentences without stopping to take a breath.
        Bluish discoloration of the fingertips or nail beds (cyanosis).