Physical Exam

On the physical exam, the most remarkable finding is bibasilar crackles. The original reports estimate that 70-80% of patients with IPF will have crackles, but it is likely closer to 90% or 100%. If we don’t hear crackles, we will start to look for other processes. The difficulty with the crackles is differentiating those of lung disease from congestive heart failure. It is also important to look for signs of other processes, because it is imperative to ensure there are no signs of a connective tissue disorder, such as clubbing, cyanosis, or edema. This patient’s hands appear rough, calloused, and cracked, and the critical question is differentiating mechanic's hands related to the occupation from clinically derived mechanic’s hands resulting from polymyositis and dermatomyositis.