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Idiopathic Pulmonary Fibrosis (IPF) — MRCP Part 1 MCQ

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HardRespiratory MedicineIdiopathic Pulmonary Fibrosis (IPF)MRCP Part 1UKMLA

A 72-year-old has progressive exertional dyspnoea, fine basal crackles and restrictive physiology. Autoimmune serology and a detailed occupational, environmental and drug history reveal no cause. HRCT shows basal subpleural reticulation, traction bronchiectasis and honeycombing with no features suggesting an alternative diagnosis. What is the most appropriate diagnostic approach?

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Correct answer: D — Reach ILD multidisciplinary consensus first, reserving lung biopsy for persisting diagnostic uncertainty

The best answer is “Reach ILD multidisciplinary consensus first, reserving lung biopsy for persisting diagnostic uncertainty”. The clinical context and HRCT describe a usual interstitial pneumonia pattern after exclusion of recognised causes. NICE requires IPF diagnosis by an interstitial-lung-disease multidisciplinary team integrating clinical, physiological and radiological information. Pathology is used when indicated, not as a mandatory step when the team can diagnose confidently. Surgical biopsy has meaningful morbidity in an older patient and is considered only when uncertainty justifies that risk.

Reference: NICE CG163, Idiopathic pulmonary fibrosis in adults: https://www.nice.org.uk/guidance/cg163/chapter/recommendations