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Acute Exacerbation of IPF — SCE Palliative Medicine MCQ

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HardNon-Malignant Palliative CareAcute Exacerbation of IPFSCE Palliative Medicine

A 60‑year‑old woman with advanced idiopathic pulmonary fibrosis develops an acute exacerbation — sudden worsening of breathlessness over days with new bilateral ground‑glass opacities on CT. What is the most accurate prognosis and management?

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Correct answer: C — Acute exacerbation of IPF carries very high mortality (often > 50 % within 3 months); current management relies on supportive care, cautious use of high‑dose corticosteroids despite limited evidence, and frank prognostic communication with patient and family

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as D · D = shown as E

Option E is correct. Acute exacerbations of IPF are associated with very high short‑term mortality—often exceeding 50 % within 3 months—and no effective therapy has been proven. Current management consists of excellent supportive care and cautious use of high‑dose corticosteroids, although evidence is weak and observational studies suggest potential harm; hence, frank prognostic discussion is essential. Distractors are implausible: lung transplantation (A) is not feasible acutely; antibiotics (B) have no proven benefit; exacerbations are well‑documented (C); survival is not excellent (D).

Reference: Brereton CJ & Jo HE, Acute exacerbations of idiopathic pulmonary fibrosis and the role of corticosteroids, Respirology Cortex, 2020; EXAFIP trial (EXAFIP): cyclophosphamide added to glucocorticoids increased 3‑month mortality, 2022. https://pubmed.ncbi.nlm.nih.gov/33447274/