skip to main content

Acute Exacerbation of IPF — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRespiratoryAcute Exacerbation of IPFRACP Adult Medicine

A 60-year-old man with known IPF (FVC 75% predicted) develops sudden worsening of dyspnoea over 3 weeks. His SpO₂ drops from 94% to 82% on room air. HRCT shows new bilateral ground-glass opacification superimposed on his UIP pattern. There is no evidence of infection or PE. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Acute exacerbation of IPF

An acute exacerbation of IPF is defined as acute worsening of dyspnoea (typically <30 days) with new bilateral ground-glass opacification on HRCT superimposed on the underlying UIP pattern, after excluding other causes (infection, PE, heart failure). It carries a very high mortality (>50% in-hospital). Treatment is high-dose corticosteroids (methylprednisolone 1 g/day for 3 days then oral prednisolone), though evidence of benefit is limited. Supportive care, oxygen therapy, and goals-of-care discussions are essential. It may be a trigger to reassess lung transplant eligibility.

Reference: eTG – 2025 – Respiratory; ATS/ERS/JRS/ALAT – 2022 – IPF Guidelines