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DLCO – bleomycin — RACP Paediatrics MCQ

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HardRespiratoryDLCO – bleomycinRACP Paediatrics

A 16-year-old previously treated with bleomycin develops exertional dyspnoea and dry cough. Oxygen saturation is normal at rest, spirometry is near baseline and chest radiography is unrevealing. Which physiological test is most sensitive for early pulmonary gas-transfer impairment?

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Correct answer: B — Diffusing capacity for carbon monoxide compared with baseline

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

D is correct. Bleomycin toxicity first impairs alveolar–capillary gas transfer, so serial DLCO is more sensitive than routine spirometry or plain radiography for early physiological change. A and B assess airflow obstruction. C may later show restriction but is less sensitive early. E functional capacity is nonspecific, and omitting oximetry further reduces sensitivity for gas-exchange impairment.

Reference: eviQ, Pulmonary toxicity associated with anti-cancer agents: https://www.eviq.org.au/clinical-resources/side-effect-and-toxicity-management/respiratory/1792-pulmonary-toxicity-associated-with-anti-cance