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Idiopathic pulmonary fibrosis — MCCQE Part 1 MCQ

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HardDyspneaIdiopathic pulmonary fibrosisMCCQE Part 1

A 55-year-old has progressive dyspnoea, restriction, reduced DLCO and basal reticular opacities. Exposure, medication and connective-tissue history are not yet complete. What is the best next diagnostic step?

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Correct answer: AObtain high-resolution chest CT and complete etiologic assessment

The physiology and radiograph suggest fibrotic interstitial lung disease, but idiopathic pulmonary fibrosis is a diagnosis made only after excluding known causes and characterizing the CT pattern. Canadian Thoracic Society guidance recommends high-resolution chest CT for suspected fibrotic ILD, integrated with exposure, medication, autoimmune and occupational assessment, ideally through multidisciplinary discussion. A confident usual-interstitial-pneumonia pattern may avoid biopsy in the appropriate context. Empiric steroids can harm some fibrotic diseases and should not precede diagnostic classification.

Reference: Canadian Thoracic Society, Evaluation of Patients with Fibrotic Interstitial Lung Disease, https://cts-sct.ca/wp-content/uploads/2018/02/Evaluation-of-pts-w_ILD-paper.pdf