RA lung assessment — SCE Rheumatology MCQ

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HardRheumatoid arthritisRA lung assessmentSCE Rheumatology

A 60-year-old woman with seropositive RA develops dry cough after several years of active disease. Examination shows fine basal crackles are heard. Investigations show spirometry shows reduced transfer factor. What is the most appropriate investigation?

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Correct answer: C — High-resolution CT chest

The best answer is “High-resolution CT chest”. High-resolution CT chest most directly resolves the diagnostic or staging uncertainty at this point in the pathway; the other investigations answer different questions or have lower yield. The remaining choices—“Serum angiotensin-converting enzyme, after specialist assessment”, “Temporal artery ultrasound, with clinical reassessment”, “Plain hand radiographs, after safety review”, “DEXA scan, after specialist assessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG100 rheumatoid arthritis in adults: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations