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Relapsing polychondritis — SCE Rheumatology MCQ

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HardPregnancy and Rare Rheumatic DiseaseRelapsing polychondritisSCE Rheumatology

A patient with relapsing polychondritis has hoarseness, expiratory wheeze and an inspiratory CT showing only mild anterior tracheal thickening. Flow-volume loops suggest variable intrathoracic obstruction. Which next investigation best evaluates occult tracheobronchomalacia?

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

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Correct answer: A — Use dynamic expiratory cervicothoracic CT with respiratory–ENT assessment

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

A is correct. Dynamic expiratory CT can reveal airway collapse missed on routine inspiratory imaging and should cover the cervical trachea and thorax. Airway-specialist input is urgent because instrumentation and anaesthesia can precipitate obstruction. B lacks dynamic anatomical assessment. C places a potentially hazardous invasive test before safer mapping. D shows inflammation but not dynamic collapse. E evaluates the wrong cartilage.

Reference: Relapsing polychondritis: state of the art on clinical practice guidelines: https://pmc.ncbi.nlm.nih.gov/articles/PMC6203097/