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Interstitial lung disease — SCE Rheumatology MCQ

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ModerateMusculoskeletal investigationsInterstitial lung diseaseSCE Rheumatology

A 74-year-old woman has connective tissue disease with dry cough and progressive breathlessness. Examination shows bibasal crackles are present. Investigations show oxygen saturation falls on exertion. The consultant wants the next test most likely to confirm the suspected process or guide treatment. The result will change diagnosis, staging or immediate treatment. What is the most appropriate investigation?

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Correct answer: D — High-resolution CT chest

High-resolution CT chest is the best answer because high-resolution ct chest is the investigation most likely to resolve the immediate diagnostic or monitoring question in interstitial lung disease. ENA profile is a plausible distractor, but it does not account for the key discriminator in the stem. Complement and anti-dsDNA and Plain radiographs of hands would be more appropriate in a different clinical pattern or at another point in the pathway, while MRI scan is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

Reference: BSR hot swollen joint guideline; NICE NG100; EULAR imaging recommendations