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Pyloric stenosis — USMLE Step 2 CK MCQ

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HardPediatricsPyloric stenosisUSMLE Step 2 CK

A 67-year-old man has exertional dyspnea, bibasilar fine crackles, restrictive physiology and a high-resolution CT showing a definite usual interstitial pneumonia pattern. Autoimmune evaluation and exposure history are unrevealing. Oxygenation is preserved at rest. Which disease-modifying treatment should be discussed?

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Correct answer: E — Start either nintedanib or pirfenidone to slow functional decline

A definite UIP pattern in the appropriate clinical context supports idiopathic pulmonary fibrosis. Nintedanib and pirfenidone slow the decline in forced vital capacity and should be discussed even before resting hypoxemia appears. Prednisone-azathioprine regimens increase harm in IPF and do not reverse fibrosis. Warfarin and ambrisentan are not disease-modifying IPF treatments and may be harmful. Supplemental oxygen and transplant referral are added according to physiology and trajectory but do not replace timely antifibrotic discussion.

Reference: American Thoracic Society: Idiopathic pulmonary fibrosis pocket guide. https://www.thoracic.org/education-center/ild/pdf/ats-pocket-guide_2021_redesign_r2.pdf