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Interstitial lung disease acute exacerbation — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsInterstitial lung disease acute exacerbationSCE Acute Medicine

A 68-year-old man is assessed on the acute medical unit. He has idiopathic pulmonary fibrosis and rapidly worsening hypoxaemia over 5 days. CT shows new bilateral ground-glass change superimposed on established honeycombing without PE. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: E — Acute exacerbation of interstitial lung disease

Acute exacerbation of interstitial lung disease is the best answer because the acute deterioration with new bilateral ground-glass change on fibrotic lung after excluding alternatives supports acute ILD exacerbation. Non-invasive ventilation failure in COPD is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Acute ILD exacerbations have high mortality and need early specialist and ceiling-of-care discussion.

Reference: BTS ILD guidance