skip to main content

Acute exacerbation of interstitial lung disease — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardAcute Respiratory PresentationsAcute exacerbation of interstitial lung diseaseSCE Acute Medicine

A 76-year-old man with known idiopathic pulmonary fibrosis presents with three days of worsening dyspnoea. He is afebrile, has fine bibasal crackles and oxygen saturation is 84% on air. CTPA excludes pulmonary embolism but shows new bilateral ground-glass change superimposed on established honeycombing. Blood cultures are negative and BNP is not raised. What is the most likely diagnosis?

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

Reveal the answer and explanation

Correct answer: E — Acute exacerbation of idiopathic pulmonary fibrosis

New bilateral ground-glass opacification in a patient with IPF, after excluding infection, pulmonary embolism and heart failure, is most consistent with acute exacerbation of IPF. Cardiogenic oedema is less likely with non-raised BNP and absent fluid overload. Lobar pneumonia would usually have focal consolidation and systemic inflammatory features. The pearl is that acute IPF exacerbation carries high mortality and requires early respiratory and critical care discussion.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/#acute-medicine-order-71-1