skip to main content

Idiopathic pulmonary fibrosis — ABIM Board MCQ

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

HardPulmonary/Critical CareIdiopathic pulmonary fibrosisABIM Board

A 72-year-old man has progressive exertional dyspnea, bibasilar crackles, restrictive physiology, and reduced DLCO. Exposure and medication histories are unrevealing; connective-tissue-disease evaluation is negative. High-resolution CT shows basal subpleural honeycombing with traction bronchiectasis and no feature suggesting an alternative diagnosis. Multidisciplinary review agrees that the pattern is definite usual interstitial pneumonia. What is the best next diagnostic step?

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

Reveal the answer and explanation

Correct answer: A — Establish idiopathic pulmonary fibrosis clinically without surgical lung biopsy

The best answer is “Establish idiopathic pulmonary fibrosis clinically without surgical lung biopsy”. In an older adult with unexplained fibrotic interstitial lung disease and a definite UIP pattern, exclusion of secondary causes plus multidisciplinary review is sufficient for IPF. Surgical or transbronchial biopsy adds procedural harm without necessary diagnostic yield. Lavage is not routinely required for a definite UIP pattern unless the clinical context suggests another disease.

Reference: ATS/ERS/JRS/ALAT Clinical Practice Guideline: Diagnosis of Idiopathic Pulmonary Fibrosis: https://www.thoracic.org/statements/resources/interstitial-lung-disease/diagnosis-IPF-full-length.pdf