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Silicosis — SCE Respiratory MCQ

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HardILDSilicosisSCE Respiratory

A 57-year-old man who sandblasted stone for 20 years has dyspnoea and weight loss. CXR shows upper-zone nodules with eggshell calcification of hilar nodes; CT shows coalescent upper-lobe masses. Sputum AFB smear is negative. What is the most likely diagnosis?

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Correct answer: A — Progressive massive fibrosis due to silicosis

The best answer is “Progressive massive fibrosis due to silicosis”. The clinical pattern, physiology and imaging described are most consistent with Progressive massive fibrosis due to silicosis. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Sarcoidosis with fibrotic stage IV disease”, “Metastatic lung cancer, after safety review”, “Chronic hypersensitivity pneumonitis, after specialist assessment”, “Asbestosis, with clinical reassessment”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society pulmonary nodule guideline: https://thorax.bmj.com/content/70/Suppl_2/ii1