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Acute exacerbation of IPF — SCE Respiratory MCQ

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HardInterstitial Lung DiseaseAcute exacerbation of IPFSCE Respiratory

A 67-year-old man with IPF deteriorates over 3 weeks with new hypoxaemia. HRCT shows new bilateral ground-glass opacities superimposed on established UIP, with no pulmonary embolism. CRP is low, cultures are negative and echocardiography shows no heart failure. What is the most likely diagnosis?

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Correct answer: D — Acute exacerbation of IPF

The best answer is “Acute exacerbation of IPF”. The clinical pattern, physiology and imaging described are most consistent with Acute exacerbation of IPF. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Cardiogenic pulmonary oedema”, “Chronic hypersensitivity pneumonitis”, “Pulmonary alveolar proteinosis”, “Drug-induced eosinophilic pneumonia”—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: NICE NG158 venous thromboembolic diseases: https://www.nice.org.uk/guidance/ng158/chapter/Recommendations