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Metalworking fluid hypersensitivity pneumonitis — SCE Respiratory MCQ

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HardOccupational Lung DiseaseMetalworking fluid hypersensitivity pneumonitisSCE Respiratory

A 44-year-old man working in a metalworking plant has recurrent Monday fever, cough and dyspnoea that improve away from work. HRCT shows centrilobular ground-glass nodules and mosaic attenuation. Spirometry shows restriction and TLCO is 55% predicted. What is the most likely diagnosis?

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Correct answer: A — Occupational hypersensitivity pneumonitis from metalworking fluid

The best answer is “Occupational hypersensitivity pneumonitis from metalworking fluid”. The clinical pattern, physiology and imaging described are most consistent with Occupational hypersensitivity pneumonitis from metalworking fluid. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Isocyanate occupational asthma, after specialist assessment”, “Asbestosis, with clinical reassessment”, “Coal workers' pneumoconiosis, within a respiratory pathway”, “Byssinosis, after safety review”—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