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Idiopathic pulmonary fibrosis — SCE Respiratory MCQ

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HardInterstitial lung diseaseIdiopathic pulmonary fibrosisSCE Respiratory

A 72-year-old man has 18 months of progressive exertional breathlessness and dry cough. Examination reveals fine bibasal inspiratory crackles and finger clubbing. HRCT shows basal subpleural reticulation, traction bronchiectasis and honeycombing without marked ground-glass change. Autoimmune serology and exposure history are unrevealing. What is the most likely diagnosis?

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Correct answer: A — Idiopathic pulmonary fibrosis

The best answer is “Idiopathic pulmonary fibrosis”. The clinical pattern, physiology and imaging described are most consistent with Idiopathic pulmonary fibrosis. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Fibrotic hypersensitivity pneumonitis”, “Cryptogenic organising pneumonia”, “Pulmonary sarcoidosis, after safety review”, “Respiratory bronchiolitis-associated ILD”—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 guideline for pleural disease: https://thorax.bmj.com/content/78/Suppl_3/s1