skip to main content

Progressive pulmonary fibrosis — SCE Respiratory MCQ

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

HardInterstitial lung diseaseProgressive pulmonary fibrosisSCE Respiratory

A 63-year-old woman with fibrotic rheumatoid arthritis-associated ILD reports worsening breathlessness over nine months. FVC has fallen from 2.55 L to 2.21 L, TLCO from 46% to 38% predicted, and HRCT shows increased traction bronchiectasis without infection. She is receiving optimised immunomodulatory treatment and has no heart failure. The MDT confirms progressive pulmonary fibrosis. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: C — Discuss antifibrotic therapy with nintedanib

Physiological decline with radiological progression despite appropriate treatment is consistent with progressive pulmonary fibrosis, where nintedanib may slow FVC decline. Long-term high-dose steroid alone is not appropriate for fibrotic progression and has substantial toxicity. The modern exam point is that non-IPF fibrosing ILDs can share a progressive fibrotic phenotype.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/