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Silicosis — SCE Respiratory MCQ

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HardOccupational lung diseaseSilicosisSCE Respiratory

A 58-year-old man who cut engineered stone worktops presents with cough and dyspnoea. CT shows upper-lobe small nodules, progressive massive fibrosis and eggshell calcification of hilar nodes. Spirometry is restrictive and TLCO is reduced. He has a positive IGRA but no symptoms of active TB. What is the most likely diagnosis?

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Correct answer: D — Silicosis with increased mycobacterial risk

The best answer is “Silicosis with increased mycobacterial risk”. The clinical pattern, physiology and imaging described are most consistent with Silicosis with increased mycobacterial risk. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Berylliosis in the absence of granulomatous disease”, “Coal worker simple pneumoconiosis in the absence of complications”, “Asbestosis with pleural plaques, with clinical reassessment”, “Hypersensitivity pneumonitis from birds, within a respiratory pathway”—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