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Coal worker pneumoconiosis — SCE Respiratory MCQ

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HardOccupational lung diseaseCoal worker pneumoconiosisSCE Respiratory

A 63-year-old retired miner has progressive dyspnoea and chronic cough. Chest radiograph shows upper-zone small rounded opacities and large bilateral upper-lobe masses with background emphysema. TB cultures are negative and there is no asbestos exposure. Spirometry shows mixed obstruction and restriction. What is the most likely diagnosis?

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Correct answer: D — Progressive massive fibrosis from coal worker pneumoconiosis

The best answer is “Progressive massive fibrosis from coal worker pneumoconiosis”. The clinical pattern, physiology and imaging described are most consistent with Progressive massive fibrosis from coal worker pneumoconiosis. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Idiopathic pulmonary fibrosis, with clinical reassessment”, “Pulmonary alveolar proteinosis, after safety review”, “Sarcoidosis with Löfgren syndrome”, “Acute eosinophilic pneumonia, with clinical reassessment”—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: Health and Safety Executive: silicosis: https://www.hse.gov.uk/lung-disease/silicosis.htm