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EVALI — SCE Respiratory MCQ

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HardRare and miscellaneousEVALISCE Respiratory

A 25-year-old man develops acute dyspnoea, chest pain and bilateral infiltrates after vaping THC-containing products bought online. Infective work-up, HIV testing and autoimmune serology are negative; CT shows diffuse ground-glass opacities with subpleural sparing. BAL shows lipid-laden macrophages but cultures are negative. He improves after cessation and supportive care. What is the most likely diagnosis?

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Correct answer: D — E-cigarette or vaping-associated lung injury

The best answer is “E-cigarette or vaping-associated lung injury”. The clinical pattern, physiology and imaging described are most consistent with E-cigarette or vaping-associated lung injury. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Acute cardiogenic pulmonary oedema”, “Idiopathic pulmonary fibrosis, with clinical reassessment”, “Pulmonary embolism with infarction”, “Alpha-1 antitrypsin deficiency, after specialist assessment”—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