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Idiopathic pulmonary fibrosis — SCE Respiratory MCQ

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HardILDIdiopathic pulmonary fibrosisSCE Respiratory

A 72-year-old ex-smoker has progressive exertional dyspnoea and dry cough. Examination reveals fine bibasal crackles and mild clubbing. HRCT shows basal subpleural reticulation, traction bronchiectasis and honeycombing without ground-glass predominance; FVC is 68% predicted and TLCO 42% predicted. What is the most likely diagnosis?

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Correct answer: A — Idiopathic pulmonary fibrosis

The age, progressive course, basal crackles and definite UIP pattern on HRCT make idiopathic pulmonary fibrosis the best diagnosis. Sarcoidosis is usually perilymphatic and upper-zone predominant, while hypersensitivity pneumonitis often has exposure history, air-trapping and centrilobular nodules. Organising pneumonia typically produces patchy consolidation rather than honeycombing.

Reference: ATS/ERS/JRS/ALAT IPF Guideline 2022; NICE NG163