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Idiopathic pulmonary fibrosis — SCE Respiratory MCQ

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HardILDIdiopathic pulmonary fibrosisSCE Respiratory

A 72-year-old man has progressive exertional dyspnoea and dry cough. Bibasal crackles are present and oxygen saturation falls from 95% to 86% during a 6-minute walk. HRCT shows basal subpleural reticulation, traction bronchiectasis and honeycombing without significant ground-glass change. FVC is 71% predicted and TLCO 42% predicted. What is the most likely diagnosis?

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Correct answer: D — Idiopathic pulmonary fibrosis with a usual interstitial pneumonia pattern

The best answer is “Idiopathic pulmonary fibrosis with a usual interstitial pneumonia pattern”. The clinical pattern, physiology and imaging described are most consistent with Idiopathic pulmonary fibrosis with a usual interstitial pneumonia pattern. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Fibrotic hypersensitivity pneumonitis, after specialist assessment, after specialist assessment”, “Organising pneumonia, with clinical reassessment, with clinical reassessment”, “Sarcoidosis stage IV, after safety review, within a respiratory pathway”, “Respiratory bronchiolitis-associated ILD, after specialist assessment, after safety review”—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