Asbestosis — SCE Respiratory MCQ

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A 74-year-old retired shipyard worker has progressive dyspnoea. CT shows bilateral calcified pleural plaques and basal subpleural fibrosis with traction bronchiectasis. Spirometry is restrictive and TLCO is reduced. There is no honeycombing and no autoimmune feature. What is the most likely diagnosis?

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Correct answer: B — Asbestosis

The best answer is “Asbestosis”. The clinical pattern, physiology and imaging described are most consistent with Asbestosis. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Chronic hypersensitivity pneumonitis”, “Pleuroparenchymal fibroelastosis, within a respiratory pathway”, “Idiopathic pulmonary fibrosis”, “Silicosis, 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