skip to main content

Acute exacerbation of idiopathic pulmonary fibrosis — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardAcute Respiratory PresentationsAcute exacerbation of idiopathic pulmonary fibrosisSCE Acute Medicine

A 63-year-old man with known idiopathic pulmonary fibrosis presents with four days of worsening breathlessness and dry cough. He is afebrile, CRP is 18 mg/L, BNP is normal and CT pulmonary angiography shows no embolus but new bilateral ground-glass change superimposed on basal honeycombing. He has no sputum production and blood cultures are negative at 24 hours. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Acute exacerbation of idiopathic pulmonary fibrosis

New bilateral ground-glass opacities on a background of established usual interstitial pneumonia, without PE, cardiac failure or clear infection, support acute exacerbation of IPF. Pulmonary oedema is less likely with a normal BNP and absent volume overload. Lobar pneumonia would usually produce focal consolidation and stronger inflammatory features. This is a high-mortality presentation where early respiratory and palliative discussions are often needed.

Reference: BTS interstitial lung disease guideline, NICE CKS idiopathic pulmonary fibrosis