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Idiopathic pulmonary fibrosis — RACP Adult Medicine MCQ

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HardRespiratoryIdiopathic pulmonary fibrosisRACP Adult Medicine

A 68-year-old former builder has 18 months of exertional dyspnoea and dry cough. Examination reveals fine end-inspiratory basal crackles and finger clubbing. Spirometry shows restriction, DLCO is 39% predicted, and HRCT shows basal subpleural reticulation with honeycombing and traction bronchiectasis. What is the most likely diagnosis?

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Correct answer: C — Idiopathic pulmonary fibrosis

The age, Velcro crackles, restrictive physiology and usual interstitial pneumonia pattern on HRCT support idiopathic pulmonary fibrosis. Sarcoidosis more often has nodal disease and upper-lobe predominance. Eosinophilic pneumonia, organising pneumonia and acute hypersensitivity pneumonitis have different imaging and clinical patterns.

Reference: TSANZ interstitial lung disease guidance; AMH