Respiratory medicine: idiopathic pulmonary fibrosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: idiopathic pulmonary fibrosis

Sample item

A 66-year-old man has had progressive exertional dyspnoea and dry cough for 8 months, with bibasal fine end-inspiratory crackles and finger clubbing. He has no relevant exposure or drug history. HRCT shows subpleural basal honeycombing with traction bronchiectasis, and spirometry is restrictive with a low DLCO. Which drug slows the decline in forced vital capacity?

AMethotrexateBLong-term oral prednisoloneCNintedanibDAzathioprine with prednisolone

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Nintedanib

This is idiopathic pulmonary fibrosis with a usual interstitial pneumonia pattern on HRCT. The antifibrotic agents nintedanib (a tyrosine kinase inhibitor) and pirfenidone slow the rate of FVC decline but do not reverse fibrosis. Immunosuppression is ineffective and the combination of prednisolone, azathioprine and N-acetylcysteine increased mortality in a trial.

Option by option

A. Methotrexate
Methotrexate has no proven benefit in IPF and can itself cause pneumonitis.
B. Long-term oral prednisolone
Corticosteroids do not alter the course of this non-inflammatory fibrosis and cause significant harm.
C. Nintedanib (correct)
Correct. Nintedanib targets fibroblast growth signalling and slows disease progression.
D. Azathioprine with prednisolone
Azathioprine with prednisolone increased deaths and hospitalisations in IPF.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Nintedanib. This is idiopathic pulmonary fibrosis with a usual interstitial pneumonia pattern on HRCT.

Why is "Methotrexate" not the answer?

Methotrexate has no proven benefit in IPF and can itself cause pneumonitis.

Why is "Long-term oral prednisolone" not the answer?

Corticosteroids do not alter the course of this non-inflammatory fibrosis and cause significant harm.

Why is "Azathioprine with prednisolone" not the answer?

Azathioprine with prednisolone increased deaths and hospitalisations in IPF.

What concept does this question test?

It tests Respiratory medicine: idiopathic pulmonary fibrosis in General Medicine. The antifibrotic agents nintedanib (a tyrosine kinase inhibitor) and pirfenidone slow the rate of FVC decline but do not reverse fibrosis. Immunosuppression is ineffective and the combination of prednisolone, azathioprine and N-acetylcysteine increased mortality in a trial.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: idiopathic pulmonary fibrosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.