Try it
General Medicine · Respiratory medicine: cryptogenic organising pneumonia
Sample itemA 55-year-old woman has had six weeks of dry cough and low-grade fever. CT shows patchy peripheral consolidations that have shifted site between scans, and two courses of antibiotics gave no benefit. Biopsy shows plugs of granulation tissue in the bronchioles and alveolar ducts with preserved lung architecture. What is the most appropriate treatment?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Oral prednisolone for several months
Cryptogenic organising pneumonia presents as a slowly resolving pneumonia that does not respond to antibiotics, with migratory consolidation on imaging and intraluminal granulation tissue plugs on biopsy. It responds well to corticosteroids, though relapse on tapering is common.
Option by option
A. Oral prednisolone for several months (correct)
Correct. Corticosteroids give a good response in organising pneumonia.
B. Referral for lung transplantation
Transplantation is for end-stage fibrotic disease, and this condition usually resolves with steroids.
C. Nintedanib
Nintedanib is an antifibrotic used in progressive fibrosing interstitial lung disease, and this condition is steroid responsive.
D. Prolonged four-drug antitubercular therapy
Antitubercular treatment is not indicated without evidence of mycobacterial infection.
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.
More General Medicine questions
- EndocrinologyA 19-year-old with type 1 diabetes presents with vomiting, deep rapid breathing, fruity…
- ElectrolytesWhich is the earliest ECG change in hyperkalaemia?
- Infectious diseaseWhat is the drug of choice for Pneumocystis jirovecii pneumonia in a patient with advanc…
- NeurologyA chronic alcohol user is brought in confused, with nystagmus and an unsteady gait. What…