American Board of Internal Medicine (ABIM) Certification Practice Exam

Which condition is characterized by active inflammation leading to pulmonary issues in lupus patients?

1. Diffuse alveolar hemorrhage

2. Pneumonia

3. Interstitial lung disease

4. Pulmonary embolism

The correct answer is: Diffuse alveolar hemorrhage

Active inflammation in lupus patients can lead to diffuse alveolar hemorrhage, which is a serious complication characterized by the presence of blood in the alveoli of the lungs. This condition arises due to the systemic inflammatory processes associated with lupus, where immune-mediated damage can result in the breakdown of the vascular integrity within the lungs. The clinical presentation of diffuse alveolar hemorrhage includes symptoms like cough, hemoptysis (coughing up blood), decreased oxygen saturation, and respiratory distress, which can significantly impact pulmonary function. Diagnosis typically involves imaging studies such as chest X-rays or CT scans and may require bronchoscopy with lavage to confirm the presence of blood and rule out other causes of similar pulmonary symptoms. In contrast, pneumonia generally results from infectious agents rather than the autoimmune processes seen in lupus. Interstitial lung disease refers more broadly to lung disorders that cause inflammation and scarring of lung tissue but doesn't specifically point to the acute inflammatory changes seen in diffuse alveolar hemorrhage. Pulmonary embolism, while a critical concern, arises from obstructive processes (such as blood clots) rather than active inflammation linked to lupus. Therefore, diffuse alveolar hemorrhage best describes the pulmonary complications directly tied to the inflammatory nature of systemic lupus erythematos