American Board of Internal Medicine (ABIM) Certification Practice Exam

What triad of symptoms is predictive of diffuse alveolar hemorrhage in systemic lupus erythematosus?

1. Fever, cough, and fatigue

2. Hypoxemia, pulmonary infiltrates, and decreasing hematocrit

3. Chest pain, hemoptysis, and wheezing

4. Joint pain, skin rash, and eye symptoms

The correct answer is: Hypoxemia, pulmonary infiltrates, and decreasing hematocrit

The triad of symptoms identified in option B—hypoxemia, pulmonary infiltrates, and decreasing hematocrit—is indicative of diffuse alveolar hemorrhage in patients with systemic lupus erythematosus (SLE). Hypoxemia refers to low levels of oxygen in the blood, which is a direct consequence of impaired oxygen exchange in the lungs due to alveolar damage and bleeding. Pulmonary infiltrates, often demonstrated by imaging studies, suggest the presence of fluid or blood within the alveoli, which is characteristic of alveolar hemorrhage. Decreasing hematocrit indicates a loss of red blood cells, often stemming from bleeding, which aligns with the pathophysiology of diffuse alveolar hemorrhage since the bleeding may lead to a decrease in overall blood volume and red blood cell concentration. This triad effectively captures the key physiological changes occurring during an episode of diffuse alveolar hemorrhage associated with SLE, making it a critical consideration for diagnosis and management in affected patients. Other symptom combinations listed in the other options do not specifically encapsulate this distinct clinical picture tied to alveolar hemorrhage in SLE.