American Board of Internal Medicine (ABIM) Certification Practice Exam

Which procedure is recommended to diagnose diffuse alveolar hemorrhage in a patient with systemic lupus erythematosus?

1. Bronchoscopy with bronchoalveolar lavage and biopsy

2. Thoracotomy

3. Chest ultrasound

4. Computed tomography scan of the chest

The correct answer is: Bronchoscopy with bronchoalveolar lavage and biopsy

Bronchoscopy with bronchoalveolar lavage and biopsy is the recommended procedure for diagnosing diffuse alveolar hemorrhage, especially in the context of a patient with systemic lupus erythematosus (SLE). This procedure allows for direct visualization of the airways and the collection of samples from the alveolar space. During bronchoalveolar lavage, a saline solution is instilled into the lungs and then retrieved along with any cellular material, which can be analyzed for evidence of bleeding and inflammation. In patients with SLE, there is an increased risk of pulmonary complications, including diffuse alveolar hemorrhage, due to the autoimmune nature of the disease affecting various organ systems. The characteristics of the fluid retrieved during bronchoalveolar lavage can provide crucial information about the underlying pathology, making it an important diagnostic tool. While other imaging techniques such as chest ultrasound or computed tomography scan of the chest are useful in evaluating lung pathology, they do not provide the same level of detail regarding alveolar involvement as bronchoscopy with bronchoalveolar lavage. Similarly, thoracotomy is an invasive surgical procedure that is typically reserved for more definitive interventions rather than initial diagnosis in cases of diffuse alveolar hemorrhage. Therefore, bronchoscopy with bronchoalveolar