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Acute pulmonary haemorrhage anti-GBM disease — SCE Acute Medicine MCQ

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ModerateAcute Respiratory PresentationsAcute pulmonary haemorrhage anti-GBM diseaseSCE Acute Medicine

A 45-year-old woman presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show haemoptysis, rapidly rising creatinine and anti-GBM positivity. What is the most likely diagnosis?

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Correct answer: E — Anti-GBM pulmonary-renal syndrome

The key discriminator is that haemoptysis, rapidly rising creatinine and anti-GBM positivity, which makes Anti-GBM pulmonary-renal syndrome the single best answer. Vasculitic pulmonary-renal syndrome is less appropriate because it does not address the dominant acute risk in the vignette; Bacterial meningitis would fit a different presentation or later stage of care. Decompensated cirrhosis and Aortic dissection are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-26-1