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Diffuse alveolar haemorrhage from vasculitis — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsDiffuse alveolar haemorrhage from vasculitisSCE Acute Medicine

A 29-year-old man 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, falling haemoglobin, renal impairment and active urinary sediment. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — ANCA-associated pulmonary-renal vasculitis

The key discriminator is that haemoptysis, falling haemoglobin, renal impairment and active urinary sediment, which makes ANCA-associated pulmonary-renal vasculitis the single best answer. Anaphylaxis is less appropriate because it does not address the dominant acute risk in the vignette; Vasculitic pulmonary-renal syndrome would fit a different presentation or later stage of care. Septic shock and Diabetic ketoacidosis 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: BSR vasculitis guidance; KDIGO GN guideline