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Diffuse alveolar haemorrhage — SCE Respiratory MCQ

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HardRespiratory physiologyDiffuse alveolar haemorrhageSCE Respiratory

A 32-year-old woman has recurrent haemoptysis and iron-deficiency anaemia. Spirometry is normal, chest radiograph shows fleeting bilateral alveolar opacities and TLCO is 138% predicted. Urinalysis shows microscopic haematuria and creatinine is mildly raised. She has no wheeze or atopy. What is the most likely underlying cause?

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Correct answer: E — Increased uptake of carbon monoxide by intra-alveolar haemoglobin

The best answer is “Increased uptake of carbon monoxide by intra-alveolar haemoglobin”. The clinical pattern, physiology and imaging described are most consistent with Increased uptake of carbon monoxide by intra-alveolar haemoglobin. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Reduced alveolar volume from restriction, with clinical reassessment”, “Emphysematous destruction of alveolar membrane, within a respiratory pathway”, “Poor inspiratory effort during testing, after safety review”, “Pulmonary vascular pruning from PAH, after specialist assessment”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: BTS/NICE/SIGN asthma guideline NG245: https://www.nice.org.uk/guidance/ng245/chapter/Recommendations