American Board of Internal Medicine (ABIM) Certification Practice Exam

In which patients is baseline and annual monitoring of pulmonary arterial hypertension recommended?

1. Patients with advanced interstitial lung disease

2. Patients with systemic sclerosis without advanced interstitial lung disease

3. Patients with rheumatoid arthritis

4. Patients with lupus nephritis

The correct answer is: Patients with systemic sclerosis without advanced interstitial lung disease

Monitoring for pulmonary arterial hypertension (PAH) is particularly crucial in patients with systemic sclerosis, even if they do not exhibit advanced interstitial lung disease. This condition, also known as scleroderma, is associated with an increased risk of PAH due to vascular changes and functional impairment related to the underlying disease. Regular baseline and annual evaluations are recommended because early detection of PAH can improve patient outcomes significantly. Symptoms of PAH can be insidious, and many patients may remain asymptomatic until the disease has progressed substantially. By implementing regular assessments, healthcare providers can identify PAH in its early stages, allowing for timely intervention and management which can help to mitigate complications associated with the condition. Other conditions mentioned, such as advanced interstitial lung disease, rheumatoid arthritis, and lupus nephritis, also carry a risk for pulmonary complications, but they do not uniformly necessitate the same degree of regular monitoring for PAH as seen in systemic sclerosis. This is primarily due to the specific pathophysiological mechanisms at play in systemic sclerosis that predispose these patients to develop PAH independently of their pulmonary status. Hence, the emphasis on annual monitoring is warranted primarily in the context of systemic sclerosis, making it the correct choice.