Rheumatology: polyarteritis nodosa: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Rheumatology: polyarteritis nodosa

Sample item

A 45-year-old man with chronic hepatitis B has fever, weight loss, livedo reticularis, hypertension, testicular pain and foot drop. ANCA is negative, and the chest radiograph is normal. Mesenteric angiography shows microaneurysms. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Polyarteritis nodosa

Polyarteritis nodosa is a necrotising vasculitis of medium-sized arteries, often associated with hepatitis B. It causes mononeuritis multiplex, renovascular hypertension, orchitis, livedo and gut ischaemia, spares the lungs and glomeruli, and is ANCA negative. Angiography shows microaneurysms and beading.

Option by option

  • A. Microscopic polyangiitis

    Microscopic polyangiitis is ANCA associated with glomerulonephritis and pulmonary haemorrhage.

  • B. Granulomatosis with polyangiitis

    Granulomatosis with polyangiitis involves the upper airways, lungs and kidneys and is usually PR3-ANCA positive.

  • C. Polyarteritis nodosa (correct)

    Correct. Medium-vessel disease with hepatitis B, microaneurysms and negative ANCA is classic.

  • D. Eosinophilic granulomatosis with polyangiitis

    Eosinophilic granulomatosis presents with asthma and eosinophilia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Polyarteritis nodosa. Polyarteritis nodosa is a necrotising vasculitis of medium-sized arteries, often associated with hepatitis B.

Why is "Microscopic polyangiitis" not the answer?

Microscopic polyangiitis is ANCA associated with glomerulonephritis and pulmonary haemorrhage.

Why is "Granulomatosis with polyangiitis" not the answer?

Granulomatosis with polyangiitis involves the upper airways, lungs and kidneys and is usually PR3-ANCA positive.

Why is "Eosinophilic granulomatosis with polyangiitis" not the answer?

Eosinophilic granulomatosis presents with asthma and eosinophilia.

What concept does this question test?

It tests Rheumatology: polyarteritis nodosa in General Medicine. It causes mononeuritis multiplex, renovascular hypertension, orchitis, livedo and gut ischaemia, spares the lungs and glomeruli, and is ANCA negative. Angiography shows microaneurysms and beading.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: polyarteritis nodosa?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.