Rheumatology: granulomatosis with polyangiitis: 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: granulomatosis with polyangiitis

Sample item

A 40-year-old man has chronic sinusitis with bloody nasal discharge, a saddle-nose deformity, cavitating lung nodules and rapidly progressive glomerulonephritis. Which antibody is most likely to be positive?

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

The answer and the reasoning

B. Cytoplasmic ANCA directed against proteinase 3

Granulomatosis with polyangiitis causes necrotising granulomatous inflammation of the upper and lower respiratory tract with pauci-immune glomerulonephritis. C-ANCA against proteinase 3 is present in most generalised cases. Induction uses glucocorticoids with rituximab or cyclophosphamide.

Option by option

  • A. Perinuclear ANCA directed against myeloperoxidase

    MPO-ANCA is more typical of microscopic polyangiitis and eosinophilic granulomatosis.

  • B. Cytoplasmic ANCA directed against proteinase 3 (correct)

    Correct. PR3-ANCA with the c-ANCA pattern is most frequent in this disease.

  • C. Anti-glomerular basement membrane antibody

    Anti-GBM disease causes pulmonary-renal syndrome but not nasal destruction or cavitating nodules.

  • D. Anti-centromere antibody

    Anti-centromere antibodies are found in limited systemic sclerosis.

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.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Cytoplasmic ANCA directed against proteinase 3. Granulomatosis with polyangiitis causes necrotising granulomatous inflammation of the upper and lower respiratory tract with pauci-immune glomerulonephritis.

Why is "Perinuclear ANCA directed against myeloperoxidase" not the answer?

MPO-ANCA is more typical of microscopic polyangiitis and eosinophilic granulomatosis.

Why is "Anti-glomerular basement membrane antibody" not the answer?

Anti-GBM disease causes pulmonary-renal syndrome but not nasal destruction or cavitating nodules.

Why is "Anti-centromere antibody" not the answer?

Anti-centromere antibodies are found in limited systemic sclerosis.

What concept does this question test?

It tests Rheumatology: granulomatosis with polyangiitis in General Medicine. C-ANCA against proteinase 3 is present in most generalised cases. Induction uses glucocorticoids with rituximab or cyclophosphamide.

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: granulomatosis with polyangiitis?

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.