Rheumatology: eosinophilic 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: eosinophilic granulomatosis with polyangiitis

Sample item

A 38-year-old man with adult-onset asthma and allergic rhinitis develops foot drop, transient pulmonary infiltrates and palpable purpura. Eosinophils are 18% of white cells, and p-ANCA is positive. What is the most likely diagnosis?

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

The answer and the reasoning

A. Eosinophilic granulomatosis with polyangiitis

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) follows a sequence of asthma and rhinosinusitis, then peripheral eosinophilia, then vasculitis with mononeuritis multiplex, purpura and infiltrates. MPO-ANCA is positive in about 40%. Treatment is with glucocorticoids, with cyclophosphamide or biologics for severe disease.

Option by option

  • A. Eosinophilic granulomatosis with polyangiitis (correct)

    Correct. Asthma, marked eosinophilia, neuropathy and ANCA define this condition.

  • B. Polyarteritis nodosa

    Polyarteritis nodosa spares the lungs and is not linked to asthma or eosinophilia.

  • C. Allergic bronchopulmonary aspergillosis

    ABPA causes asthma and eosinophilia but not systemic vasculitis or neuropathy.

  • D. Granulomatosis with polyangiitis

    GPA centres on destructive upper airway disease, cavitating nodules and glomerulonephritis, with PR3 positivity.

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 A, Eosinophilic granulomatosis with polyangiitis. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) follows a sequence of asthma and rhinosinusitis, then peripheral eosinophilia, then vasculitis with mononeuritis multiplex, purpura and infiltrates.

Why is "Polyarteritis nodosa" not the answer?

Polyarteritis nodosa spares the lungs and is not linked to asthma or eosinophilia.

Why is "Allergic bronchopulmonary aspergillosis" not the answer?

ABPA causes asthma and eosinophilia but not systemic vasculitis or neuropathy.

Why is "Granulomatosis with polyangiitis" not the answer?

GPA centres on destructive upper airway disease, cavitating nodules and glomerulonephritis, with PR3 positivity.

What concept does this question test?

It tests Rheumatology: eosinophilic granulomatosis with polyangiitis in General Medicine. MPO-ANCA is positive in about 40%. Treatment is with glucocorticoids, with cyclophosphamide or biologics for severe disease.

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: eosinophilic 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.