Rheumatology: microscopic 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: microscopic polyangiitis

Sample item

A 60-year-old man has rapidly progressive glomerulonephritis, pulmonary haemorrhage and mononeuritis multiplex. Serum p-ANCA with anti-myeloperoxidase antibodies is positive. Renal biopsy shows pauci-immune necrotising crescentic glomerulonephritis, with no granulomas, and he has no asthma or eosinophilia. What is the diagnosis?

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

The answer and the reasoning

A. Microscopic polyangiitis

Microscopic polyangiitis is a small-vessel ANCA vasculitis, usually MPO-ANCA positive, with pauci-immune glomerulonephritis and pulmonary capillaritis and no granulomas. Induction is with corticosteroids plus cyclophosphamide or rituximab.

Option by option

  • A. Microscopic polyangiitis (correct)

    Correct. MPO-ANCA, pauci-immune crescentic nephritis and no granulomas or asthma define microscopic polyangiitis.

  • B. Eosinophilic granulomatosis with polyangiitis

    Eosinophilic granulomatosis requires asthma and eosinophilia.

  • C. Granulomatosis with polyangiitis

    Granulomatosis with polyangiitis is usually PR3-ANCA positive with granulomatous upper airway disease.

  • D. Anti-glomerular basement membrane disease

    Anti-GBM disease shows linear IgG deposition on biopsy and anti-GBM antibodies, and ANCA is negative.

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 A, Microscopic polyangiitis. Microscopic polyangiitis is a small-vessel ANCA vasculitis, usually MPO-ANCA positive, with pauci-immune glomerulonephritis and pulmonary capillaritis and no granulomas.

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

Eosinophilic granulomatosis requires asthma and eosinophilia.

Why is "Granulomatosis with polyangiitis" not the answer?

Granulomatosis with polyangiitis is usually PR3-ANCA positive with granulomatous upper airway disease.

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

Anti-GBM disease shows linear IgG deposition on biopsy and anti-GBM antibodies, and ANCA is negative.

What concept does this question test?

It tests Rheumatology: microscopic polyangiitis in General Medicine. Induction is with corticosteroids plus cyclophosphamide or rituximab.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: microscopic 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.