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ANCA vasculitis with glomerulonephritis — SCE Acute Medicine MCQ

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HardAcute Rheumatological and Dermatological EmergenciesANCA vasculitis with glomerulonephritisSCE Acute Medicine

A 82-year-old woman presents with rash, allergic features, visual symptoms or systemic inflammation. Relevant history includes recent drug exposure, autoimmune disease or allergen exposure. On assessment, skin, mucosal or vascular findings suggest systemic disease. Investigations show PR3-ANCA positivity with pulmonary-renal features and active urinary sediment. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Urgent nephrology and rheumatology referral for induction immunosuppression

The key discriminator is that PR3-ANCA positivity with pulmonary-renal features and active urinary sediment, which makes Urgent nephrology and rheumatology referral for induction immunosuppression the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent specialist referral would fit a different presentation or later stage of care. Give analgesia and antiemetic therapy and Arrange urgent CT imaging are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSR vasculitis guideline; KDIGO GN guideline