PR3-ANCA vasculitis — SCE Rheumatology MCQ

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ModerateMusculoskeletal InvestigationsPR3-ANCA vasculitisSCE Rheumatology

A 42-year-old woman has sinus disease, cavitating pulmonary nodules, glomerulonephritis, C-ANCA pattern and PR3 antibodies. What is the most appropriate investigation?

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Correct answer: D — Renal biopsy and ANCA specificity

Renal biopsy and ANCA specificity is the single best answer because PR3-ANCA with ENT, lung and renal disease supports GPA. The stem is testing investigation selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Synovial fluid microscopy, Gram stain and culture is less suitable because it fits a different clinical pattern or a different treatment threshold; MRI of the sacroiliac joints, High-resolution CT chest and Renal biopsy do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: BSR hot swollen joint guidance; EULAR imaging/autoantibody recommendations