Microscopic polyangiitis — SCE Rheumatology MCQ
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Correct answer: A — Renal biopsy to assess active and chronic lesions
Renal biopsy to assess active and chronic lesions is the single best answer because MPO-ANCA pulmonary renal disease without granulomatous ENT features suggests microscopic polyangiitis. The stem is testing investigation selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Migraine is less suitable because it fits a different clinical pattern or a different treatment threshold; Sarcoidosis, Aspirin monotherapy and Etanercept 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/EULAR vasculitis recommendations; NICE technology appraisals; BNF