ANCA-associated vasculitis — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateVasculitisANCA-associated vasculitisSCE Rheumatology

A 54-year-old man has chronic sinusitis, epistaxis, cough and haemoptysis. Urinalysis shows blood 3+ and protein 2+, and creatinine has risen to 188 micromol/L. PR3-ANCA is positive. Chest CT shows cavitating nodules. What is the most likely diagnosis?

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

Reveal the answer and explanation

Correct answer: D — Granulomatosis with polyangiitis

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

Granulomatosis with polyangiitis is best because ENT disease, cavitating lung nodules, glomerulonephritis and PR3-ANCA point to GPA. A is less suitable because Goodpasture disease causes lung-kidney syndrome but not chronic granulomatous ENT disease; B is less suitable because microscopic polyangiitis usually lacks granulomatous ENT disease and cavitating nodules; C is less suitable because EGPA would have asthma and eosinophilia; E is less suitable because sarcoidosis does not typically cause rapidly progressive glomerulonephritis with PR3-ANCA. Clinical pearl: ANCA pattern supports but does not replace clinical syndrome recognition.

Reference: BSR ANCA-associated vasculitis recommendations 2025; EULAR AAV recommendations 2022