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Opioid prescribing safety — USMLE Step 3 MCQ

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HardEthics, Patient Safety, Quality Improvement, Systems-Based PracticeOpioid prescribing safetyUSMLE Step 3

A 31-year-old has hemoptysis, rapidly rising creatinine, red-cell casts, and diffuse alveolar opacities. Anti-GBM antibody is strongly positive, kidney biopsy shows crescentic glomerulonephritis, and there is no irreversible end-stage scarring. Which treatment is most appropriate?

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Correct answer: C — Use plasma exchange plus glucocorticoids plus cyclophosphamide for induction

The best answer is “Use plasma exchange plus glucocorticoids plus cyclophosphamide for induction”. Pulmonary hemorrhage with active anti-GBM glomerulonephritis requires rapid antibody removal, inflammation control, and prevention of new antibody production. Monotherapy and delayed exchange are inadequate; supportive dialysis does not treat the immune process. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: KDIGO, Glomerular Diseases Guideline: https://kdigo.org/guidelines/gd/