C-ANCA Positive Pulmonary and Renal Symptoms! - USMLE Forums
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  #1  
Old 06-11-2012
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Question C-ANCA Positive Pulmonary and Renal Symptoms!

A 34-year-old woman is admitted with one week of hemoptysis, a low-grade fever, and a 15-pound weight loss over the last two months. There are no chills or night sweats. She uses trimethoprim/sulfamethoxazole (Bactrim) intermittently for recurrent respiratory tract infections. Currently, her temperature is 100 F with a heart rate of 92/min, a respiratory rate of 18/min, and a blood pressure of 138/82 mm Hg. Her chest has bronchial breath sounds on auscultation of the left upper lung field. Her BUN is 26 mg/dL, and creatinine is 2.0 mg/dL. The C-ANCA is positive. Chest x-ray shows a cavitary lesion in the left upper lobe. Her urinalysis shows 2+ proteinuria with 20-30 red cells/hpf, but no red cell casts.

What is the most specific diagnostic test?

(A) Bronchoalveolar lavage with transbronchial biopsy
(B) Open lung biopsy
(C) Renal biopsy
(D) 24-hour urine protein and creatinine clearance
(E) CT scan of the chest with needle biopsy
(F) Nasal biopsy
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  #2  
Old 06-11-2012
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-ans=C. this wegner granulomatosis.
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(E) CT scan of the chest with needle biopsy
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Quote:
Originally Posted by um aala View Post
-ans=C. this wegner granulomatosis.
Yes it is Wegner but the most specific test for Wegner is lung biopsy (MTB2-192).
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Quote:
Originally Posted by Novobiocin View Post
Yes it is Wegner but the most specific test for Wegner is lung biopsy (MTB2-192).
the most specific test is lung and renal biopsy,but renal biopsy is easyer than lung biopsy ,medscape say:if theris plumonery-renal syndrom;renal biopsy is most useful and more optinable.
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Originally Posted by um aala View Post
the most specific test is lung and renal biopsy,but renal biopsy is easyer than lung biopsy ,medscape say:if theris plumonery-renal syndrom;renal biopsy is most useful and more optinable.
yes but MTB 2 says if lung biopsy is in the choices pick lung biopsy over renal biopsy.
Also, if renal biopsy was the right option then they would not have given three options of doing lung biopsy (usually in a question if they give many ways of doing the same thing, one of those is the correct answer).
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Old 06-12-2012
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Default qbank says

This patient has a combination of renal and lung disease and a positive CANCA
test -- all consistent with a diagnosis of Wegener's granulomatosis.
The most accurate diagnostic test for Wegener's is an open lung biopsy.
Nasal biopsy may be sufficient to confirm the diagnosis, but it may not
show a vasculitis. Open lung biopsy is more specifically diagnostic than is
a nasal biopsy, renal biopsy, or transthoracic biopsy. Bronchoalveolar
lavage with transbronchial biopsy is more effective in diagnosing infection.
In the majority of the cases, it can miss the vasculitis. Renal biopsy is not
as sensitive or specific as open lung biopsy.
The 24-hour urine cannot
determine the precise cause of what is found, even if the test is markedly
abnormal.
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Old 06-12-2012
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so answer is B ?
__________________
I'm Predictable In The Unpredictable Future !
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Quote:
Originally Posted by dryogi View Post
so answer is B ?
Yup...........
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Quote:
Originally Posted by Novobiocin View Post
Yup...........
-so ican't trust medscape any more?!...irealy love it
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Internal-Medicine-, Nephrology-, Pulmonology-, Step-2-Questions

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