USMLE Q Bank Step 1 – 202

A 55 year-old man presents to his physician complaining of sinusitis, chest pain and productive cough for 2 weeks. His sputum is mixed with blood. He also has pain and swelling of hands and feet for 3 months. On examination, he has synovitis of proximal interphalangeal joints of both hands. His laboratory tests reveal anemia, elevated ESR, elevated creatinine and positive c-ANCA. Urinalysis shows red blood casts and proteinuria. Chest x-ray shows multiple nodules in both lungs.

What is the most likely diagnosis?

A- Acute glomerulonephritis

B- Miliary tuberculosis

C- Wegener granulomatosis

D- Rheumatoid arthritis

E- Systemic lupus erythematosus


This is a typical case of Wegener granulomatosis which is characterized by upper and lower respiratory and renal involvement. Positive c-ANCA confirms the diagnosis.

The correct answer is C

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