#august2020mccqe1
A 23-year-old man presents with a 3-month history of cough with blood-tinged sputum, shortness of breath, and gross hematuria. His temperature is 37.5 C (99.5 F), blood pressure is 158/94 mm Hg, pulse is 87/min, and respirations are 22/min. Examination reveals bilateral crackles at the lung base and mild edema of the palpebrae and feet. A chest x-ray film shows scattered pulmonary infiltrates in a distribution different from that present on a film taken 2 months ago. Examination of the sputum shows hemosiderin-laden macrophages but no microorganisms. Laboratory investigations show modest iron-deficiency anemia and no evidence of ANCA-type antibodies. Urinalysis shows gross hematuria and modest proteinuria. A renal biopsy demonstrates the presence of glomerulonephritis with linear deposition of IgG and complement components along the glomerular basement membrane. Which of the following is the most likely diagnosis?
(A) Churg-Strauss syndrome
(B) Goodpasture syndrome
(C) Idiopathic pulmonary hemosiderosis
(D) Postinfectious glomerulonephritis
(E) Wegener granulomatosis
A 23-year-old man presents with a 3-month history of cough with blood-tinged sputum, shortness of breath, and gross hematuria. His temperature is 37.5 C (99.5 F), blood pressure is 158/94 mm Hg, pulse is 87/min, and respirations are 22/min. Examination reveals bilateral crackles at the lung base and mild edema of the palpebrae and feet. A chest x-ray film shows scattered pulmonary infiltrates in a distribution different from that present on a film taken 2 months ago. Examination of the sputum shows hemosiderin-laden macrophages but no microorganisms. Laboratory investigations show modest iron-deficiency anemia and no evidence of ANCA-type antibodies. Urinalysis shows gross hematuria and modest proteinuria. A renal biopsy demonstrates the presence of glomerulonephritis with linear deposition of IgG and complement components along the glomerular basement membrane. Which of the following is the most likely diagnosis?
(A) Churg-Strauss syndrome
(B) Goodpasture syndrome
(C) Idiopathic pulmonary hemosiderosis
(D) Postinfectious glomerulonephritis
(E) Wegener granulomatosis
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