USMLE Forum Archives - USMLE Step 2 CK - IM 7
IM 7
TheOne - 10-30-06 18:38
A 41-year-old man comes to the clinic complaining of a chronic cough over the past 4 months,
which has now been accompanied by hemoptysis. He denies smoking or any past medical
history. On physical examination, his head and neck examination is normal. His lungs have
diffuse bilateral rales. Cardiac examination is normal. Laboratory findings reveal a sodium of
142 mEq/L, a potassium of 4.3 mEq/L, a chloride of 110 mEq/L, a bicarbonate of 24 mEq/L, a
BUN of 39 mg/dL, and a creatinine of 2.9 mg/dL. Urinalysis reveals microscopic hematuria and
4+ proteinuria. Which of the following serologic blood tests would most help confirm the
suspected diagnosis?
A. Anti-glomerular basement membrane antibodies
B. Anti-mitochondrial antibodies
C. Anti-neutrophilic antibodies
D. Anti-parietal cell antibodies
E. Anti-smooth muscle antibodies
TheOne - 10-30-06 18:38
A 41-year-old man comes to the clinic complaining of a chronic cough over the past 4 months,
which has now been accompanied by hemoptysis. He denies smoking or any past medical
history. On physical examination, his head and neck examination is normal. His lungs have
diffuse bilateral rales. Cardiac examination is normal. Laboratory findings reveal a sodium of
142 mEq/L, a potassium of 4.3 mEq/L, a chloride of 110 mEq/L, a bicarbonate of 24 mEq/L, a
BUN of 39 mg/dL, and a creatinine of 2.9 mg/dL. Urinalysis reveals microscopic hematuria and
4+ proteinuria. Which of the following serologic blood tests would most help confirm the
suspected diagnosis?
A. Anti-glomerular basement membrane antibodies
B. Anti-mitochondrial antibodies
C. Anti-neutrophilic antibodies
D. Anti-parietal cell antibodies
E. Anti-smooth muscle antibodies
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#1
Re: IM 7 kingkong - 10-30-06 20:45 A CLEARCUT CASE OF GOODPASTURE SYNDROME.ANTI GLOMERULAR BASEMENT ANTIBODIES AGAINST THE KIDNEY AND LUNGS GIVING HEMATURIA AND HEMOPTYSIS.
#2
Yep
TheOne - 11-02-06 19:10 The correct answer is A. The combination of hematuria and hemoptysis should always
raise the possibility of Goodpasture syndrome. Anti-glomerular basement membrane
antibodies are pathognomonic for this diagnosis.
Anti-mitochondrial antibodies (choice B) are found in patients with primary biliary
cirrhosis.
The anti-neutrophilic cytoplasmic antibodies (choice C) are found in patients with
Wegener granulomatosis. Wegener granulomatosis may also present with pulmonary
and renal involvement but will have associated upper respiratory tract findings, e.g,
sinusitis and sinus abscesses.
Anti-parietal cell antibodies (choice D) are found in patients with the autoimmune
disease known as pernicious anemia.
Anti-smooth muscle antibodies (choice E) are found in patients with autoimmune
hepatitis.
#4
Re: IM 7 bingousmle - 07-19-10 08:54 Anti-glomerular basement membrane antibodies should be tested as he has a scenario of a typical goodpastures syndrome due to respiratory and renal involvement
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