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NBME 16 Answers

nbme16/Block 1/Question#14 (reveal difficulty score)
A 30-year-old man develops hemoptysis, ...
Autoantibodies against host basement cell membrane ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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submitted by โˆ—cassdawg(1778)

This is goodpasture syndrome which has antibodies directed against alveolar and glomerular basement membranes (FA2020 p596)

The key hints are:

  • Lung involvement
  • Crescent formation (indicating rapidly progressive "crescentic" glomerulonephritis)
  • "Linear" deposits of IgG and C3 - this is characteristic of Goodpasture because the antibodies are to the glomerular basement membrane so they deposit all along the glomerulus basement membrane leading to linear immunofluorescence.
  • Remember that the other main lung/kidney combination, granulomatosis with polyangiitis, is Pauci immune with no immunofluorescence and they will usually mention ANCA
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sexymexican888  Microscopic polyangitis also presents with lung/kidney problems except theres no nasopharyngeal involvement and also churg strauss but that presents w asthma and both are P-ANCA positive vs C-ANCA for granulomatosis for polyangitis (weCner's granulomatosis) +1

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