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OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is Goodpasture syndrome. While this may seem a odd practice, it is useful to see multiple examples of how Goodpasture syndrome will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for Goodpasture syndrome.
Chief Complaints:
- Shortness of breath: caused by alveolar hemorrhage.
- Hemoptysis: due to lung involvement
- Hematuria due to kidney involvement
Patient History:
- Recent respiratory illness: this will precede other symptoms and can be the trigger for this autoimmune condition.
Clinical Workup:
- Presence of pulmonary infiltrates on chest X-ray: caused by pulmonary hemorrhage.
- Increased carbon monoxide diffusion capacity (DLCO) on pulmonary function testing: the present of blood in the alveoli (due to alveolar hemorrhage) results in increased DLCO
- Glomerular crescents can be observed on light microscopy.
- Linear deposition of IgG in the glomeruli (immunoflorescence): this is a very classic buzzword to describe this condition.
QUESTION EXAMPLES
Question # 1
A 30 year old male comes to the clinic with a 3.5 week history of a cough and hemoptysis. These symptoms began after he was diagnosed with a upper respiratory tract infection. He denies having any fever, nigh sweats, and has not noticed any changes to his weight. Currently his blood pressure is 155/90 mm Hg, and his pulse is 85 bpm. A physical exam is notable for bilateral crackles and he also has edema on his lower extremities. Lab studies are conducted an reveal a creatinine of 4.5 mg/dL. Urine tests show the presence of proteinuria and also hematuria. A chest X-ray demonstrates the presence of bilateral pulmonary infiltrates. Pulmonary function testing reveals an increased carbon monoxide diffusion capacity (DLCO). What condition might this patient have?
Explanation # 1
Hemoptysis + hematuria + symptoms preceded by respiratory illness + increased DLCO = Goodpasture syndrome
Question # 2
A 25 year old male comes to the clinic because he has had a productive cough with bloody sputum for the past week. Currently his blood pressure is 165/100 mm Hg. A serum creatine concentration is 4. 1 mg/dL. Urine studies show the presence of red blood cell casts. A renal biopsy is performed and and immunofluoresnce microscopy shows the presence of linear deposits of IgG in the glomeruli. What is the likely diagnosis in this patient?
Explanation # 2
Hemoptysis + hematuria + linear deposition of IgG in glomeruli = Goodpasture syndrome
Question # 3
A 23 year old male presents with hemoptysis and hematuria that has been occurring for the past 2 months. Lab studies reveal that the patient is suffering from a hypothermic microcytic anemia. Ligh microscopy reveals the presence of glomerular crescents on a renal biopsy. What is the likely diagnosis in this patient?
Explanation # 3
Hemoptysis + hematuria + glomerular crescents = Goodpasture syndrome
Question # 4
A 27 year old male develops shortness of breath, hematuria, and beings to cough up blood. A bronchospy is performed and shows the presence of diffuse pulmonary hemorrhages in both the right and left lungs. A renal biopsy is perfumed and is notable for glomerular present formation and there is linear deposition of IgG and C3 in the glomerulus. What is the diagnosis in this patient?
Explanation # 4
Hemoptysis + hematuria + linear deposition of IgG in glomeruli = Goodpasture syndrome
TESTABLE FACTS ABOUT THIS CONDITION (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below::
Cause (autoimmune condition):
- Type II hypersensitivity reaction: collagen IV is specifically targeted (the alpha 3 chain to be more specific).
- Autoantibodies against glomerular basement membrane (GBM): explains renal involvement
- Autoantibodies against alveolar basement membrane: explains lung involvement
- Type of renal disease: this condition belongs to the category of a rapidly progressive glomerulonephritis
Histological findings:
- What will be seen on light microscopy: glomerular crescents (this is a RPGN disease after all)
- What is deposited in the glomerular basement membrane: linear IgG and C3 deposited
- What will be seen on electron microscopy: no deposits will be visible here.
Page Updated: 05.06.2017