Gastroenterology: Whipple disease: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology: Whipple disease

Sample item

A 50-year-old man has had seronegative arthralgia for years and now has weight loss, diarrhoea with steatorrhoea and low-grade fever. Duodenal biopsy shows lamina propria macrophages packed with PAS-positive, diastase-resistant granules; Ziehl-Neelsen stain is negative. Which organism is responsible?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Tropheryma whipplei

Whipple disease is a multisystem infection by Tropheryma whipplei, an actinobacterium, causing arthropathy, malabsorption, weight loss and sometimes neurological disease. Biopsy shows foamy PAS-positive macrophages, and treatment is ceftriaxone followed by prolonged cotrimoxazole. M. avium shows similar macrophages but they are acid-fast positive and occur in advanced HIV.

Option by option

  • A. Giardia lamblia

    Giardia is a protozoan seen on the mucosal surface and in stool, not within macrophages.

  • B. Cryptosporidium parvum

    Cryptosporidium organisms sit on the surface of enterocytes and cause self-limiting diarrhoea mainly in immunocompromised patients.

  • C. Tropheryma whipplei (correct)

    Correct. T. whipplei accounts for PAS-positive, acid-fast-negative macrophages with arthralgia and malabsorption.

  • D. Mycobacterium avium complex

    M. avium complex gives acid-fast-positive macrophages and typically occurs in advanced HIV infection.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Tropheryma whipplei. Whipple disease is a multisystem infection by Tropheryma whipplei, an actinobacterium, causing arthropathy, malabsorption, weight loss and sometimes neurological disease.

Why is "Giardia lamblia" not the answer?

Giardia is a protozoan seen on the mucosal surface and in stool, not within macrophages.

Why is "Cryptosporidium parvum" not the answer?

Cryptosporidium organisms sit on the surface of enterocytes and cause self-limiting diarrhoea mainly in immunocompromised patients.

Why is "Mycobacterium avium complex" not the answer?

M. avium complex gives acid-fast-positive macrophages and typically occurs in advanced HIV infection.

What concept does this question test?

It tests Gastroenterology: Whipple disease in General Medicine. Biopsy shows foamy PAS-positive macrophages, and treatment is ceftriaxone followed by prolonged cotrimoxazole. M. avium shows similar macrophages but they are acid-fast positive and occur in advanced HIV.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology: Whipple disease?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.