Virology: BK polyomavirus: practice question

A Microbiology 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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Microbiology · Virology: BK polyomavirus

Sample item

Four months after kidney transplantation a patient has a rising serum creatinine. Urine cytology shows decoy cells, plasma BK virus PCR is high and biopsy shows tubular nuclear inclusions with interstitial inflammation. What is the best management?

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

The answer and the reasoning

A. Reduce the immunosuppression

BK polyomavirus is latent in the urinary tract and reactivates under heavy immunosuppression, causing polyomavirus-associated nephropathy and graft loss. It is separated from rejection by biopsy and viral load. Because no antiviral is proven, management is to lower immunosuppression, whereas steroids would worsen replication.

Option by option

  • A. Reduce the immunosuppression (correct)

    Correct. Lowering immunosuppression allows immune control of BK virus.

  • B. Give pulse methylprednisolone for acute rejection

    Pulse steroids treat rejection but would increase BK viral replication.

  • C. Start intravenous ganciclovir

    Ganciclovir acts on cytomegalovirus and is not effective against BK virus.

  • D. Start oral acyclovir

    Acyclovir acts on herpes simplex and varicella and not on polyomaviruses.

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 Microbiology question

What is the answer to this Microbiology question?

The best answer is A, Reduce the immunosuppression. BK polyomavirus is latent in the urinary tract and reactivates under heavy immunosuppression, causing polyomavirus-associated nephropathy and graft loss.

Why is "Give pulse methylprednisolone for acute rejection" not the answer?

Pulse steroids treat rejection but would increase BK viral replication.

Why is "Start intravenous ganciclovir" not the answer?

Ganciclovir acts on cytomegalovirus and is not effective against BK virus.

Why is "Start oral acyclovir" not the answer?

Acyclovir acts on herpes simplex and varicella and not on polyomaviruses.

What concept does this question test?

It tests Virology: BK polyomavirus in Microbiology. It is separated from rejection by biopsy and viral load. Because no antiviral is proven, management is to lower immunosuppression, whereas steroids would worsen replication.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Virology: BK polyomavirus?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology 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.