Neuropathology: progressive multifocal leukoencephalopathy: practice question

A Pathology 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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Pathology · Neuropathology: progressive multifocal leukoencephalopathy

Sample item

A 35-year-old man with HIV and a CD4 count of 40 per microlitre has progressive hemiparesis and visual loss over several weeks. MRI shows non-enhancing white matter lesions without mass effect. Which histological finding is expected?

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

The answer and the reasoning

D. Demyelination with enlarged oligodendrocyte nuclei containing viral inclusions

Progressive multifocal leukoencephalopathy is caused by reactivation of JC polyomavirus, which infects oligodendrocytes. The loss of myelin gives multifocal white matter lesions without enhancement or mass effect. Enlarged oligodendrocyte nuclei with ground-glass inclusions and bizarre astrocytes are seen.

Option by option

  • A. Microglial nodules with multinucleated giant cells

    Microglial nodules with giant cells characterise HIV encephalitis, which causes dementia without focal white matter destruction.

  • B. Perivenular demyelination with preserved oligodendrocytes

    Perivenular demyelination with preserved oligodendrocytes suggests multiple sclerosis in immunocompetent individuals.

  • C. Necrotising abscess with tachyzoites at the margin

    Toxoplasma abscess causes ring-enhancing lesions with mass effect.

  • D. Demyelination with enlarged oligodendrocyte nuclei containing viral inclusions (correct)

    Correct. JC virus destroys oligodendrocytes, producing demyelination with viral inclusions.

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 Pathology question

What is the answer to this Pathology question?

The best answer is D, Demyelination with enlarged oligodendrocyte nuclei containing viral inclusions. Progressive multifocal leukoencephalopathy is caused by reactivation of JC polyomavirus, which infects oligodendrocytes.

Why is "Microglial nodules with multinucleated giant cells" not the answer?

Microglial nodules with giant cells characterise HIV encephalitis, which causes dementia without focal white matter destruction.

Why is "Perivenular demyelination with preserved oligodendrocytes" not the answer?

Perivenular demyelination with preserved oligodendrocytes suggests multiple sclerosis in immunocompetent individuals.

Why is "Necrotising abscess with tachyzoites at the margin" not the answer?

Toxoplasma abscess causes ring-enhancing lesions with mass effect.

What concept does this question test?

It tests Neuropathology: progressive multifocal leukoencephalopathy in Pathology. The loss of myelin gives multifocal white matter lesions without enhancement or mass effect. Enlarged oligodendrocyte nuclei with ground-glass inclusions and bizarre astrocytes are seen.

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 Neuropathology: progressive multifocal leukoencephalopathy?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.