Amyloidosis: reactive systemic amyloid: 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 · Amyloidosis: reactive systemic amyloid

Sample item

A 50-year-old man with long-standing bronchiectasis develops nephrotic-range proteinuria and hepatosplenomegaly. A rectal biopsy shows Congo red-positive deposits with apple-green birefringence. What is the precursor protein of this amyloid?

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

The answer and the reasoning

A. Serum amyloid A

Chronic inflammation drives hepatic synthesis of serum amyloid A, an acute phase protein, and proteolytic fragments form AA amyloid. It is the usual amyloid after long-standing infections such as bronchiectasis, chronic osteomyelitis and tuberculosis, and in rheumatoid arthritis, and it commonly affects kidney, liver and spleen. Controlling the inflammation can stabilise it.

Option by option

  • A. Serum amyloid A (correct)

    Serum amyloid A rises with chronic inflammation and is the AA amyloid precursor.

  • B. Immunoglobulin light chain

    Light chains form AL amyloid, linked to plasma cell neoplasms rather than chronic infection.

  • C. Beta-2 microglobulin

    Beta-2 microglobulin amyloid occurs in long-term dialysis patients with osteoarticular disease.

  • D. Transthyretin

    Transthyretin forms senile cardiac and familial amyloid, and it is not an inflammatory product.

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 A, Serum amyloid A. Chronic inflammation drives hepatic synthesis of serum amyloid A, an acute phase protein, and proteolytic fragments form AA amyloid.

Why is "Immunoglobulin light chain" not the answer?

Light chains form AL amyloid, linked to plasma cell neoplasms rather than chronic infection.

Why is "Beta-2 microglobulin" not the answer?

Beta-2 microglobulin amyloid occurs in long-term dialysis patients with osteoarticular disease.

Why is "Transthyretin" not the answer?

Transthyretin forms senile cardiac and familial amyloid, and it is not an inflammatory product.

What concept does this question test?

It tests Amyloidosis: reactive systemic amyloid in Pathology. It is the usual amyloid after long-standing infections such as bronchiectasis, chronic osteomyelitis and tuberculosis, and in rheumatoid arthritis, and it commonly affects kidney, liver and spleen. Controlling the inflammation can stabilise it.

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 Amyloidosis: reactive systemic amyloid?

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.