Immunopathology: bullous pemphigoid: 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 · Immunopathology: bullous pemphigoid

Sample item

A 75-year-old man has tense itchy blisters on the flexures. Biopsy shows a subepidermal blister with eosinophils, and the roof of the blister is intact. Antibodies are directed against which structure?

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

The answer and the reasoning

C. Hemidesmosomal proteins BP180 and BP230

Bullous pemphigoid involves IgG against hemidesmosomal BP180 and BP230, with complement activation, eosinophil recruitment and subepidermal splitting. Because the epidermis stays intact, the blisters are tense. Desmoglein antibodies cause pemphigus, with fragile intraepidermal blisters.

Option by option

  • A. Desmoglein 3 in desmosomes

    Desmoglein 3 is the target in pemphigus vulgaris, with fragile suprabasal blisters.

  • B. Tissue transglutaminase

    Tissue transglutaminase antibodies are linked to coeliac disease and dermatitis herpetiformis.

  • C. Hemidesmosomal proteins BP180 and BP230 (correct)

    Correct. Hemidesmosomal antigens anchor basal keratinocytes, and attack gives subepidermal blisters.

  • D. Type VII collagen anchoring fibrils

    Type VII collagen is the target in epidermolysis bullosa acquisita.

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 C, Hemidesmosomal proteins BP180 and BP230. Bullous pemphigoid involves IgG against hemidesmosomal BP180 and BP230, with complement activation, eosinophil recruitment and subepidermal splitting.

Why is "Desmoglein 3 in desmosomes" not the answer?

Desmoglein 3 is the target in pemphigus vulgaris, with fragile suprabasal blisters.

Why is "Tissue transglutaminase" not the answer?

Tissue transglutaminase antibodies are linked to coeliac disease and dermatitis herpetiformis.

Why is "Type VII collagen anchoring fibrils" not the answer?

Type VII collagen is the target in epidermolysis bullosa acquisita.

What concept does this question test?

It tests Immunopathology: bullous pemphigoid in Pathology. Because the epidermis stays intact, the blisters are tense. Desmoglein antibodies cause pemphigus, with fragile intraepidermal blisters.

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 Immunopathology: bullous pemphigoid?

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.