Bacteriology: typhoid complications: 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 · Bacteriology: typhoid complications

Sample item

A 24-year-old whose blood culture on day 5 of fever grew Salmonella Typhi, and who was not treated, suddenly has severe abdominal pain, a rigid abdomen, tachycardia and a fall in temperature. Erect radiograph shows gas under the diaphragm. Which pathological lesion is the most probable source of the peritonitis?

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

The answer and the reasoning

A. A necrosed Peyer patch in the terminal ileum

In enteric fever, Salmonella Typhi invades the Peyer patches, which hypertrophy in the second week and slough in the third week, leaving ulcers along the long axis of the ileum. Perforation or haemorrhage can follow in the third week. Treatment is surgical repair with ceftriaxone or azithromycin and metronidazole cover.

Option by option

  • A. A necrosed Peyer patch in the terminal ileum (correct)

    Correct. Necrosis of Peyer patches in the third week leads to ileal perforation.

  • B. An inflamed appendix

    Appendicitis does not explain a bacteraemic fever of nearly three weeks and is a much less likely source here.

  • C. A sigmoid diverticulum

    Diverticular disease of the sigmoid is a disease of older people and does not fit the story.

  • D. A caseating ileocaecal tuberculous ulcer

    Tuberculous ileal ulcers can perforate, but culture-proven typhoid in the third week points to Peyer patch necrosis.

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, A necrosed Peyer patch in the terminal ileum. In enteric fever, Salmonella Typhi invades the Peyer patches, which hypertrophy in the second week and slough in the third week, leaving ulcers along the long axis of the ileum.

Why is "An inflamed appendix" not the answer?

Appendicitis does not explain a bacteraemic fever of nearly three weeks and is a much less likely source here.

Why is "A sigmoid diverticulum" not the answer?

Diverticular disease of the sigmoid is a disease of older people and does not fit the story.

Why is "A caseating ileocaecal tuberculous ulcer" not the answer?

Tuberculous ileal ulcers can perforate, but culture-proven typhoid in the third week points to Peyer patch necrosis.

What concept does this question test?

It tests Bacteriology: typhoid complications in Microbiology. Perforation or haemorrhage can follow in the third week. Treatment is surgical repair with ceftriaxone or azithromycin and metronidazole cover.

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 Bacteriology: typhoid complications?

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.