Chronic inflammation: cat-scratch disease: 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 · Chronic inflammation: cat-scratch disease

Sample item

A 7-year-old child has had a tender axillary lymph node for 2 weeks, after being scratched by a kitten. A node biopsy shows stellate necrotising granulomas with central neutrophilic microabscesses. Which stain is most useful to demonstrate the causative organism in the tissue?

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

The answer and the reasoning

A. Warthin-Starry silver stain

Cat-scratch disease is caused by Bartonella henselae, a small Gram-negative bacillus that is not seen on routine stains. The organism is demonstrated in tissue by silver impregnation such as the Warthin-Starry stain. The characteristic lesion is a stellate granuloma with central necrosis and neutrophils.

Option by option

  • A. Warthin-Starry silver stain (correct)

    Correct. Silver stains such as Warthin-Starry reveal the small curved Bartonella bacilli.

  • B. Congo red stain

    Congo red detects amyloid, and is irrelevant to this infection.

  • C. Ziehl-Neelsen stain

    Ziehl-Neelsen stain identifies acid-fast bacilli of tuberculosis, which produces caseating granulomas.

  • D. Periodic acid-Schiff stain

    Periodic acid-Schiff highlights fungi, glycogen and basement membranes, not Bartonella.

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, Warthin-Starry silver stain. Cat-scratch disease is caused by Bartonella henselae, a small Gram-negative bacillus that is not seen on routine stains.

Why is "Congo red stain" not the answer?

Congo red detects amyloid, and is irrelevant to this infection.

Why is "Ziehl-Neelsen stain" not the answer?

Ziehl-Neelsen stain identifies acid-fast bacilli of tuberculosis, which produces caseating granulomas.

Why is "Periodic acid-Schiff stain" not the answer?

Periodic acid-Schiff highlights fungi, glycogen and basement membranes, not Bartonella.

What concept does this question test?

It tests Chronic inflammation: cat-scratch disease in Pathology. The organism is demonstrated in tissue by silver impregnation such as the Warthin-Starry stain. The characteristic lesion is a stellate granuloma with central necrosis and neutrophils.

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 Chronic inflammation: cat-scratch disease?

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.