Immunopathology: AA amyloidosis: 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: AA amyloidosis

Sample item

A 45-year-old man with chronic osteomyelitis for 15 years develops nephrotic-range proteinuria and hepatosplenomegaly. A renal biopsy stained with Congo red shows apple-green birefringence under polarised light. What is the precursor protein of the deposits?

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

The answer and the reasoning

B. Serum amyloid A, an acute-phase protein made by the liver under the influence of IL-6

Reactive (AA) amyloidosis complicates chronic inflammatory conditions such as osteomyelitis, tuberculosis, bronchiectasis and rheumatoid arthritis. IL-6 and IL-1 raise hepatic production of serum amyloid A, which is cleaved and deposited. The kidney is the commonest organ involved, and treating the underlying inflammation is the mainstay.

Option by option

  • A. Beta-2 microglobulin retained in renal failure

    Beta-2 microglobulin forms amyloid in long-term dialysis patients, typically affecting joints and carpal tunnel.

  • B. Serum amyloid A, an acute-phase protein made by the liver under the influence of IL-6 (correct)

    Correct. Serum amyloid A deposits in long-standing inflammatory disease.

  • C. Transthyretin made in the liver

    Transthyretin forms familial and senile cardiac amyloid, not renal amyloid after chronic infection.

  • D. Monoclonal immunoglobulin light chains from clonal plasma cells

    Light chains form AL amyloid and need a plasma cell dyscrasia, not chronic infection.

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 B, Serum amyloid A, an acute-phase protein made by the liver under the influence of IL-6. Reactive (AA) amyloidosis complicates chronic inflammatory conditions such as osteomyelitis, tuberculosis, bronchiectasis and rheumatoid arthritis.

Why is "Beta-2 microglobulin retained in renal failure" not the answer?

Beta-2 microglobulin forms amyloid in long-term dialysis patients, typically affecting joints and carpal tunnel.

Why is "Transthyretin made in the liver" not the answer?

Transthyretin forms familial and senile cardiac amyloid, not renal amyloid after chronic infection.

Why is "Monoclonal immunoglobulin light chains from clonal plasma cells" not the answer?

Light chains form AL amyloid and need a plasma cell dyscrasia, not chronic infection.

What concept does this question test?

It tests Immunopathology: AA amyloidosis in Pathology. IL-6 and IL-1 raise hepatic production of serum amyloid A, which is cleaved and deposited. The kidney is the commonest organ involved, and treating the underlying inflammation is the mainstay.

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: AA amyloidosis?

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.