Systemic pathology: infective endocarditis lesions: 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 · Systemic pathology: infective endocarditis lesions

Sample item

A 32-year-old man with infective endocarditis has non-tender erythematous macules on his palms and soles. Biopsy of a lesion shows neutrophilic microabscesses containing bacteria within dermal vessels. What is the mechanism of these lesions?

AFibrin microthrombi from disseminated intravascular coagulationBLeukocytoclastic vasculitis due to a drug reactionCImmune complex deposition in dermal capillariesDSeptic microemboli from the valve vegetation

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

The answer and the reasoning

D. Septic microemboli from the valve vegetation

Janeway lesions are painless haemorrhagic macules on the palms and soles caused by septic microemboli lodging in dermal vessels, so organisms and neutrophilic microabscesses are seen. Osler nodes are painful and attributed to immune complex deposition. Both are peripheral signs of subacute and acute endocarditis.

Option by option

A. Fibrin microthrombi from disseminated intravascular coagulation
DIC microthrombi contain fibrin and not bacteria with neutrophil microabscesses.
B. Leukocytoclastic vasculitis due to a drug reaction
A drug-induced vasculitis would not show bacteria in the vessels.
C. Immune complex deposition in dermal capillaries
Immune complex deposition explains Osler nodes, which are painful nodules on the finger pulps.
D. Septic microemboli from the valve vegetation (correct)
Correct. Bacteria-containing emboli from vegetations cause Janeway lesions.

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.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Septic microemboli from the valve vegetation. Janeway lesions are painless haemorrhagic macules on the palms and soles caused by septic microemboli lodging in dermal vessels, so organisms and neutrophilic microabscesses are seen.

Why is "Fibrin microthrombi from disseminated intravascular coagulation" not the answer?

DIC microthrombi contain fibrin and not bacteria with neutrophil microabscesses.

Why is "Leukocytoclastic vasculitis due to a drug reaction" not the answer?

A drug-induced vasculitis would not show bacteria in the vessels.

Why is "Immune complex deposition in dermal capillaries" not the answer?

Immune complex deposition explains Osler nodes, which are painful nodules on the finger pulps.

What concept does this question test?

It tests Systemic pathology: infective endocarditis lesions in Pathology. Osler nodes are painful and attributed to immune complex deposition. Both are peripheral signs of subacute and acute endocarditis.

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 Systemic pathology: infective endocarditis lesions?

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.