Systemic pathology: tuberculous meningitis: 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.

Try it

Pathology · Systemic pathology: tuberculous meningitis

Sample item

A 6-year-old child has a subacute illness with headache, vomiting and a cranial nerve palsy. CSF shows lymphocytic pleocytosis, markedly raised protein, low glucose and a cobweb clot on standing. Which gross finding is expected at autopsy?

AThick gelatinous exudate around the basal cisternsBHaemorrhagic necrosis of the temporal lobesCPurulent exudate over the cerebral convexitiesDMultiple cortical ring-enhancing abscesses

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

The answer and the reasoning

A. Thick gelatinous exudate around the basal cisterns

Tuberculous meningitis produces a thick gelatinous exudate at the base of the brain, which entraps cranial nerves and causes hydrocephalus and endarteritis with infarcts. CSF shows lymphocytes, high protein, low glucose and a fibrin web. Pyogenic meningitis gives convexity pus.

Option by option

A. Thick gelatinous exudate around the basal cisterns (correct)
Correct. Basal gelatinous exudate explains cranial nerve palsies and hydrocephalus.
B. Haemorrhagic necrosis of the temporal lobes
Haemorrhagic necrosis of the temporal lobes is the lesion of herpes simplex encephalitis.
C. Purulent exudate over the cerebral convexities
A purulent convexity exudate is typical of acute bacterial meningitis with neutrophilic CSF.
D. Multiple cortical ring-enhancing abscesses
Multiple abscesses are a different process and are not the feature of tuberculous meningitis.

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 A, Thick gelatinous exudate around the basal cisterns. Tuberculous meningitis produces a thick gelatinous exudate at the base of the brain, which entraps cranial nerves and causes hydrocephalus and endarteritis with infarcts.

Why is "Haemorrhagic necrosis of the temporal lobes" not the answer?

Haemorrhagic necrosis of the temporal lobes is the lesion of herpes simplex encephalitis.

Why is "Purulent exudate over the cerebral convexities" not the answer?

A purulent convexity exudate is typical of acute bacterial meningitis with neutrophilic CSF.

Why is "Multiple cortical ring-enhancing abscesses" not the answer?

Multiple abscesses are a different process and are not the feature of tuberculous meningitis.

What concept does this question test?

It tests Systemic pathology: tuberculous meningitis in Pathology. CSF shows lymphocytes, high protein, low glucose and a fibrin web. Pyogenic meningitis gives convexity pus.

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 Systemic pathology: tuberculous meningitis?

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.