Chemotherapy: natalizumab and progressive multifocal leukoencephalopathy: practice question

A Pharmacology 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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Pharmacology · Chemotherapy: natalizumab and progressive multifocal leukoencephalopathy

Sample item

A woman with relapsing multiple sclerosis on natalizumab for three years develops subacute right hemiparesis, a visual field defect and cognitive decline. MRI shows new asymmetric non-enhancing subcortical white matter lesions. Which complication is most likely?

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

The answer and the reasoning

D. Progressive multifocal leukoencephalopathy

Natalizumab blocks alpha-4 integrin and reduces lymphocyte entry into the central nervous system. This allows reactivation of JC virus, causing PML, and the risk rises with duration of therapy, prior immunosuppression and anti-JC virus antibody positivity. Treatment is stopped and plasma exchange speeds drug removal.

Option by option

  • A. Acute disseminated encephalomyelitis

    Acute disseminated encephalomyelitis follows infection or vaccination and is monophasic with enhancing lesions.

  • B. Posterior reversible encephalopathy syndrome

    PRES presents with headache, seizures and posterior oedema and is linked to calcineurin inhibitors.

  • C. Subacute sclerosing panencephalitis

    Subacute sclerosing panencephalitis follows measles virus infection in childhood.

  • D. Progressive multifocal leukoencephalopathy (correct)

    Correct. Natalizumab predisposes to JC virus reactivation causing PML.

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.

More Pharmacology questions

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, Progressive multifocal leukoencephalopathy. Natalizumab blocks alpha-4 integrin and reduces lymphocyte entry into the central nervous system.

Why is "Acute disseminated encephalomyelitis" not the answer?

Acute disseminated encephalomyelitis follows infection or vaccination and is monophasic with enhancing lesions.

Why is "Posterior reversible encephalopathy syndrome" not the answer?

PRES presents with headache, seizures and posterior oedema and is linked to calcineurin inhibitors.

Why is "Subacute sclerosing panencephalitis" not the answer?

Subacute sclerosing panencephalitis follows measles virus infection in childhood.

What concept does this question test?

It tests Chemotherapy: natalizumab and progressive multifocal leukoencephalopathy in Pharmacology. This allows reactivation of JC virus, causing PML, and the risk rises with duration of therapy, prior immunosuppression and anti-JC virus antibody positivity. Treatment is stopped and plasma exchange speeds drug removal.

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 Chemotherapy: natalizumab and progressive multifocal leukoencephalopathy?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.