Haemodynamics: Waterhouse-Friderichsen syndrome: 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 · Haemodynamics: Waterhouse-Friderichsen syndrome

Sample item

A 7-year-old boy dies within 14 hours of fever, headache and a spreading purpuric rash. Blood culture grew Gram-negative diplococci. What is the expected finding in the adrenal glands at autopsy?

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

The answer and the reasoning

A. Bilateral massive haemorrhagic necrosis

Fulminant meningococcaemia with DIC can cause massive bilateral adrenal haemorrhage, known as Waterhouse-Friderichsen syndrome. The sudden loss of cortisol and aldosterone adds adrenal crisis to septic shock.

Option by option

  • A. Bilateral massive haemorrhagic necrosis (correct)

    Correct. Endotoxaemia and DIC cause bilateral adrenal haemorrhage and necrosis.

  • B. Bilateral caseating granulomas

    Caseating granulomas are the cause of chronic adrenal insufficiency in tuberculosis.

  • C. Bilateral cortical atrophy with lymphocytic infiltrate

    Cortical atrophy with lymphocytes is autoimmune Addison disease, which develops slowly.

  • D. Bilateral deposition of amorphous amyloid

    Amyloid can enlarge the adrenals but does not explain a death within hours.

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, Bilateral massive haemorrhagic necrosis. Fulminant meningococcaemia with DIC can cause massive bilateral adrenal haemorrhage, known as Waterhouse-Friderichsen syndrome.

Why is "Bilateral caseating granulomas" not the answer?

Caseating granulomas are the cause of chronic adrenal insufficiency in tuberculosis.

Why is "Bilateral cortical atrophy with lymphocytic infiltrate" not the answer?

Cortical atrophy with lymphocytes is autoimmune Addison disease, which develops slowly.

Why is "Bilateral deposition of amorphous amyloid" not the answer?

Amyloid can enlarge the adrenals but does not explain a death within hours.

What concept does this question test?

It tests Haemodynamics: Waterhouse-Friderichsen syndrome in Pathology. The sudden loss of cortisol and aldosterone adds adrenal crisis to septic shock.

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 Haemodynamics: Waterhouse-Friderichsen syndrome?

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.