Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue: 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: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue

Sample item

Two years after bilateral adrenalectomy for Cushing disease, a patient develops headaches, bitemporal field loss and darkening of the skin. What is the cause?

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

The answer and the reasoning

D. Enlarging corticotroph adenoma freed from cortisol feedback

Nelson syndrome is rapid growth of a pituitary corticotroph adenoma after the loss of cortisol negative feedback. High ACTH and related peptides darken the skin.

Option by option

  • A. Ectopic ACTH from small cell lung carcinoma

    Ectopic ACTH from lung cancer would not follow adrenalectomy for pituitary disease, and the visual field loss points to the pituitary.

  • B. Hyperplasia of an adrenal remnant

    An adrenal remnant would not explain a visual field defect from a sellar mass.

  • C. Autoimmune adrenalitis

    Autoimmune adrenalitis is not relevant after both glands were removed.

  • D. Enlarging corticotroph adenoma freed from cortisol feedback (correct)

    Correct. Without cortisol feedback the pituitary tumour grows, compresses the chiasm and raises ACTH.

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 Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Enlarging corticotroph adenoma freed from cortisol feedback. Nelson syndrome is rapid growth of a pituitary corticotroph adenoma after the loss of cortisol negative feedback.

Why is "Ectopic ACTH from small cell lung carcinoma" not the answer?

Ectopic ACTH from lung cancer would not follow adrenalectomy for pituitary disease, and the visual field loss points to the pituitary.

Why is "Hyperplasia of an adrenal remnant" not the answer?

An adrenal remnant would not explain a visual field defect from a sellar mass.

Why is "Autoimmune adrenalitis" not the answer?

Autoimmune adrenalitis is not relevant after both glands were removed.

What concept does this question test?

It tests Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue in Pathology. High ACTH and related peptides darken the skin.

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: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue?

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.