Cell injury: fatty change: 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 · Cell injury: fatty change

Sample item

A 44-year-old man who has consumed alcohol heavily for 15 years has a smooth, enlarged, yellow liver on ultrasound. A biopsy shows macrovesicular fat in hepatocytes. Which mechanism chiefly explains this fatty change?

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

The answer and the reasoning

A. Raised NADH to NAD+ ratio, reducing fatty acid oxidation and favouring triglyceride synthesis

Ethanol metabolism by alcohol and aldehyde dehydrogenase generates large amounts of NADH. This shifts hepatocyte metabolism away from mitochondrial beta-oxidation and towards fatty acid synthesis, so triglyceride accumulates. Starvation and diabetes cause fatty liver through peripheral mobilisation of fat, and carbon tetrachloride or protein malnutrition act through reduced apoprotein synthesis.

Option by option

  • A. Raised NADH to NAD+ ratio, reducing fatty acid oxidation and favouring triglyceride synthesis (correct)

    Correct. The excess NADH from ethanol oxidation suppresses beta-oxidation and promotes lipogenesis.

  • B. Increased intestinal absorption of dietary triglyceride

    Dietary fat absorption does not by itself cause hepatic steatosis in an alcoholic.

  • C. Decreased synthesis of apoproteins needed for lipoprotein export

    Reduced apoprotein synthesis explains fatty change from carbon tetrachloride and kwashiorkor.

  • D. Excessive mobilisation of fatty acids from adipose tissue

    Mobilisation from fat stores explains fatty liver in starvation and uncontrolled diabetes, not the main mechanism of alcohol.

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, Raised NADH to NAD+ ratio, reducing fatty acid oxidation and favouring triglyceride synthesis. Ethanol metabolism by alcohol and aldehyde dehydrogenase generates large amounts of NADH.

Why is "Increased intestinal absorption of dietary triglyceride" not the answer?

Dietary fat absorption does not by itself cause hepatic steatosis in an alcoholic.

Why is "Decreased synthesis of apoproteins needed for lipoprotein export" not the answer?

Reduced apoprotein synthesis explains fatty change from carbon tetrachloride and kwashiorkor.

Why is "Excessive mobilisation of fatty acids from adipose tissue" not the answer?

Mobilisation from fat stores explains fatty liver in starvation and uncontrolled diabetes, not the main mechanism of alcohol.

What concept does this question test?

It tests Cell injury: fatty change in Pathology. This shifts hepatocyte metabolism away from mitochondrial beta-oxidation and towards fatty acid synthesis, so triglyceride accumulates. Starvation and diabetes cause fatty liver through peripheral mobilisation of fat, and carbon tetrachloride or protein malnutrition act through reduced apoprotein synthesis.

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 Cell injury: fatty change?

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.