Cell injury: fibrinoid necrosis: 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: fibrinoid necrosis

Sample item

A 38-year-old man with blood pressure 240/140 mmHg has headache and retinal haemorrhages. A renal biopsy shows afferent arterioles with a bright pink, smudged wall and loss of nuclei. What is the lesion?

AAmyloid deposition in the vessel wallBFibrinoid necrosis from plasma protein and fibrin leakage into the injured vessel wallCHyaline arteriolosclerosis from chronic benign hypertensionDCaseous necrosis of the arteriolar wall

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

The answer and the reasoning

B. Fibrinoid necrosis from plasma protein and fibrin leakage into the injured vessel wall

Fibrinoid necrosis is seen in the walls of arterioles in malignant hypertension and in immune vasculitis, where damaged vessels leak plasma proteins including fibrin. The deposit looks bright pink and amorphous on H and E. Hyaline arteriolosclerosis is a milder, homogeneous thickening without necrosis.

Option by option

A. Amyloid deposition in the vessel wall
Amyloid is acellular and Congo red positive but does not show fibrin-rich necrosis of the wall.
B. Fibrinoid necrosis from plasma protein and fibrin leakage into the injured vessel wall (correct)
Correct. Bright pink amorphous wall material with necrosis is fibrinoid necrosis.
C. Hyaline arteriolosclerosis from chronic benign hypertension
Hyaline arteriolosclerosis is a homogeneous thickening of the wall from chronic benign hypertension or diabetes, with no necrosis.
D. Caseous necrosis of the arteriolar wall
Caseous necrosis is a granulomatous, cheesy necrosis of infection, not an arteriolar change.

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 B, Fibrinoid necrosis from plasma protein and fibrin leakage into the injured vessel wall. Fibrinoid necrosis is seen in the walls of arterioles in malignant hypertension and in immune vasculitis, where damaged vessels leak plasma proteins including fibrin.

Why is "Amyloid deposition in the vessel wall" not the answer?

Amyloid is acellular and Congo red positive but does not show fibrin-rich necrosis of the wall.

Why is "Hyaline arteriolosclerosis from chronic benign hypertension" not the answer?

Hyaline arteriolosclerosis is a homogeneous thickening of the wall from chronic benign hypertension or diabetes, with no necrosis.

Why is "Caseous necrosis of the arteriolar wall" not the answer?

Caseous necrosis is a granulomatous, cheesy necrosis of infection, not an arteriolar change.

What concept does this question test?

It tests Cell injury: fibrinoid necrosis in Pathology. The deposit looks bright pink and amorphous on H and E. Hyaline arteriolosclerosis is a milder, homogeneous thickening without necrosis.

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: fibrinoid necrosis?

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.