Hypertension: malignant hypertension: 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 · Hypertension: malignant hypertension

Sample item

A 35-year-old man has blood pressure of 250/150 mmHg, papilloedema, haematuria and rapidly worsening renal function. Which renal arteriolar change is expected on biopsy?

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

The answer and the reasoning

B. Hyperplastic arteriolosclerosis with onion-skin concentric thickening and fibrinoid necrosis

Malignant hypertension causes hyperplastic arteriolosclerosis, with concentric laminated smooth muscle and basement membrane thickening producing an onion-skin appearance, and fibrinoid necrosis of arteriolar walls. Petechial haemorrhages give the kidney a flea-bitten look. Without urgent control, renal failure and hypertensive encephalopathy follow.

Option by option

  • A. Hyaline arteriolosclerosis with homogeneous pink thickening of the wall

    Hyaline arteriolosclerosis is the lesion of benign hypertension and diabetes, developing slowly.

  • B. Hyperplastic arteriolosclerosis with onion-skin concentric thickening and fibrinoid necrosis (correct)

    Correct. Onion-skin hyperplastic arteriolosclerosis with fibrinoid necrosis marks malignant hypertension.

  • C. Medial calcific sclerosis of muscular arteries

    Medial calcific sclerosis (Monckeberg) is an age-related calcification that does not narrow the lumen.

  • D. Atheromatous plaque in the main renal artery

    Atheroma of the main renal artery causes renovascular hypertension, not arteriolar injury of this type.

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 B, Hyperplastic arteriolosclerosis with onion-skin concentric thickening and fibrinoid necrosis. Malignant hypertension causes hyperplastic arteriolosclerosis, with concentric laminated smooth muscle and basement membrane thickening producing an onion-skin appearance, and fibrinoid necrosis of arteriolar walls.

Why is "Hyaline arteriolosclerosis with homogeneous pink thickening of the wa…" not the answer?

Hyaline arteriolosclerosis is the lesion of benign hypertension and diabetes, developing slowly.

Why is "Medial calcific sclerosis of muscular arteries" not the answer?

Medial calcific sclerosis (Monckeberg) is an age-related calcification that does not narrow the lumen.

Why is "Atheromatous plaque in the main renal artery" not the answer?

Atheroma of the main renal artery causes renovascular hypertension, not arteriolar injury of this type.

What concept does this question test?

It tests Hypertension: malignant hypertension in Pathology. Petechial haemorrhages give the kidney a flea-bitten look. Without urgent control, renal failure and hypertensive encephalopathy follow.

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 Hypertension: malignant hypertension?

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.