Haemodynamics: cholesterol atheroembolism: 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: cholesterol atheroembolism

Sample item

A 68-year-old man with severe atherosclerosis develops a bluish mottled rash on both feet, eosinophilia and a rising creatinine two weeks after coronary angiography. Palpable pedal pulses are present. A renal biopsy would most likely show which feature?

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

The answer and the reasoning

D. Needle-shaped clefts within occluded arterioles

Catheter manipulation can dislodge fragments of atheromatous plaque. Cholesterol crystals lodge in small arteries and arterioles, leaving needle-shaped clefts after tissue processing, with a foreign-body reaction. Livedo reticularis with preserved pulses, eosinophilia and renal impairment is the typical picture.

Option by option

  • A. Concentric onion-skin thickening of arterioles

    Onion-skin arteriolar thickening belongs to malignant hypertension.

  • B. Fibrin thrombi within glomerular capillary loops

    Fibrin thrombi in glomeruli are seen in thrombotic microangiopathy and DIC.

  • C. Fibrinoid necrosis with transmural neutrophils

    Transmural fibrinoid necrosis with neutrophils points to polyarteritis nodosa.

  • D. Needle-shaped clefts within occluded arterioles (correct)

    Correct. Cholesterol crystals dissolve during processing and leave biconvex needle-like clefts.

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 D, Needle-shaped clefts within occluded arterioles. Catheter manipulation can dislodge fragments of atheromatous plaque.

Why is "Concentric onion-skin thickening of arterioles" not the answer?

Onion-skin arteriolar thickening belongs to malignant hypertension.

Why is "Fibrin thrombi within glomerular capillary loops" not the answer?

Fibrin thrombi in glomeruli are seen in thrombotic microangiopathy and DIC.

Why is "Fibrinoid necrosis with transmural neutrophils" not the answer?

Transmural fibrinoid necrosis with neutrophils points to polyarteritis nodosa.

What concept does this question test?

It tests Haemodynamics: cholesterol atheroembolism in Pathology. Cholesterol crystals lodge in small arteries and arterioles, leaving needle-shaped clefts after tissue processing, with a foreign-body reaction. Livedo reticularis with preserved pulses, eosinophilia and renal impairment is the typical picture.

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 Haemodynamics: cholesterol atheroembolism?

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.