Systemic pathology: non-alcoholic steatohepatitis: 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: non-alcoholic steatohepatitis

Sample item

A 48-year-old obese woman with type 2 diabetes has mildly raised ALT. Viral and autoimmune markers are negative and she drinks no alcohol. Biopsy shows macrovesicular fat. Which additional feature separates steatohepatitis from simple steatosis?

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

The answer and the reasoning

C. Hepatocyte ballooning with lobular inflammation

Steatohepatitis shows steatosis with ballooned, injured hepatocytes, lobular inflammation and often perisinusoidal fibrosis in zone 3. Simple steatosis has fat alone and carries a much lower risk of progression to cirrhosis.

Option by option

  • A. Glycogenated nuclei in periportal hepatocytes

    Glycogenated nuclei are a nonspecific finding seen in diabetes and Wilson disease.

  • B. Large fat droplets within hepatocytes

    Large droplets of fat occur in simple steatosis and therefore do not separate it from steatohepatitis.

  • C. Hepatocyte ballooning with lobular inflammation (correct)

    Correct. Ballooning with inflammation, with or without Mallory-Denk bodies, defines steatohepatitis.

  • D. Excess iron in periportal hepatocytes

    Iron deposition indicates haemochromatosis and is not part of this diagnosis.

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 C, Hepatocyte ballooning with lobular inflammation. Steatohepatitis shows steatosis with ballooned, injured hepatocytes, lobular inflammation and often perisinusoidal fibrosis in zone 3.

Why is "Glycogenated nuclei in periportal hepatocytes" not the answer?

Glycogenated nuclei are a nonspecific finding seen in diabetes and Wilson disease.

Why is "Large fat droplets within hepatocytes" not the answer?

Large droplets of fat occur in simple steatosis and therefore do not separate it from steatohepatitis.

Why is "Excess iron in periportal hepatocytes" not the answer?

Iron deposition indicates haemochromatosis and is not part of this diagnosis.

What concept does this question test?

It tests Systemic pathology: non-alcoholic steatohepatitis in Pathology. Simple steatosis has fat alone and carries a much lower risk of progression to cirrhosis.

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 Systemic pathology: non-alcoholic steatohepatitis?

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.