Haemodynamics: chronic passive congestion: 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: chronic passive congestion

Sample item

A 60-year-old man with chronic right heart failure has a tender enlarged liver. The cut surface shows alternating dark red and pale brown areas. Where is the dark red zone located histologically?

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

The answer and the reasoning

D. Centrilobular region with sinusoidal congestion and haemorrhage

Chronic passive hepatic congestion produces the nutmeg liver. Blood backs up from the hepatic veins into the central veins, so the centrilobular hepatocytes are congested, hypoxic and may undergo necrosis, while periportal cells receive better oxygenated blood and show fatty change, giving the pale zones.

Option by option

  • A. Periportal region with fatty change

    Periportal cells are better oxygenated and form the paler zone, not the congested one.

  • B. Midzonal region with ballooning of hepatocytes

    Midzonal change is typical of yellow fever, not of passive congestion.

  • C. Portal tracts with lymphoid aggregates

    Portal lymphoid aggregates are typical of chronic hepatitis C, not of congestion.

  • D. Centrilobular region with sinusoidal congestion and haemorrhage (correct)

    Centrilobular congestion forms the dark red zones because venous blood drains from this region.

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, Centrilobular region with sinusoidal congestion and haemorrhage. Chronic passive hepatic congestion produces the nutmeg liver.

Why is "Periportal region with fatty change" not the answer?

Periportal cells are better oxygenated and form the paler zone, not the congested one.

Why is "Midzonal region with ballooning of hepatocytes" not the answer?

Midzonal change is typical of yellow fever, not of passive congestion.

Why is "Portal tracts with lymphoid aggregates" not the answer?

Portal lymphoid aggregates are typical of chronic hepatitis C, not of congestion.

What concept does this question test?

It tests Haemodynamics: chronic passive congestion in Pathology. Blood backs up from the hepatic veins into the central veins, so the centrilobular hepatocytes are congested, hypoxic and may undergo necrosis, while periportal cells receive better oxygenated blood and show fatty change, giving the pale zones.

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 Haemodynamics: chronic passive congestion?

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.