Haemodynamics: hepatic changes in shock: 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: hepatic changes in shock

Sample item

A 60-year-old man develops a sudden fall in blood pressure after massive myocardial infarction. Two days later aminotransferases are over 3000 U/L. Which pattern of hepatocyte necrosis would be expected on biopsy?

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

The answer and the reasoning

B. Necrosis around the central veins (zone 3)

Hepatocytes around the central vein receive the least oxygenated blood and are the first to die in hypoperfusion, giving centrilobular (zone 3) ischaemic necrosis. Periportal necrosis occurs in eclampsia and phosphorus poisoning, and midzonal necrosis in yellow fever.

Option by option

  • A. Piecemeal necrosis at the limiting plate

    Piecemeal necrosis is the interface hepatitis of chronic active hepatitis.

  • B. Necrosis around the central veins (zone 3) (correct)

    Correct. Zone 3 cells lie farthest from the arterial supply and are most vulnerable to ischaemia.

  • C. Necrosis around the portal tracts (zone 1)

    Periportal necrosis is the pattern in eclampsia and phosphorus toxicity.

  • D. Necrosis limited to the midzone (zone 2)

    Midzonal necrosis is typical of yellow fever.

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, Necrosis around the central veins (zone 3). Hepatocytes around the central vein receive the least oxygenated blood and are the first to die in hypoperfusion, giving centrilobular (zone 3) ischaemic necrosis.

Why is "Piecemeal necrosis at the limiting plate" not the answer?

Piecemeal necrosis is the interface hepatitis of chronic active hepatitis.

Why is "Necrosis around the portal tracts (zone 1)" not the answer?

Periportal necrosis is the pattern in eclampsia and phosphorus toxicity.

Why is "Necrosis limited to the midzone (zone 2)" not the answer?

Midzonal necrosis is typical of yellow fever.

What concept does this question test?

It tests Haemodynamics: hepatic changes in shock in Pathology. Periportal necrosis occurs in eclampsia and phosphorus poisoning, and midzonal necrosis in yellow fever.

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: hepatic changes in shock?

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.