Systemic pathology: berry aneurysm structure: 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: berry aneurysm structure

Sample item

A 45-year-old woman has a sudden thunderclap headache and neck stiffness. CT shows blood in the subarachnoid space, and angiography reveals a saccular aneurysm at a bifurcation of the circle of Willis. Which structural defect underlies such aneurysms?

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

The answer and the reasoning

C. Congenital attenuation of the media and elastic lamina at branch points

Berry aneurysms arise at arterial branch points where the media is deficient and the internal elastic lamina is attenuated or absent. Hypertension, smoking and polycystic kidney disease increase the risk of rupture.

Option by option

  • A. Lipid-laden foam cell plaque with a fibrous cap

    Atherosclerotic plaque weakens large vessels and forms fusiform aneurysms, not saccular ones at the circle of Willis.

  • B. Fibrinoid necrosis of small penetrating arteries

    Fibrinoid necrosis of small arteries is seen in malignant hypertension and vasculitis.

  • C. Congenital attenuation of the media and elastic lamina at branch points (correct)

    Correct. A focal defect of the media and elastic lamina at bifurcations allows saccular outpouching.

  • D. Cystic medial degeneration with mucoid pooling

    Cystic medial degeneration underlies aortic dissection in Marfan syndrome and hypertension.

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, Congenital attenuation of the media and elastic lamina at branch points. Berry aneurysms arise at arterial branch points where the media is deficient and the internal elastic lamina is attenuated or absent.

Why is "Lipid-laden foam cell plaque with a fibrous cap" not the answer?

Atherosclerotic plaque weakens large vessels and forms fusiform aneurysms, not saccular ones at the circle of Willis.

Why is "Fibrinoid necrosis of small penetrating arteries" not the answer?

Fibrinoid necrosis of small arteries is seen in malignant hypertension and vasculitis.

Why is "Cystic medial degeneration with mucoid pooling" not the answer?

Cystic medial degeneration underlies aortic dissection in Marfan syndrome and hypertension.

What concept does this question test?

It tests Systemic pathology: berry aneurysm structure in Pathology. Hypertension, smoking and polycystic kidney disease increase the risk of rupture.

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: berry aneurysm structure?

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.