Systemic pathology: lacunar infarct: 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: lacunar infarct

Sample item

A 65-year-old hypertensive man has a sudden pure motor hemiparesis with no cortical signs. Years later, autopsy shows a small cavity 1 cm wide in the internal capsule. Which vessel change is the usual cause?

AGiant cell arteritis of the temporal arteryBAtheromatous plaque in the internal carotid arteryCEmbolus from the left atrial appendageDHyaline arteriolosclerosis of small penetrating arteries

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

The answer and the reasoning

D. Hyaline arteriolosclerosis of small penetrating arteries

Lacunar infarcts are small cavitated infarcts in the deep grey and white matter caused by lipohyalinosis or hyaline arteriolosclerosis of penetrating arteries in hypertension and diabetes. They produce pure motor or sensory syndromes without cortical features.

Option by option

A. Giant cell arteritis of the temporal artery
Giant cell arteritis affects extracranial branches of the carotid artery and causes visual loss.
B. Atheromatous plaque in the internal carotid artery
Carotid atheroma produces larger cortical infarcts by artery-to-artery embolism.
C. Embolus from the left atrial appendage
A cardiac embolus usually lodges in a large cortical branch and produces cortical signs.
D. Hyaline arteriolosclerosis of small penetrating arteries (correct)
Correct. Hypertensive small vessel disease occludes penetrating arteries and produces small deep cavities.

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.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Hyaline arteriolosclerosis of small penetrating arteries. Lacunar infarcts are small cavitated infarcts in the deep grey and white matter caused by lipohyalinosis or hyaline arteriolosclerosis of penetrating arteries in hypertension and diabetes.

Why is "Giant cell arteritis of the temporal artery" not the answer?

Giant cell arteritis affects extracranial branches of the carotid artery and causes visual loss.

Why is "Atheromatous plaque in the internal carotid artery" not the answer?

Carotid atheroma produces larger cortical infarcts by artery-to-artery embolism.

Why is "Embolus from the left atrial appendage" not the answer?

A cardiac embolus usually lodges in a large cortical branch and produces cortical signs.

What concept does this question test?

It tests Systemic pathology: lacunar infarct in Pathology. They produce pure motor or sensory syndromes without cortical features.

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: lacunar infarct?

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.