Systemic Pathology by Organ Practice Questions
19 free Systemic Pathology by Organ practice questions for the USMLE Step 1. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
Which lesion is most characteristic of a myocardial infarction (MI) on gross pathology, 24 hours after onset?
- A Pale, yellow-tan softening of myocardium
- B Dark mottling of subendocardial region
- C Hypereosinophilic contraction bands
- D Grey-white scar formation
Correct answer: Dark mottling of subendocardial region
On the standard gross (Robbins) timeline, dark mottling of the infarcted myocardium appears at roughly 12-24 hours after onset. A pale, yellow-tan softened appearance develops later, at about 1-3 days, becoming maximal by 7-10 days, and a grey-white scar forms over weeks to months. Hypereosinophilic contraction-band change is a microscopic finding, not a gross one, so it does not fit a gross-pathology question.
In chronic passive congestion of the liver due to right-sided heart failure, what gross feature is most likely observed?
- A Nodular cirrhosis throughout the liver
- B Nutmeg appearance with centrilobular congestion
- C Extensive fat infiltration (steatosis)
- D Peliosis hepatis with blood-filled cavities
Correct answer: Nutmeg appearance with centrilobular congestion
Chronic right-sided heart failure causes congestion of hepatic venous outflow, leading to centrilobular (zone 3) congestion and hemorrhage producing the classic nutmeg liver appearance. (Systemic pathology references)
Which glomerular disease is most likely in a patient with systemic lupus erythematosus showing “wire-loop” lesions on light microscopy?
- A Focal segmental glomerulosclerosis
- B Minimal change disease
- C Diffuse proliferative glomerulonephritis
- D Membranous nephropathy
Correct answer: Diffuse proliferative glomerulonephritis
Diffuse proliferative glomerulonephritis (DPGN) — often seen in SLE — shows thickened capillary walls and subendothelial immune-complex deposition, producing the characteristic “wire-loop” appearance. (Glomerular disease pathology)
Which morphological change is most typical of long-standing pulmonary emphysema on gross lung examination?
- A Numerous firm white nodules
- B Honeycomb cystic spaces predominantly subpleural
- C Dilated, over-inflated lungs with blebs
- D Caseating granulomas in upper lobes
Correct answer: Dilated, over-inflated lungs with blebs
Emphysema causes destruction of alveolar walls, leading to over-inflated lungs and formation of blebs or bullae; grossly the lungs appear hyper-inflated and pale. (Respiratory system pathology)
Which liver pathology is characterized by multiple, randomly distributed, blood-filled spaces within the parenchyma, sometimes associated with anabolic steroid use or chronic illness?
- A Cirrhosis
- B Peliosis hepatis
- C Steatohepatitis
- D Hemochromatosis
Correct answer: Peliosis hepatis
Peliosis hepatis is defined by blood-filled cystic spaces in liver parenchyma; it's associated with anabolic steroid use, chronic infections or immunosuppression. (Peliosis hepatis summary)
Which cardiac pathology is associated with asymmetric hypertrophy of the ventricular walls and histologic evidence of myofiber disarray, and may cause sudden death in young individuals?
- A Dilated cardiomyopathy
- B Ischemic cardiomyopathy
- C Hypertrophic cardiomyopathy
- D Amyloid cardiomyopathy
Correct answer: Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy shows asymmetric septal hypertrophy and myocyte disarray, and may cause outflow obstruction or arrhythmias leading to sudden death.
In a patient with chronic hepatitis B infection, deposition of immune complexes in glomeruli may cause which renal pathology?
- A Minimal change disease
- B Membranous glomerulonephritis
- C Focal segmental glomerulosclerosis
- D Acute tubular necrosis
Correct answer: Membranous glomerulonephritis
Hepatitis B-associated immune-complex deposition classically causes membranous glomerulonephritis, damaging the capillary walls and producing proteinuria or nephrotic syndrome.
Which gross feature is most characteristic of cirrhosis of the liver?
- A Uniform enlargement with a smooth surface
- B Shrunken, nodular liver with fibrous septa
- C Multiple cystic cavities filled with bile
- D Extensive fatty change without fibrosis
Correct answer: Shrunken, nodular liver with fibrous septa
Cirrhosis produces diffuse fibrosis and regenerative nodules, giving the liver a shrunken, nodular surface with bridging fibrous septa — the hallmark gross finding.
Which vascular pathology involves a tear in the intima leading to false lumen formation within the aortic wall?
- A True fusiform aneurysm
- B Aortic dissection
- C Saccular aneurysm
- D Arteriovenous fistula
Correct answer: Aortic dissection
Aortic dissection involves an intimal tear with blood tracking through the media to form a false lumen, unlike the simple dilation of an aneurysm.
Which kidney lesion is most likely to result from prolonged hypertension and lead to bilateral small kidneys with scarring?
- A Acute tubular necrosis
- B Chronic pyelonephritis
- C Hypertensive nephrosclerosis
- D Minimal change disease
Correct answer: Hypertensive nephrosclerosis
Chronic hypertension over time causes nephrosclerosis — hyaline arteriosclerosis, glomerulosclerosis, interstitial fibrosis — resulting in small, shrunken kidneys with reduced function. (Renal pathology basics)
Which pathological change in the lung is most characteristic of acute lobar pneumonia on gross examination?
- A Dry, rubbery non-consolidated lobes
- B Grey hepatization with consolidation
- C Multiple large bullae and blebs
- D Diffuse honeycomb fibrosis
Correct answer: Grey hepatization with consolidation
In lobar pneumonia the alveoli fill with exudate and the lobe consolidates, becoming firm and liver-like (hepatization) — red early, then grey as cells and fibrin organize.
Which of the following is the most common glomerular pathology pattern seen in patients with chronic liver disease on renal biopsy studies?
- A Minimal change disease
- B IgA-dominant glomerulonephritis
- C Focal segmental glomerulosclerosis
- D Membranous nephropathy
Correct answer: IgA-dominant glomerulonephritis
Chronic liver disease commonly produces IgA-dominant glomerular lesions with mesangial proliferation and immune-complex deposition (hepatic glomerulosclerosis).
Which gross feature is suggestive of pulmonary tuberculosis in lungs obtained at autopsy?
- A Diffuse consolidation of entire lobes
- B Honeycomb fibrotic change throughout
- C Upper-lobe cavitary caseous granulomas
- D Multiple bullous spaces and blebs
Correct answer: Upper-lobe cavitary caseous granulomas
Tuberculosis produces granulomas with caseous necrosis that can cavitate over time, characteristically in the upper lobes.
Which heart pathology often leads to concentric hypertrophy of the ventricular wall due to increased afterload?
- A Aortic stenosis or hypertension
- B Volume overload from valve regurgitation
- C Old myocardial infarction scar
- D Dilated cardiomyopathy
Correct answer: Aortic stenosis or hypertension
Pressure-overload states such as aortic stenosis and systemic hypertension increase afterload, driving concentric hypertrophy of the ventricular wall.
Which organ is most commonly affected first in hepatorenal syndrome secondary to advanced cirrhosis?
- A Lungs
- B Kidneys
- C Heart
- D Brain
Correct answer: Kidneys
Hepatorenal syndrome refers to progressive kidney failure in the setting of liver cirrhosis, with renal vasoconstriction and impaired perfusion despite no intrinsic renal disease. (Liver-renal systemic pathology)
Which of the following describes a saccular true aneurysm?
- A Fusiform dilation of the entire circumference
- B Localized outpouching of all three wall layers
- C False aneurysm with only a fibrous wall
- D Segmental dissection between intima and media
Correct answer: Localized outpouching of all three wall layers
A true saccular aneurysm is a localized outpouching of the vessel wall that involves all three layers — intima, media, and adventitia.
Which renal pathology often presents clinically with heavy proteinuria, hypoalbuminemia, edema and hyperlipidemia?
- A Acute tubular necrosis
- B Nephritic syndrome
- C Nephrotic syndrome
- D Interstitial nephritis
Correct answer: Nephrotic syndrome
Nephrotic syndrome arises from glomerular capillary wall damage leading to massive proteinuria, hypoalbuminemia, edema, and secondary hyperlipidemia. (Renal pathology basics)
Which of the following is a major mechanism by which atherosclerosis leads to ischemic heart disease?
- A Mural thrombosis occurring without any plaque
- B Intimal thickening from smooth muscle hyperplasia only
- C Lipid-cored plaque narrowing the arterial lumen
- D Destruction of the media without luminal narrowing
Correct answer: Lipid-cored plaque narrowing the arterial lumen
Atherosclerosis forms a plaque with a lipid core and fibrous cap that progressively narrows the arterial lumen, reducing coronary flow and causing ischemia.
Which of the following findings in the liver is characteristic of alcoholic fatty liver disease in early stages?
- A Extensive bridging fibrosis and nodular cirrhosis
- B Macrovesicular steatosis with pale hepatocytes
- C Multiple blood-filled vascular spaces (peliosis)
- D Marked iron deposition within hepatocytes
Correct answer: Macrovesicular steatosis with pale hepatocytes
Alcoholic fatty liver disease begins with macrovesicular steatosis — fat accumulation giving pale, enlarged hepatocytes; fibrosis and cirrhosis develop later.