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USMLE Step 1 Pathology: Cell Injury, Inflammation and Neoplasia — quiz

15 multiple-choice questions covering Cell Injury, Apoptosis vs Necrosis, Types of Necrosis, Inflammation, Granulomas. One answer each; you get a score at the end and the explanation for every question. No account needed.

Updated 2026-11-04. Keys 1–4 pick an answer, Enter moves on. Redo it any time, in order or shuffled.

The questions

Answers and explanations are shown after you finish.

1. Cell Injury

   A kidney cell experiences a brief period of ischemia. Shortly after the insult, which change would most likely be present and still fully reversible if blood flow is restored promptly?

   • Karyolysis of nuclear chromatin
   • Massive calcium influx activating endonucleases and proteases
   • ATP depletion causing Na+/K+-ATPase failure with cellular and mitochondrial swelling
   • Opening of the mitochondrial permeability transition pore
2. Apoptosis vs Necrosis

   A cell undergoing programmed death forms membrane-bound apoptotic bodies that are cleared by neighboring phagocytes without producing local inflammation. Which feature best explains the lack of an inflammatory response, in contrast to necrosis?

   • It is ATP-dependent and keeps cellular contents packaged within membrane-bound fragments
   • It depends exclusively on complement activation
   • It always uses the extrinsic Fas-FasL pathway
   • It relies on karyolysis to clear nuclear debris
3. Types of Necrosis

   A patient suffers a middle cerebral artery stroke. One week later, imaging shows a soft, liquefied cavity at the infarct site, unlike the firm, ghost-outline necrosis typical of a myocardial infarction. What best explains this difference?

   • Lipase-mediated saponification occurs in brain tissue
   • Protein denaturation preserves cellular architecture in the brain
   • High lipid content and enzymatic digestion by microglia produce liquefactive necrosis in the brain
   • Granulomatous inflammation causes caseous necrosis in the brain
4. Inflammation

   A biopsy of a long-standing wound shows an infiltrate dominated by lymphocytes, plasma cells, and macrophages with very few neutrophils. Which cell population is most characteristic of this chronic inflammatory stage, distinguishing it from acute inflammation?

   • Lymphocytes, plasma cells, and macrophages
   • Natural killer cells only
   • Eosinophils and mast cells
   • Neutrophils and basophils
5. Inflammation

   A patient takes aspirin for pain relief. Which arachidonic acid metabolites will be reduced, while leukotriene levels remain largely unaffected?

   • Prostaglandins and thromboxane A2, via COX inhibition
   • Histamine release from mast cells
   • C3a and C5a, via complement inhibition
   • Leukotriene B4, via lipoxygenase inhibition
6. Granulomas

   In a patient with tuberculosis, CD4+ Th1 cells secrete a cytokine that activates macrophages, driving their transformation into epithelioid cells that fuse into multinucleated giant cells. Which cytokine is primarily responsible?

   • IL-4
   • TNF-alpha alone
   • IFN-gamma
   • IL-10
7. Wound Healing

   A patient with chronic vitamin C deficiency presents with poor wound healing and bleeding gums. Which step in collagen synthesis is most directly impaired?

   • Fibroblast proliferation within granulation tissue
   • Conversion of type III collagen to type I during remodeling
   • Hydroxylation of proline and lysine residues needed for collagen cross-linking
   • Myofibroblast-mediated wound contraction
8. Free Radical Injury

   Which enzyme sequence correctly converts superoxide radicals into water, limiting oxidative damage to cell membranes and DNA?

   • Superoxide dismutase, then catalase/glutathione peroxidase
   • Myeloperoxidase, then superoxide dismutase
   • Cytochrome P450, then NADPH oxidase
   • Glutathione peroxidase, then NADPH oxidase
9. Amyloidosis

   A patient with long-standing rheumatoid arthritis develops renal amyloid deposition. Which precursor protein is most likely responsible for this amyloid?

   • Immunoglobulin light chains
   • Serum amyloid A
   • Amylin
   • Beta-2 microglobulin
10. Neoplasia Nomenclature

    A lung mass biopsy shows disorganized but mature cartilage, smooth muscle, and respiratory epithelium—all tissue types normally found in the lung—arranged haphazardly. This benign lesion is best classified as a:

    • Choristoma
    • Carcinoma in situ
    • Sarcoma
    • Hamartoma
11. Hallmarks of Cancer

    FDG-PET imaging detects tumors because cancer cells preferentially metabolize glucose through aerobic glycolysis even when oxygen is abundant. This phenomenon is known as the:

    • Cori cycle
    • Pasteur effect
    • Warburg effect
    • Upregulation of oxidative phosphorylation
12. Tumor Suppressors & Oncogenes

    A child is diagnosed with retinoblastoma and later develops osteosarcoma. Both cancers result from loss-of-function mutations in a single tumor suppressor that normally binds and inhibits E2F to control the G1/S checkpoint. Which gene is defective?

    • APC
    • RB
    • p53
    • VHL
13. Tumor Markers

    Elevated serum alpha-fetoprotein is most useful for monitoring which two conditions?

    • Hepatocellular carcinoma and yolk sac tumor
    • Choriocarcinoma and seminoma
    • Prostate cancer and colorectal cancer
    • Ovarian cancer and pancreatic cancer
14. Paraneoplastic Syndromes

    A patient with small cell lung carcinoma develops muscle weakness that improves with repeated use, along with autoantibodies against presynaptic voltage-gated calcium channels. Which paraneoplastic syndrome does this describe?

    • SIADH
    • Myasthenia gravis
    • Guillain-Barre syndrome
    • Lambert-Eaton myasthenic syndrome
15. Carcinogens

    Which carcinogen-cancer pairing is correctly matched?

    • Aflatoxin - hepatic angiosarcoma
    • Vinyl chloride - hepatic angiosarcoma
    • Asbestos - hepatocellular carcinoma
    • Arsenic - transitional cell carcinoma of the bladder