🧬 NCLEX Pathology MCQs (Part 1: Q.1–50)
Introduction
Pathology is the study of disease — its causes, mechanisms, and effects on the body. For nursing and medical students preparing for the NCLEX, understanding pathology is essential to connect theory with clinical practice. These NCLEX Pathology MCQs with answers and explanations will help you master important topics like cell injury, inflammation, neoplasia, cardiovascular disorders, respiratory diseases, and more.
1. Which of the following is an example of reversible cell injury?
A) Fatty change in liver due to alcohol abuse
B) Myocardial infarction
C) Brain infarction
D) Pulmonary embolism
Answer: A. Fatty change in liver due to alcohol abuse
👉 Reversible injury includes swelling, fatty change, and cellular degeneration. Infarction and embolism cause irreversible necrosis.
2. What is the hallmark of irreversible cell injury?
A) Cellular swelling
B) Mitochondrial damage
C) Loss of nuclear staining (karyolysis)
D) Fatty change
Answer: C. Loss of nuclear staining (karyolysis)
👉 Nuclear changes such as pyknosis, karyorrhexis, and karyolysis indicate irreversible damage.
3. Apoptosis differs from necrosis in that apoptosis:
A) Causes inflammation
B) Occurs in single cells
C) Always follows ischemia
D) Results in cellular swelling
Answer: B. Occurs in single cells
👉 Apoptosis is a programmed cell death affecting single cells without inflammation. Necrosis involves groups of cells with inflammation.
4. Which type of necrosis is characteristic of myocardial infarction?
A) Liquefactive necrosis
B) Caseous necrosis
C) Fat necrosis
D) Coagulative necrosis
Answer: D. Coagulative necrosis
👉 Ischemic injury to most solid organs (except brain) produces coagulative necrosis.
5. Which type of necrosis is most commonly seen in the brain?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Fat necrosis
Answer: B. Liquefactive necrosis
👉 Brain infarction leads to liquefactive necrosis due to enzymatic digestion of tissue.
6. Caseous necrosis is a feature of:
A) Tuberculosis
B) Fat necrosis
C) Myocardial infarction
D) Gangrene
Answer: A. Tuberculosis
👉 Caseous (“cheese-like”) necrosis is typically seen in TB granulomas.
7. Which enzyme is a marker of myocardial infarction?
A) Creatine kinase-MB (CK-MB)
B) Alkaline phosphatase
C) Lipase
D) Amylase
Answer: A. CK-MB
👉 CK-MB and troponins are elevated in myocardial infarction.
8. Which WBC is first to arrive in acute inflammation?
A) Monocytes
B) Lymphocytes
C) Neutrophils
D) Eosinophils
Answer: C. Neutrophils
👉 Neutrophils are the first responders in acute inflammation.
9. Which chemical mediator causes vasodilation in acute inflammation?
A) Histamine
B) Bradykinin
C) Prostaglandins
D) All of the above
Answer: D. All of the above
👉 Histamine, bradykinin, and prostaglandins all cause vasodilation and increased permeability.
10. Which cytokine is most important in septic shock?
A) IL-1
B) TNF-alpha
C) IL-6
D) IFN-gamma
Answer: B. TNF-alpha
👉 TNF-alpha is a major mediator of septic shock, fever, and systemic inflammation.
11. Which immunoglobulin is first produced in an acute infection?
A) IgG
B) IgA
C) IgE
D) IgM
Answer: D. IgM
👉 IgM is the first antibody to appear during an acute infection; IgG follows later for long-term immunity.
12. Granulomatous inflammation is characterized by:
A) Neutrophil accumulation
B) Giant cells and epithelioid macrophages
C) Fibrin exudation
D) Absence of lymphocytes
Answer: B. Giant cells and epithelioid macrophages
👉 Granulomas are formed when macrophages fuse into epithelioid cells and giant cells, often in TB and sarcoidosis.
13. Which of the following is an example of free radical injury?
A) Carbon monoxide poisoning
B) Lipid peroxidation in cell membranes
C) Alcohol-induced fatty liver
D) Cyanide poisoning
Answer: B. Lipid peroxidation in cell membranes
👉 Free radicals damage membranes by lipid peroxidation.
14. A 55-year-old man develops jaundice. Which type of pigment is deposited in hepatocytes?
A) Hemosiderin
B) Lipofuscin
C) Bilirubin
D) Melanin
Answer: C. Bilirubin
👉 Excess bilirubin deposits in liver cells and skin → jaundice.
15. Which of the following is a benign tumor of glandular origin?
A) Adenocarcinoma
B) Adenoma
C) Fibrosarcoma
D) Liposarcoma
Answer: B. Adenoma
👉 Adenoma = benign tumor; adenocarcinoma = malignant.
16. Which cancer is most commonly linked with smoking?
A) Lung cancer
B) Liver cancer
C) Skin cancer
D) Brain tumor
Answer: A. Lung cancer
👉 Smoking is the leading risk factor for lung carcinoma.
17. Which virus is associated with cervical cancer?
A) HBV
B) HIV
C) HPV
D) EBV
Answer: C. HPV
👉 HPV (types 16, 18) causes cervical cancer.
18. Which of the following tumors is most radiosensitive?
A) Melanoma
B) Osteosarcoma
C) Lymphoma
D) Glioblastoma
Answer: C. Lymphoma
👉 Lymphomas are highly radiosensitive.
19. A 5-year-old child presents with “starry sky” appearance in lymph nodes. Which malignancy is suspected?
A) Burkitt’s lymphoma
B) Hodgkin’s lymphoma
C) Leukemia
D) Neuroblastoma
Answer: A. Burkitt’s lymphoma
👉 “Starry sky” = Burkitt’s, associated with EBV.
20. Reed-Sternberg cells are seen in:
A) Non-Hodgkin’s lymphoma
B) Hodgkin’s lymphoma
C) Leukemia
D) Multiple myeloma
Answer: B. Hodgkin’s lymphoma
👉 Reed-Sternberg cells = pathognomonic for Hodgkin’s disease.
21. Which vitamin deficiency causes defective collagen synthesis?
A) Vitamin A
B) Vitamin C
C) Vitamin D
D) Vitamin K
Answer: B. Vitamin C
👉 Vitamin C deficiency (scurvy) impairs collagen cross-linking.
22. Amyloidosis involves deposition of:
A) Lipid
B) Protein
C) Glycogen
D) Pigments
Answer: B. Protein
👉 Amyloid = misfolded protein deposits in tissues.
23. Which organ is most affected in systemic amyloidosis?
A) Brain
B) Kidney
C) Liver
D) Heart
Answer: B. Kidney
👉 Kidney involvement (proteinuria, renal failure) is most common.
24. Which cardiac condition is most associated with rheumatic fever?
A) Aortic stenosis
B) Mitral stenosis
C) Mitral regurgitation
D) Tricuspid regurgitation
Answer: B. Mitral stenosis
👉 Mitral valve is most affected in rheumatic fever.
25. “Aschoff bodies” are seen in:
A) Tuberculosis
B) Rheumatic heart disease
C) Myocardial infarction
D) Endocarditis
Answer: B. Rheumatic heart disease
👉 Aschoff bodies = granulomatous lesions in rheumatic myocarditis.
26. The most common cause of myocardial infarction is:
A) Coronary artery spasm
B) Coronary artery embolism
C) Coronary atherosclerosis with thrombosis
D) Hypertension
Answer: C. Coronary atherosclerosis with thrombosis
👉 Plaque rupture + thrombus = MI.
27. Atherosclerosis primarily affects which part of blood vessels?
A) Intima
B) Media
C) Adventitia
D) Endothelium only
Answer: A. Intima
👉 Atherosclerotic plaques form in the intima.
28. Hyaline arteriosclerosis is most commonly seen in:
A) Diabetes mellitus
B) Hypertension
C) Both A & B
D) Tuberculosis
Answer: C. Both A & B
👉 Hyaline arteriosclerosis = seen in HTN + diabetes.
29. Which infection is most associated with rheumatic fever?
A) Staphylococcus aureus
B) Streptococcus pyogenes
C) Streptococcus viridans
D) Neisseria gonorrhoeae
Answer: B. Streptococcus pyogenes
👉 Rheumatic fever follows group A strep throat infection.
30. “Onion-skin” appearance in blood vessels is seen in:
A) Atherosclerosis
B) Malignant hypertension
C) Diabetes mellitus
D) Tuberculosis
Answer: B. Malignant hypertension
👉 Severe HTN → onion-skin arteriolosclerosis.
31. Which pathology is associated with “nutmeg liver”?
A) Viral hepatitis
B) Chronic passive congestion due to heart failure
C) Cirrhosis
D) Alcoholic liver disease
Answer: B. Chronic passive congestion
👉 Right heart failure → congested nutmeg liver.
32. Which hepatitis virus can cause chronic infection?
A) HAV
B) HBV
C) HCV
D) Both B & C
Answer: D. Both B & C
👉 HBV & HCV cause chronic hepatitis.
33. Wilson’s disease is due to accumulation of:
A) Iron
B) Copper
C) Calcium
D) Lead
Answer: B. Copper
👉 Wilson’s = copper deposition in liver, brain, cornea.
34. “Kayser-Fleischer rings” in eyes are seen in:
A) Hemochromatosis
B) Wilson’s disease
C) Vitamin A deficiency
D) Glaucoma
Answer: B. Wilson’s disease
👉 KF rings = copper in cornea.
35. Hemochromatosis is due to excess accumulation of:
A) Calcium
B) Iron
C) Sodium
D) Lead
Answer: B. Iron
👉 Iron overload → bronze diabetes, liver cirrhosis, diabetes.
36. Which cancer is most associated with chronic alcohol abuse?
A) Breast cancer
B) Liver cancer (hepatocellular carcinoma)
C) Stomach cancer
D) Pancreatic cancer
Answer: B. Liver cancer
👉 Cirrhosis due to alcohol predisposes to hepatocellular carcinoma.
37. Which renal pathology is associated with “crescent formation”?
A) Minimal change disease
B) Focal segmental glomerulosclerosis
C) Rapidly progressive glomerulonephritis
D) Diabetic nephropathy
Answer: C. RPGN
👉 RPGN shows crescents in glomeruli.
38. Which lung cancer is strongly linked to hypercalcemia (PTHrP secretion)?
A) Adenocarcinoma
B) Small cell carcinoma
C) Squamous cell carcinoma
D) Large cell carcinoma
Answer: C. Squamous cell carcinoma
👉 Squamous cell → PTHrP → hypercalcemia.
39. Which lung cancer is most aggressive?
A) Adenocarcinoma
B) Small cell carcinoma
C) Squamous cell carcinoma
D) Large cell carcinoma
Answer: B. Small cell carcinoma
👉 Small cell = highly aggressive, early metastasis.
40. “Bence-Jones proteins” in urine are diagnostic of:
A) Leukemia
B) Multiple myeloma
C) Hodgkin’s lymphoma
D) Amyloidosis
Answer: B. Multiple myeloma
👉 Light chains in urine = multiple myeloma.
41. Which type of hypersensitivity reaction is anaphylaxis?
A) Type I
B) Type II
C) Type III
D) Type IV
Answer: A. Type I
👉 Immediate IgE-mediated hypersensitivity = anaphylaxis.
42. Graves’ disease is an example of which hypersensitivity?
A) Type I
B) Type II
C) Type III
D) Type IV
Answer: B. Type II
👉 Antibody-mediated activation of receptors = Type II.
43. Which autoimmune disease is associated with “butterfly rash”?
A) Rheumatoid arthritis
B) SLE
C) Dermatomyositis
D) Psoriasis
Answer: B. SLE
👉 Butterfly rash = systemic lupus erythematosus.
44. Rheumatoid arthritis mainly affects:
A) Large weight-bearing joints
B) Small joints of hands and feet
C) Spine only
D) Shoulder joint only
Answer: B. Small joints of hands and feet
👉 Symmetrical small joint arthritis is classic for RA.
45. Which HLA type is strongly associated with ankylosing spondylitis?
A) HLA-DR3
B) HLA-B27
C) HLA-DR2
D) HLA-DQ8
Answer: B. HLA-B27
👉 HLA-B27 = ankylosing spondylitis.
46. The most common cause of death in SLE is:
A) Heart failure
B) Renal failure
C) Stroke
D) Skin infections
Answer: B. Renal failure
👉 Lupus nephritis = leading cause of death in SLE.
47. Which leukemia is most common in children?
A) AML
B) CML
C) ALL
D) CLL
Answer: C. ALL
👉 Acute lymphoblastic leukemia is most common in children.
48. Philadelphia chromosome is associated with:
A) AML
B) CML
C) ALL
D) CLL
Answer: B. CML
👉 t(9;22) Philadelphia chromosome → CML.
49. Auer rods are seen in:
A) AML
B) ALL
C) CML
D) CLL
Answer: A. AML
👉 Auer rods = myeloblasts in AML.
50. The “starry sky” appearance is characteristic of:
A) Burkitt’s lymphoma
B) Hodgkin’s lymphoma
C) Follicular lymphoma
D) CLL
Answer: A. Burkitt’s lymphoma
👉 Rapidly growing lymphoma with “starry sky” histology.
That completes Part 1 (Q.1–50) of NCLEX Pathology MCQs 🎯
We covered cell injury, necrosis, inflammation, tumors, cardiovascular, renal, autoimmune, and hematological pathologies — all highly relevant for NCLEX preparation.