Vascular Pathology Practice Questions

Q: Which of the following vasculitis is NOT classified as a medium-vessel disease?

Microscopic polyangiitis (MPA). ***Microscopic polyangiitis (MPA)*** - This condition is classified as a **small-vessel vasculitis** because it primarily affects capillaries, venules, and arterioles. - It is strongly associated with **p-ANCA** and typically presents as a pauci-immune necrotizing vasculitis without granulomatous inflammation. *Polyarteritis nodosa (PAN)* - This is a classic example of a **medium-vessel vasculitis** characterized by necrotizing inflammation of medium-sized muscular arteries. - It typically spares the **pulmonary circulation** and is often associated with **Hepatitis B** infection. *Buerger's disease (Thromboangiitis obliterans)* - This is considered a **medium-vessel vasculitis** (or sometimes small-to-medium) that affects the arteries and veins of the extremities. - It is strongly associated with **tobacco use** and leads to segmental, thrombotic, occlusive inflammation. *Kawasaki disease* - This is a well-known **medium-vessel vasculitis** affecting children, classically causing mucocutaneous lymph node syndrome. - A major clinical concern with this disease is the development of **coronary artery aneurysms** due to its affinity for medium-sized vessels.

Q: Which multifocal tumor of vascular origin is commonly seen in patients with AIDS?

Kaposi sarcoma. **Explanation:** **Kaposi Sarcoma (KS)** is the correct answer as it is the most common neoplasm associated with HIV/AIDS. It is a **multifocal tumor of vascular endothelial origin** caused by **Human Herpesvirus 8 (HHV-8)**, also known as Kaposi Sarcoma-associated Herpesvirus (KSHV). In AIDS patients, it typically presents as painless, reddish-purple skin nodules or plaques, but it can also involve the viscera (lungs, GI tract). It is considered an AIDS-defining illness. **Analysis of Incorrect Options:** * **Astrocytoma:** This is a primary brain tumor of glial origin. While HIV patients are at risk for various CNS issues, astrocytomas are not specifically linked to HIV or vascular proliferation. * **Gastric Carcinoma:** This is an epithelial malignancy. While HIV patients have a higher risk of certain GI cancers (like Lymphoma), gastric adenocarcinoma is not the classic vascular tumor associated with the virus. * **Primary CNS Lymphoma:** This is the second most common malignancy in AIDS patients (associated with **EBV**). However, it is a tumor of **lymphoid origin**, not vascular origin. **High-Yield Clinical Pearls for NEET-PG:** * **Histology:** Characterized by **spindle-shaped cells**, slit-like vascular spaces, and extravasated RBCs. * **Transmission:** HHV-8 is primarily transmitted through saliva and sexual contact. * **Other HHV-8 Associations:** Primary Effusion Lymphoma (PEL) and Multicentric Castleman Disease. * **Treatment:** Highly Active Antiretroviral Therapy (HAART) often leads to regression of lesions by boosting CD4 counts.

Question 1

Which of the following vasculitis is NOT classified as a medium-vessel disease?

Accepted Answer

Microscopic polyangiitis (MPA)

Answer

Polyarteritis nodosa (PAN)

Answer

Buerger's disease (Thromboangiitis obliterans)

Answer

Kawasaki disease

Question 2

A 25-year-old male is brought to the emergency department 48 hours after sustaining a closed fracture of the right femur in a road traffic accident. He develops sudden onset confusion, petechial rash over the chest, and progressive hypoxia. Chest X-ray shows bilateral diffuse infiltrates. A lung biopsy specimen is stained with hematoxylin and eosin (H&E) on a paraffin section and examined (Image 1). Which of the following best explains the pathophysiological mechanism responsible for the pulmonary findings seen in this image?

Accepted Answer

A. Mechanical obstruction of pulmonary capillaries by marrow-derived neutral lipids released from fractured bone, triggering a secondary inflammatory cascade

Answer

B. Thrombotic occlusion of pulmonary arterioles by platelet-fibrin thrombi originating from deep venous thrombosis in the injured limb

Answer

C. Diffuse alveolar damage caused by direct aspiration of gastric contents following loss of consciousness at the time of injury

Answer

D. Immune complex deposition in pulmonary capillary walls triggering complement-mediated neutrophilic inflammation

Question 3

Kaposi's sarcoma is a tumor of which system?

Accepted Answer

Blood vessels

Answer

Reticuloendothelial system

Answer

Striated muscles

Answer

Smooth muscles

Question 4

A 55-year-old woman presents with several weeks of fever, abdominal pain, weight loss, and fatigue. Three days prior to assessment, she developed a left foot drop. Her blood pressure is 160/90 mm Hg and pulse is 80/min. Physical examination confirms left peroneal nerve damage and a bilateral sensory neuropathy in both legs. There are no skin rashes. Laboratory evaluation reveals an ESR of 105 mm/h, WBC of 14,000/mL, and negative serologic tests for antineutrophil cytoplasmic antibody (ANCA) and ANA. The eosinophil count is normal, and urinalysis is negative for casts, protein, and red cells. A clinical diagnosis of polyarteritis nodosa is made. Which of the following is the most likely mechanism for renal injury in this condition?

Accepted Answer

necrotizing vasculitis of vessels

Answer

nephrotic syndrome

Answer

diffuse glomerulonephritis

Answer

granuloma formation

Question 5

Which multifocal tumor of vascular origin is commonly seen in patients with AIDS?

Accepted Answer

Kaposi sarcoma

Answer

Astrocytoma

Answer

Gastric Carcinoma

Answer

Primary CNS lymphoma

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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