Vascular Pathology Practice Questions

Q: Migratory thrombophlebitis is seen in which of the following conditions?

Disseminated cancer. **Explanation:** **Migratory thrombophlebitis**, also known as **Trousseau syndrome**, is a clinical condition characterized by recurrent episodes of superficial venous thrombosis that appear at different sites over time [3]. **1. Why Disseminated Cancer is Correct:** The underlying mechanism is a **paraneoplastic syndrome** associated with occult or disseminated malignancy [2]. Cancer cells (especially **adenocarcinomas**) release procoagulants such as tissue factor and mucins into the circulation [3]. These substances trigger the extrinsic coagulation pathway and cause platelet aggregation, leading to a hypercoagulable state [1]. While most classically associated with **pancreatic carcinoma** (body and tail), it is also seen in lung, gastric, and colon cancers [3]. **2. Why Other Options are Incorrect:** * **Rheumatic Heart Disease (RHD):** While RHD can lead to atrial fibrillation and subsequent systemic embolism, it does not typically cause migratory superficial venous thrombosis. * **Libman-Sacks Endocarditis:** This is a form of non-bacterial verrucous endocarditis seen in Systemic Lupus Erythematosus (SLE). While SLE is a hypercoagulable state (often via Antiphospholipid Syndrome), Libman-Sacks itself refers to sterile vegetations on heart valves, not migratory thrombophlebitis. **Clinical Pearls for NEET-PG:** * **Classic Association:** Pancreatic Adenocarcinoma (High-yield: Look for a patient with weight loss, jaundice, and migrating skin nodules/redness) [4]. * **Trousseau Sign vs. Trousseau Syndrome:** Do not confuse *Trousseau syndrome* (migratory thrombophlebitis) with *Trousseau sign of latent tetany* (carpal spasm induced by BP cuff inflation in hypocalcemia). * **Management:** The definitive treatment is managing the underlying malignancy; however, **Low Molecular Weight Heparin (LMWH)** is the preferred anticoagulant, as these patients often respond poorly to Warfarin.

Q: Glomerulonephritis is NOT a feature of which of the following conditions?

Polyarteritis nodosa. ### Explanation The key to answering this question lies in understanding the classification of systemic vasculitides based on the size of the vessels involved. **Why Polyarteritis Nodosa (PAN) is the correct answer:** Polyarteritis nodosa is a **medium-vessel vasculitis**. By definition, it involves the medium-sized muscular arteries and specifically **spares the smallest vessels**, such as capillaries, venules, and arterioles. Since the glomerular tuft is composed of capillaries, PAN does not cause glomerulonephritis. While PAN frequently involves the kidneys (causing renal artery aneurysms, infarcts, and hypertension), it manifests as **renovascular disease** rather than intrinsic glomerular inflammation. **Why the other options are incorrect:** Options A, B, and C are all classified as **ANCA-associated small-vessel vasculitides**. Small-vessel vasculitis characteristically involves the intraparenchymal capillaries [1]. * **Granulomatosis with polyangiitis (GPA):** Frequently presents with "Pauci-immune" crescentic glomerulonephritis (RPGN) [1]. * **Microscopic polyangiitis (MPA):** Glomerulonephritis is a hallmark feature, occurring in nearly 90% of cases. * **Churg-Strauss syndrome (EGPA):** While less common than in GPA or MPA, renal involvement in the form of glomerulonephritis can occur. **NEET-PG High-Yield Pearls:** * **PAN & Hepatitis B:** There is a strong clinical association between PAN and Hepatitis B surface antigenemia (HBsAg). * **Imaging in PAN:** The "gold standard" for diagnosis is often digital subtraction angiography showing **"string of beads"** appearance (multiple microaneurysms). * **ANCA Status:** PAN is characteristically **ANCA-negative**, whereas GPA (c-ANCA/PR3) and MPA/EGPA (p-ANCA/MPO) are typically ANCA-positive. * **Rule of Thumb:** If a question mentions "Glomerulonephritis" or "Pulmonary Capillaritis/Hemorrhage," think **Small-Vessel Vasculitis**, not PAN [1].

Question 1

Migratory thrombophlebitis is seen in which of the following conditions?

Accepted Answer

Disseminated cancer

Answer

Rheumatic heart disease

Answer

Libman-Sacks endocarditis

Answer

All of the above

Question 2

Glomerulonephritis is NOT a feature of which of the following conditions?

Accepted Answer

Polyarteritis nodosa

Answer

Granulomatosis with polyangiitis (Wegener's)

Answer

Churg-Strauss syndrome

Answer

Microscopic polyangiitis

Question 3

A 30-year-old male smoker presents with gangrene of his extremities. Which one of the following histologic findings from a biopsy of the blood vessels supplying this area would be most suggestive of Buerger's disease?

Accepted Answer

Thrombosis with microabscesses

Answer

Granulomatous inflammation with giant cells

Answer

Fibrinoid necrosis with overlying thrombosis

Answer

Focal aneurysmal dilation

Question 4

Which of the following is associated with C-ANCA?

Accepted Answer

Proteinase 3

Answer

Myeloperoxidase

Answer

Alkaline phosphatase

Answer

Lactate dehydrogenase

Question 5

Which of the following is true about the basic structure of an atherosclerotic plaque?

Accepted Answer

The convex part is formed by the fibrous cap.

Answer

The concave part is formed by the fibrous cap.

Answer

The convex part is formed by the tunica media of the vessel.

Answer

The necrotic core contains collagen, elastin, and proteoglycans.

Question 6

In a patient with risk factors including smoking, hypertension, diabetes mellitus, and a serum cholesterol level of 280 mg/dl, in which of the following locations would you least expect to find significant atherosclerotic lesions?

Accepted Answer

Pulmonary artery trunk

Answer

Left main coronary artery

Answer

Aortic bifurcation

Answer

Circle of Willis

Question 7

In which of the following conditions is c-ANCA typically seen?

Accepted Answer

Wegener's granulomatosis

Answer

Polyarteritis nodosa

Answer

Churg-Strauss syndrome

Answer

Bechet's syndrome

Question 8

Glomus cells are found in which of the following conditions?

Accepted Answer

Carotid body tumor

Answer

Thyroid carcinoma

Answer

Liver carcinoma

Answer

Glomous tumor

Question 9

Migratory thrombophlebitis is seen in all except?

Accepted Answer

Carcinoma of breast

Answer

Carcinoma of pancreas

Answer

Carcinoma of prostate

Answer

Carcinoma of lung

Question 10

A 21-year-old woman is in the third trimester of an uncomplicated pregnancy. She has noted an enlarging nodule in her mouth for the past 2 weeks. On physical examination, there is a 1-cm red nodule on the left lateral gingiva below the first molar. The nodule regresses following delivery. What is this nodule most likely to be?

Accepted Answer

Capillary hemangioma

Answer

Bacillary angiomatosis

Answer

Cavernous lymphangioma

Answer

Glomus tumor

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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