Vascular Pathology Practice Questions

Q: What is an important feature in Henoch-Schönlein purpura?

Raised IgA. **Explanation:** **Henoch-Schönlein Purpura (HSP)**, now commonly referred to as **IgA Vasculitis**, is a small-vessel vasculitis characterized by the deposition of immune complexes containing **Immunoglobulin A (IgA)**. 1. **Why "Raised IgA" is correct:** The hallmark of HSP is a Type III hypersensitivity reaction where IgA-dominant immune complexes deposit in the walls of small vessels (capillaries, venules, and arterioles). This leads to systemic inflammation. Clinically, serum IgA levels are elevated in approximately 50% of patients, and immunofluorescence microscopy of skin or renal biopsies characteristically shows granular IgA deposits [1]. 2. **Why other options are incorrect:** * **Membranous glomerulonephritis:** HSP is associated with **IgA Nephropathy** (Berger’s disease-like picture), characterized by mesangial proliferation [2], not membranous glomerulonephritis (which involves subepithelial IgG/C3 deposits). * **Absent radial pulse:** This is a classic feature of **Takayasu Arteritis** ("Pulseless disease"), a large-vessel vasculitis. * **Aneurysm of branching point:** This refers to **Berry Aneurysms** (associated with ADPKD) or the "string of beads" appearance seen in **Polyarteritis Nodosa (PAN)**, a medium-vessel vasculitis. **NEET-PG High-Yield Pearls:** * **Classic Tetrad:** 1. Palpable purpura (buttocks/legs), 2. Arthralgia, 3. Abdominal pain (colic/intussusception), 4. Renal disease (hematuria). * **Epidemiology:** Most common vasculitis in children; often follows an Upper Respiratory Tract Infection (URTI) [2]. * **Biopsy:** Shows Leukocytoclastic vasculitis with IgA deposition. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 535-536. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 928-929.

Q: Atherosclerosis in the coronary circulation most commonly affects which artery?

Left anterior descending artery. **Explanation:** Atherosclerosis is a chronic inflammatory process characterized by the formation of fibro-fatty plaques in the intima of large and medium-sized arteries [1]. In the coronary circulation, the distribution of these plaques is not uniform; they occur most frequently at sites of **turbulent blood flow and branch points**. **1. Why Option A is Correct:** The **Left Anterior Descending (LAD) artery** is the most common site for clinically significant atherosclerosis. It is often referred to as the "widow-maker" because it supplies the majority of the left ventricle (the apex, anterior wall, and anterior two-thirds of the interventricular septum). The high hemodynamic stress and specific branching pattern at the LAD origin make it highly susceptible to plaque formation. **2. Why Other Options are Incorrect:** * **Options B & C:** While the **Right Coronary Artery (RCA)** and the **Left Circumflex Artery (LCX)** are frequently involved, they follow the LAD in terms of statistical frequency. The typical order of involvement in coronary atherosclerosis is: **LAD > RCA > LCX**. * **Option D:** While atherosclerosis can be diffuse, it does not affect all arteries with equal frequency or severity; the LAD remains the primary site of predilection. **Clinical Pearls for NEET-PG:** * **Order of Arterial Involvement (General):** Lower Abdominal Aorta > Coronary Arteries > Popliteal Arteries [1] > Internal Carotid > Circle of Willis. * **Vessel Sparing:** The **Internal Mammary (Thoracic) Artery** and the **Upper Extremity Arteries** are characteristically spared from atherosclerosis. * **Risk Factors:** The most important modifiable risk factor is **Hyperlipidemia/Hypercholesterolemia**, while the most important non-modifiable risk factor is **Family History**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 507-508.

Q: A 25-year-old man presents to the emergency room with severe abdominal pain. Guaiac test on stool demonstrates occult blood. The patient undergoes exploratory laparotomy, revealing a small area of infarcted small bowel, which is surgically removed. Histologic studies on the removed section of bowel demonstrate a recent thrombus occluding a small muscular artery. The adjacent vessel wall shows fibrinoid necrosis with a mixed inflammatory infiltrate containing neutrophils, eosinophils, and mononuclear cells. Which of the following is the most likely cause of the small bowel infarction?

Polyarteritis nodosa. **Explanation:** The clinical presentation and histopathology point toward **Polyarteritis Nodosa (PAN)**. PAN is a systemic necrotizing vasculitis that typically affects small-to-medium-sized muscular arteries. **Why the correct answer is right:** The hallmark of PAN is **segmental, transmural inflammation** of the vessel wall. The description of **fibrinoid necrosis** with a mixed inflammatory infiltrate (neutrophils and eosinophils) is pathognomonic for the acute phase of PAN. Because it involves the mesenteric arteries, it frequently leads to bowel ischemia, infarction, or perforation. The presence of "recent thrombus" in a "small muscular artery" in a young patient (25 years old) strongly favors a vasculitis over degenerative vascular diseases. **Why incorrect options are wrong:** * **A. Atherosclerosis:** Typically occurs in older patients with risk factors (smoking, DM, HTN). It involves large elastic arteries and shows cholesterol plaques rather than fibrinoid necrosis. * **B. Cystic medial necrosis:** Characterized by the degeneration of the tunica media (common in Marfan syndrome), leading to aortic aneurysms or dissections, not small bowel infarction via small artery occlusion. * **C. Monckeberg’s arteriosclerosis:** Involves dystrophic calcification of the media in medium-sized arteries. It is usually an incidental finding as it does not narrow the lumen and does not cause ischemia. **High-Yield Clinical Pearls for NEET-PG:** * **PAN Association:** Strongly associated with **Hepatitis B surface antigen (HBsAg)** in ~30% of cases. * **Vessel Involvement:** PAN characteristically **spares the pulmonary vessels**. * **Imaging:** Classic "string of pearls" appearance on angiography due to microaneurysms. * **Key Histology:** Lesions of **different stages** (acute fibrinoid necrosis vs. fibrous thickening) coexist in the same or different vessels.

Question 1

What is an important feature in Henoch-Schönlein purpura?

Accepted Answer

Raised IgA

Answer

Membranous glomerulonephritis

Answer

Absent radial pulse

Answer

Aneurysm of branching point

Question 2

What is the most widely accepted theory regarding the cause of atherosclerosis?

Accepted Answer

Lipid infiltration of the intima

Answer

Smoking

Answer

Hyperlipidemia

Question 3

A 56-year-old male presents with the sudden onset of excruciating pain. He describes the pain as beginning in the anterior chest, radiating to the back, and then moving downward into the abdomen. His blood pressure is found to be 160/115. ECG shows no changes. An abdominal x-ray reveals a "double-barrel" aorta. This abnormality most likely results from?

Accepted Answer

Loss of elastic tissue in the media

Answer

A microbial infection

Answer

A congenital defect in the wall of the aorta

Answer

Atherosclerosis of the abdominal aorta

Question 4

Buerger disease affects which layers of the artery?

Accepted Answer

All of the above

Answer

Tunica intima

Answer

Tunica media

Answer

Tunica adventitia

Question 5

Atherosclerosis in the coronary circulation most commonly affects which artery?

Accepted Answer

Left anterior descending artery

Answer

Left circumflex artery

Answer

Right coronary artery

Answer

All of the above

Question 6

Pericyte formation occurs in which of the following?

Accepted Answer

Myopericytoma

Answer

Kaposi's sarcoma

Answer

Glomus tumor

Answer

Hemangiopericytoma

Question 7

Which of the following is NOT a small vessel vasculitis?

Accepted Answer

Takayasu's arteritis

Answer

Wegener's granulomatosis

Answer

Churg Strauss Syndrome

Answer

Microscopic polyangitis

Question 8

Which of the following statements regarding glomus tumors is not true?

Accepted Answer

It is usually asymptomatic and produces pain only if it undergoes malignant change.

Answer

It is a benign tumor of the glomus body.

Answer

The most common site is the distal phalanges.

Answer

It is a tumor of modified smooth muscle cells.

Question 9

A 25-year-old man presents to the emergency room with severe abdominal pain. Guaiac test on stool demonstrates occult blood. The patient undergoes exploratory laparotomy, revealing a small area of infarcted small bowel, which is surgically removed. Histologic studies on the removed section of bowel demonstrate a recent thrombus occluding a small muscular artery. The adjacent vessel wall shows fibrinoid necrosis with a mixed inflammatory infiltrate containing neutrophils, eosinophils, and mononuclear cells. Which of the following is the most likely cause of the small bowel infarction?

Accepted Answer

Polyarteritis nodosa

Answer

Atherosclerosis

Answer

Cystic medial necrosis

Answer

Monckeberg's arteriosclerosis

Question 10

An 80-year old male diabetic presents with a 7-cm pulsating mass in the midline of his lower abdomen. He has diminished pulses in his lower extremities. Which of the following complications of aortic atherosclerosis is responsible for the development of this lesion?

Accepted Answer

Atrophy (thinning) of the media

Answer

Ulceration of atherosclerotic plaque

Answer

Thrombosis overlying atherosclerotic plaque

Answer

Hemorrhage into the plaque substance

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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