Vascular Pathology Practice Questions

Q: A 20-year-old patient presents with a soft to firm reddish swelling progressing in size over the precordium. Histopathological examination showed findings consistent with this lesion. What is the most likely diagnosis?

Hemangioma. ***Hemangioma*** - A **soft to firm reddish swelling** that progresses in size is characteristic of hemangioma, especially in a **young patient**. - Histopathologically shows **dilated blood-filled vascular channels** lined by **benign endothelial cells**, consistent with vascular proliferation. *Fibroadenoma* - This is a **benign breast tumor** composed of **glandular and stromal tissue**, not typically found over the precordium. - Presents as a **well-circumscribed, mobile mass** in the breast, usually **non-reddish** in appearance. *Lipoma* - A **benign adipose tissue tumor** that appears **yellow** and soft, not reddish as described in this case. - Histologically shows **mature fat cells** without vascular proliferation or endothelial cell lining. *Dermatofibroma* - A **benign fibrous skin tumor** that typically presents as a **firm, brownish papule**, not a reddish swelling. - Histologically shows **fibrous tissue proliferation** in the dermis, lacking the vascular channels seen in hemangiomas.

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: Neointimal hyperplasia causes vascular graft failure as a result of hypertrophy of -

Smooth muscle cells. **Explanation:** **Neointimal hyperplasia** is the universal response of a vessel to injury (such as vascular grafting, stenting, or balloon angioplasty) [1]. The correct answer is **Smooth Muscle Cells (SMCs)** because the hallmark of this process is the migration and proliferation of SMCs from the media into the intima [1]. 1. **Why Smooth Muscle Cells are correct:** When a vessel is injured, inflammatory mediators and growth factors (like PDGF and FGF) trigger quiescent SMCs in the tunica media to undergo a phenotypic switch [1]. They migrate into the subendothelial space (intima), proliferate, and acquire new biosynthetic capabilities [1]. This results in a thickened "neointima" that narrows the vessel lumen, leading to graft failure or restenosis [1]. 2. **Why other options are incorrect:** * **Endothelial cells:** While endothelial injury initiates the process, these cells do not undergo hypertrophy to cause luminal narrowing; rather, their dysfunction or loss triggers the SMC response. * **Collagen and Elastic fibers:** These are components of the extracellular matrix. While collagen deposition increases during intimal thickening, the primary cellular driver and the entity undergoing "hypertrophy/proliferation" is the smooth muscle cell, not the fibers themselves. **NEET-PG High-Yield Pearls:** * **Key Growth Factor:** Platelet-Derived Growth Factor (PDGF) is the most potent stimulator of SMC migration. * **Phenotypic Switch:** SMCs change from a "contractile" state to a "synthetic" state during neointimal formation [1]. * **Difference from Atherosclerosis:** Neointimal hyperplasia is a predictable, stereotyped response to mechanical injury, whereas atherosclerosis is a chronic inflammatory process involving lipid accumulation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 494-495.

Question 1

A 25-year-old female underwent septic abortion. What is the most likely site for embolism of tricuspid valve vegetation?

Accepted Answer

Lung

Answer

Liver

Answer

Meninges

Answer

Spleen

Question 2

Which of the following arteries is most likely to be involved with serious atherosclerosis?

Accepted Answer

Anterior descending coronary artery.

Answer

Right coronary artery.

Answer

Left coronary artery.

Answer

Circumflex coronary artery.

Question 3

Churg-Strauss syndrome involves which of the following, except?

Accepted Answer

Heart

Answer

Lungs

Answer

Kidneys

Answer

Small blood vessels

Question 4

Which of the following conditions are classified as small vessel vasculitis?

Accepted Answer

All of the above

Answer

Wegener granulomatosis

Answer

Microscopic polyangiitis

Answer

Churg-Strauss syndrome

Question 5

Deficiency of which of the following factors increases the incidence of thrombus formation?

Accepted Answer

Lipoprotein(a)

Answer

Protein C

Answer

Antithrombin III

Answer

Protein S

Question 6

Which of the following statements is NOT true regarding hypersensitivity vasculitis?

Accepted Answer

Affects small, medium-sized, and larger arteries commonly.

Answer

May be due to deposition of immune complexes or delayed hypersensitivity.

Answer

Represents an immunologic response to an antigen.

Answer

None of the above.

Question 7

A 20-year-old patient presents with a soft to firm reddish swelling progressing in size over the precordium. Histopathological examination showed findings consistent with this lesion. What is the most likely diagnosis?

Accepted Answer

Hemangioma

Answer

Fibroadenoma

Answer

Lipoma

Answer

Dermatofibroma

Question 8

What is the most common site of acute aortic dissection?

Accepted Answer

Right lateral wall of ascending aorta

Answer

Arch of aorta

Answer

Suprarenal abdominal aorta

Answer

Infrarenal abdominal aorta

Question 9

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 10

Neointimal hyperplasia causes vascular graft failure as a result of hypertrophy of -

Accepted Answer

Smooth muscle cells

Answer

Endothelial cells

Answer

Collagen fibers

Answer

Elastic fibers

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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