Vascular Pathology Practice Questions

Q: Onion skin thickening of the arteriolar wall is seen in which of the following conditions?

Lyme arthritis. **Explanation:** The characteristic **"onion-skin" thickening** of arteriolar walls is a hallmark of **Hyperplastic Arteriolosclerosis** [1]. While classically associated with malignant hypertension, it is also a pathognomonic histopathological feature of **Lyme arthritis** (caused by *Borrelia burgdorferi*). In Lyme disease, this appearance results from the concentric proliferation of smooth muscle cells and laminated basement membrane thickening, often accompanied by a perivascular lymphocytic infiltrate [2]. **Analysis of Options:** * **A. Atherosclerosis:** Characterized by the formation of intimal "atheromas" (fibrofatty plaques) in large and medium-sized arteries, not concentric arteriolar thickening [2]. * **B. Monckeberg Medial Calcific Sclerosis:** Involves dystrophic calcification of the media of medium-sized muscular arteries. It does not narrow the lumen and lacks the "onion-skin" layers. * **C. Hyaline Arteriolosclerosis:** Seen in chronic hypertension and diabetes mellitus. It shows homogenous, pink, acidophilic thickening of the wall due to plasma protein leakage, leading to luminal narrowing, but lacks the laminated "onion-skin" appearance [2]. **High-Yield Pearls for NEET-PG:** * **Hyperplastic Arteriolosclerosis ("Onion-skinning"):** Seen in Malignant Hypertension (BP >200/120 mmHg), Scleroderma renal crisis, and Lyme arthritis [1]. * **Lyme Disease Triad:** Erythema chronicum migrans (bull’s eye rash), bilateral facial nerve palsy, and arthritis with onion-skin vascular changes. * **Fibrinoid Necrosis:** Often accompanies hyperplastic changes in malignant hypertension, particularly in the kidney (necrotizing arteriolitis) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 943-945. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 498-499.

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.

Question 1

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

Accepted Answer

Lipid infiltration of the intima

Answer

Smoking

Answer

Hyperlipidemia

Question 2

Onion skin thickening of the arteriolar wall is seen in which of the following conditions?

Accepted Answer

Lyme arthritis

Answer

Atherosclerosis

Answer

Median calcific sclerosis

Answer

Hyaline arteriolosclerosis

Question 3

What is the most common association with atherosclerosis?

Accepted Answer

Cigarette smoking

Answer

Less physical activity

Answer

Diabetes Mellitus

Answer

Increased uptake of unsaturated fatty acids

Question 4

An atheromatous plaque does not contain which of the following?

Accepted Answer

Neutrophils

Answer

Platelets

Answer

Smooth muscle fibres

Answer

Monocytes

Question 5

What is the most common source of systemic emboli?

Accepted Answer

Mural thrombi

Answer

Varicose veins

Answer

Cardiac thrombi

Answer

Pulmonary embolism

Question 6

Buerger disease affects which layers of the artery?

Accepted Answer

All of the above

Answer

Tunica intima

Answer

Tunica media

Answer

Tunica adventitia

Question 7

A 40-year-old pregnant female in her third trimester presents with bilateral leg swelling. Which type of thrombosis is most likely to develop in this patient?

Accepted Answer

Venous

Answer

Arterial

Answer

Mural

Answer

Saddle

Question 8

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 9

A lesion composed of microscopic vessels is called as:

Accepted Answer

Haemangioma and Angioma

Answer

Haemangioma

Answer

Angioma

Answer

None of Haemangioma and Angioma

Question 10

The defect in Berry aneurysm lies in which layer of the artery?

Accepted Answer

Degeneration of the media/muscle cell layer

Answer

Degeneration of the internal elastic lamina

Answer

Deposition of mucoid material in the media

Answer

Low-grade inflammation of the vessel wall

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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