Vascular Pathology Practice Questions

Q: Which of the following is a vascular disease characterized by panarteritis where the internal elastic lamina is preserved?

Buerger's disease. **Explanation:** **Buerger’s Disease (Thromboangiitis Obliterans)** is the correct answer because it is a unique segmental, inflammatory, and thrombosing disease of small and medium-sized arteries [1]. The hallmark of Buerger’s disease is **panarteritis** (inflammation involving all layers of the vessel wall) with a distinct feature: the **internal elastic lamina remains preserved**. Unlike other vasculitides, the inflammatory process often extends to involve adjacent veins and nerves, and the thrombus typically contains microabscesses [1]. **Why other options are incorrect:** * **Takayasu Arteritis:** This is a large-vessel vasculitis (Granulomatous) that typically causes massive intimal thickening and **destruction/fragmentation of the internal elastic lamina**, leading to "pulseless disease" [2]. * **Raynaud’s Disease:** This is a functional vasospastic disorder, not an inflammatory vasculitis. There is no panarteritis or structural damage to the vessel wall in primary Raynaud’s. * **Churg-Strauss Syndrome (EGPA):** This is a small-vessel necrotizing vasculitis associated with asthma and eosinophilia. It typically involves **fibrinoid necrosis**, which destroys the vessel wall architecture, including the elastic lamina. **High-Yield Clinical Pearls for NEET-PG:** * **Patient Profile:** Almost exclusively occurs in **heavy smokers**, usually males <45 years [1]. * **Triad:** Distal ischemia (claudication), Raynaud’s phenomenon, and Migratory superficial thrombophlebitis. * **Angiographic finding:** "Corkscrew" appearance of collateral vessels. * **Treatment:** Absolute smoking cessation is the only way to halt disease progression [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 280-281. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 516-517.

Q: Glomus tumour arises from which germ layer?

Mesoderm. **Explanation:** **1. Why Mesoderm is Correct:** A Glomus tumor (glomangioma) is a benign, highly painful vascular neoplasm. It arises from the **modified smooth muscle cells** of the **glomus body**. The glomus body is a specialized arteriovenous anastomosis involved in thermoregulation. Since all vascular components—including endothelial cells, pericytes, and smooth muscle cells—are derived from the **mesoderm**, the glomus tumor is mesodermal in origin. **2. Why Other Options are Incorrect:** * **Ectoderm:** This layer gives rise to the epidermis and its appendages. While glomus tumors are often found under the nail bed (subungual), they arise from the deeper vascular structures, not the epithelial surface. * **Endoderm:** This layer primarily forms the epithelial lining of the gastrointestinal and respiratory tracts. It does not contribute to vascular or muscular tissues. * **Neuroectoderm:** This gives rise to the nervous system and melanocytes. Although glomus tumors are exquisitely painful (leading some to mistakenly associate them with nerves), the pain is due to the rich innervation of the glomus body, not because the tumor cells themselves are neural in origin. **3. High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Paroxysmal pain, pinpoint tenderness, and sensitivity to cold. * **Most Common Site:** Subungual (under the fingernails), appearing as a small, blue-red nodule. * **Histology:** Nests of uniform, round "glomus cells" surrounding thin-walled vascular spaces. * **IHC Marker:** Positive for **Alpha-Smooth Muscle Actin (α-SMA)**, confirming its smooth muscle origin. * **Treatment:** Simple surgical excision is curative.

Q: Leutic aneurysms are common in all of the following locations EXCEPT?

Abdominal aorta. **Explanation:** **Leutic aneurysms** (syphilitic aneurysms) are a complication of tertiary syphilis. The underlying pathophysiology involves **obliterative endarteritis** of the **vasa vasorum** [1]. This leads to ischemic injury of the tunica media (mesoatortitis), resulting in the loss of elastic tissue and subsequent aneurysmal dilatation [1]. **Why the Abdominal Aorta is the Correct Answer:** The distribution of leutic aneurysms is directly proportional to the density of the vasa vasorum. The **ascending aorta and arch of the aorta** have the highest concentration of vasa vasorum, making them the most common sites. As we move distally, the density of these vessels decreases significantly. The **abdominal aorta** has the fewest vasa vasora; therefore, it is rarely involved in syphilis. Instead, the abdominal aorta is the most common site for **atherosclerotic aneurysms**. **Analysis of Incorrect Options:** * **A & B (Ascending Aorta & Arch):** These are the most frequent sites (approx. 80%) for syphilitic involvement due to the rich vascular supply to the media [1]. * **C (Descending Thoracic Aorta):** While less common than the arch, it is still a recognized site for leutic aneurysms as it contains more vasa vasorum than the abdominal segment. **High-Yield Clinical Pearls for NEET-PG:** * **Gross Appearance:** The damaged intima heals with scarring, leading to a characteristic **"Tree-bark appearance."** * **Complication:** Dilation of the ascending aorta often stretches the aortic valve ring, leading to **Aortic Regurgitation** and "Cor Bovinum" (massive heart). * **Microscopy:** Plasma cell-rich infiltrate around the vasa vasorum [1]. * **Key Distinction:** Syphilis = Thoracic Aorta; Atherosclerosis = Abdominal Aorta. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 388-389.

Question 1

What is the commonest histological finding in benign hypertension?

Accepted Answer

Hyaline arteriosclerosis

Answer

Proliferative endarteritis

Answer

Necrotizing arteriolitis

Answer

Cystic medial necrosis

Question 2

Which of the following is a vascular disease characterized by panarteritis where the internal elastic lamina is preserved?

Accepted Answer

Buerger's disease

Answer

Takayasu arteritis

Answer

Raynaud's disease

Answer

Churg Strauss syndrome

Question 3

Glomus tumour arises from which germ layer?

Accepted Answer

Mesoderm

Answer

Ectoderm

Answer

Endoderm

Answer

Neuroectoderm

Question 4

All of the following conditions are associated with granulomatous pathology, except?

Accepted Answer

Polyarteritis nodosa (Classic PAN)

Answer

Wegener's granulomatosis (WG)

Answer

Takayasu arteritis (TA)

Answer

Giant cell arteritis (GCA)

Question 5

Leutic aneurysms are common in all of the following locations EXCEPT?

Accepted Answer

Abdominal aorta

Answer

Ascending aorta

Answer

Arch of aorta

Answer

Descending thoracic aorta

Question 6

Takayasu arteritis mainly affects which artery?

Accepted Answer

Subclavian artery

Answer

Dorsalis pedis artery

Answer

Celiac artery

Answer

Superior mesenteric artery

Question 7

Fat embolism is characterized by:

Accepted Answer

All

Answer

Petechial hemorrhages

Answer

Closed fractures of femur

Answer

Aggregation of chylomicrons

Question 8

Onion skin thickening of the arteriolar wall is seen in:

Accepted Answer

Hyperplastic arteriolosclerosis

Answer

Atherosclerosis

Answer

Median calcific sclerosis

Answer

Hyaline arteriolosclerosis

Question 9

Calcification of the aortic valve is seen in which of the following conditions?

Accepted Answer

Aortic stenosis

Answer

Aortic regurgitation

Answer

Marfan's syndrome

Answer

Hurler's syndrome

Question 10

What is the most common site of venous thrombosis?

Accepted Answer

Veins of the lower extremity

Answer

Veins of the upper extremity

Answer

Dural sinus

Answer

Popliteal vein

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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