Vascular Pathology Practice Questions

Q: A 22-year-old biker sustained a severe injury in a road traffic accident. After admission to the hospital, his condition suddenly worsened, leading to death. A pathological specimen was provided. What is the likely cause of death?

Pulmonary thromboembolism. ***Pulmonary thromboembolism*** - **Sudden deterioration and death** in a young trauma patient strongly suggests **massive pulmonary embolism**, likely from a **saddle embolus** blocking the main pulmonary artery. - Post-traumatic **immobilization** and **hypercoagulable state** predispose to **deep vein thrombosis** formation, which can dislodge and cause fatal **pulmonary embolism**. *Septic shock* - Would typically develop over **hours to days** with signs of **infection** like fever, elevated white cell count, and positive blood cultures. - **Sudden death** without preceding systemic inflammatory response syndrome (SIRS) makes septic shock unlikely. *Deep vein thrombosis* - DVT itself **rarely causes sudden death**; it's the source of emboli that travel to pulmonary circulation causing fatal outcomes. - Would present as **leg swelling and pain** but doesn't explain the acute fatal deterioration. *Varicosities of the vein* - **Chronic condition** involving superficial veins with tortuous, dilated appearance, not associated with sudden death. - Does not predispose to **thromboembolism** and would not cause acute fatal complications in trauma patients.

Q: Mönckenberg's sclerosis involves which layer of the artery?

Media. **Explanation:** **Mönckenberg’s Sclerosis** (also known as Medial Calcific Sclerosis) is characterized by dystrophic calcification within the **tunica media** of medium and small-sized muscular arteries. 1. **Why Option B is Correct:** The hallmark of this condition is the deposition of calcium salts in the internal elastic lamina and the muscular media. This leads to the formation of "pipe-stem" calcifications. Crucially, this process does not involve the vessel lumen; therefore, the blood flow remains patent and the condition is typically asymptomatic. 2. **Why Other Options are Incorrect:** * **Option A (Intima):** This layer is involved in **Atherosclerosis**, where fibro-fatty plaques narrow the lumen [1]. In Mönckenberg’s, the intima remains unaffected. * **Option C (Adventitia):** This is the outermost connective tissue layer. While it provides structural support, it is not the primary site of calcification in this pathology. * **Option D (All layers):** This would describe a transmural process, such as certain types of vasculitis (e.g., Polyarteritis Nodosa), rather than the localized medial calcification seen here. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most commonly seen in individuals over age 50 and patients with **Diabetes Mellitus** or **Chronic Kidney Disease**. * **Radiology:** It is often an incidental finding on X-rays, appearing as "railroad track" or "ring-like" calcifications in the extremities (e.g., femoral, tibial, or radial arteries). * **Clinical Significance:** Because it does not narrow the lumen, it does not cause ischemia. However, it makes the arteries non-compressible, which can lead to **falsely elevated Blood Pressure** readings or an abnormally high Ankle-Brachial Index (ABI). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 268-270.

Question 1

A 22-year-old biker sustained a severe injury in a road traffic accident. After admission to the hospital, his condition suddenly worsened, leading to death. A pathological specimen was provided. What is the likely cause of death?

Accepted Answer

Pulmonary thromboembolism

Answer

Septic shock

Answer

Deep vein thrombosis

Answer

Varicosities of the vein

Question 2

The Virchow triad includes all of the following except:

Accepted Answer

Pulmonary embolism

Answer

Endothelial injury

Answer

Abnormal blood flow

Answer

Hypercoagulability

Question 3

All of the following are true about pulmonary embolism except:

Accepted Answer

All cases of pulmonary embolism lead to infarction

Answer

60-80% are asymptomatic

Answer

Most thrombi are formed in deep leg veins

Answer

Embolism may lead to hemorrhagic infarcts in medium arteries

Question 4

Lymphangiosarcoma most commonly occurs in the setting of which condition?

Accepted Answer

Chronic lymphedema

Answer

Lymphangiomas

Answer

Lymphomas

Answer

Serous cavity tumors

Question 5

Which of the following shows a pumping action?

Accepted Answer

Central hemangioma

Answer

Peripheral hemangioma

Answer

Central giant cell granuloma

Answer

All of the above

Question 6

Mönckenberg's sclerosis involves which layer of the artery?

Accepted Answer

Media

Answer

Intima

Answer

Adventitia

Answer

All layers

Question 7

Which vasculitis is not commonly seen in adults?

Accepted Answer

Kawasaki disease

Answer

Henoch-Schonlein purpura

Answer

Temporal arteritis

Answer

Polyarteritis nodosa

Question 8

Kaposi sarcoma arises from which type of tissue?

Accepted Answer

Vascular tissue

Answer

Muscle tissue

Answer

Connective tissue

Answer

None of the above

Question 9

An embolus which passes through an arteriovenous communication and enters the systemic circulation is called?

Accepted Answer

Paradoxical embolus

Answer

Retrograde embolus

Answer

Saddle embolus

Answer

Atheroembolus

Question 10

What is the most common site of thrombosis?

Accepted Answer

Vein

Answer

Artery

Answer

Heart

Answer

Capillary

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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