Vasculitis — MCQs
All of the following conditions are associated with raised ANCA, except:
Which one of the following conditions is associated with Kawasaki's syndrome?
Which of the following is a type of small vessel vasculitis?
All of the following statements about Giant cell arteritis are true except?
Which type of blood vessel is most commonly affected in hypersensitivity vasculitis?
Which of the following is NOT a large vessel vasculitis?
A patient presents with pulmonary hemorrhage and is P-ANCA positive. What is the most likely diagnosis?
Which of the following is a 'Small Vessel Vasculitis':
A 12-year-old boy presents with weak pulses in the upper limbs, a blood pressure of 90/60 mmHg , and retinal hemorrhages. What is the most likely diagnosis?
Fibrinoid necrosis with neutrophilic infiltration is seen in ?
Vasculitis Indian Medical PG Practice Questions and MCQs
Question 1: All of the following conditions are associated with raised ANCA, except:
- A. Polyarteritis Nodosa (Correct Answer)
- B. Wegener's granulomatosis
- C. Microscopic Polyangitis
- D. Churg-Strauss syndrome
Explanation: ***Polyarteritis Nodosa*** - Polyarteritis Nodosa is not typically associated with **positive ANCA** (Anti-Neutrophil Cytoplasmic Antibodies) and is mainly characterized by systemic vasculitis affecting medium-sized arteries. [1] - This condition usually presents with symptoms like **weight loss**, **fever**, and **muscle pain**, without the underlying ANCA association. [1] *Wegener's granulomatosis* - Also known as Granulomatosis with Polyangiitis, this condition is strongly associated with **c-ANCA** positivity, often targeting **proteinase 3**. - Clinical features include **respiratory symptoms** and renal involvement, particularly **glomerulonephritis**. *Microscopic Polyangitis* - This vasculitis is associated with **p-ANCA** positivity, commonly targeting **myeloperoxidase** (MPO). - It frequently presents with **pulmonary hemorrhage** and **renal vasculitis**. *Churg-Strauss syndrome* - Known as Eosinophilic Granulomatosis with Polyangiitis, it is associated with **p-ANCA** and involves asthma, eosinophilia, and systemic vasculitis [2]. - Typical manifestations include **respiratory involvement** and peripheral neuropathy, further linking it to ANCA positivity.
Question 2: Which one of the following conditions is associated with Kawasaki's syndrome?
- A. Acute rheumatic fever
- B. Pulmonary embolus
- C. Systemic lupus erythematosus
- D. Coronary artery aneurysm (Correct Answer)
Explanation: ***Coronary artery aneurysm*** - **Coronary artery aneurysms** are a major and potentially life-threatening complication, occurring in 15-25% of untreated children with Kawasaki disease [1]. - This is due to the disease's predilection for causing **vasculitis** in medium-sized arteries, particularly the coronary arteries [1]. *Acute rheumatic fever* - Acute rheumatic fever is an **inflammatory disease** that can develop after an infection with Group A Streptococcus (strep throat or scarlet fever) [2]. - It primarily affects the **heart, joints, brain, and skin**, but its pathophysiology and clinical presentation are distinct from Kawasaki disease [2]. *Pulmonary embolus* - A **pulmonary embolus** is a block in one of the pulmonary arteries in your lungs, usually caused by blood clots that travel to the lungs from the legs or, rarely, other parts of the body. - It is not a characteristic feature or complication of **Kawasaki disease**. *Systemic lupus erythematosus* - **Systemic lupus erythematosus (SLE)** is a chronic autoimmune disease that can affect almost any part of the body, leading to a wide range of symptoms. - While it can cause vasculitis, its epidemiology, clinical presentation, and specific organ involvement are distinctly different from **Kawasaki disease**.
Question 3: Which of the following is a type of small vessel vasculitis?
- A. Classical PAN
- B. Giant cell arteritis
- C. Granulomatosis with polyangiitis (GPA) (Correct Answer)
- D. None of the options
Explanation: ***Granulomatosis with polyangiitis (GPA)*** - GPA is a prototypic **ANCA-associated small vessel vasculitis** characterized by necrotizing granulomas and vasculitis [1], [2]. - It commonly involves the **upper and lower respiratory tracts** and the **kidneys** with necrotizing granulomatous inflammation [1], [2]. - Classified as small vessel vasculitis according to the **Chapel Hill Consensus Conference** classification. *Classical PAN* - This refers to **Polyarteritis Nodosa (PAN)**, which is a **medium-sized vessel vasculitis**. - PAN is characterized by multifocal inflammatory and necrotizing lesions of medium-sized muscular arteries, **not small vessels**. *Giant cell arteritis* - **Giant cell arteritis (GCA)** is a **large vessel vasculitis** that primarily affects the aorta and its major branches, particularly the temporal artery [3]. - Symptoms include headache, jaw claudication, and visual disturbances, reflecting the involvement of larger blood vessels [3]. *None of the options* - This option is incorrect because Granulomatosis with polyangiitis (GPA) is a clear example of a small vessel vasculitis. - There is a correct answer among the provided choices. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 519-520. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 536-537. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 515-516.
Question 4: All of the following statements about Giant cell arteritis are true except?
- A. Involves large to small sized arteries (Correct Answer)
- B. Granulomatous inflammation
- C. Segmental nature of the involvement
- D. Can involve the aorta and its major branches
Explanation: ***Involves large to small sized arteries*** - Giant cell arteritis (GCA) predominantly affects **medium to large-sized arteries**, most commonly the branches of the **carotid artery**, such as the temporal arteries [1]. - While it can affect various arteries, it does not typically involve **small-sized arteries**, such as arterioles, directly as a primary site of inflammation. *Granulomatous inflammation* - GCA is characterized histologically by **granulomatous inflammation** within the arterial wall, which includes multinucleated **giant cells** and lymphocytes [2]. - This specific inflammatory pattern is a hallmark feature used in the diagnosis of GCA upon biopsy [2]. *Segmental nature of the involvement* - The arterial inflammation in GCA is often **segmental**, meaning that affected arteries may have inflamed and non-inflamed sections alternating along their length [2]. - This segmental involvement often necessitates **longer biopsies** (e.g., 2-3 cm for temporal artery biopsy) to increase the diagnostic yield. *Can involve the aorta and its major branches* - GCA can indeed affect the **aorta** (aortitis) and its major branches, leading to complications like **aneurysms** or **dissections**. - Involvement of these larger vessels can manifest as symptoms such as **claudication** in the limbs or asymptomatic aneurysms detectable on imaging [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 688-689. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 516-517.
Question 5: Which type of blood vessel is most commonly affected in hypersensitivity vasculitis?
- A. Postcapillary venules (Correct Answer)
- B. Arterioles
- C. Veins
- D. Capillaries
Explanation: ***Postcapillary venules*** - Hypersensitivity vasculitis primarily affects **postcapillary venules**, leading to immune complex deposition and subsequent inflammation [1]. - This type of vasculitis results in **nonspecific inflammation**, commonly seen in conditions like **drug reactions** and **infections**. - The immune complex vasculitis typically involves **small vessels such as the vascular plexus of the skin**, which features neutrophilic infiltration [2]. *Veins* - While veins can be involved in various vascular diseases, they are not specifically characteristic of **hypersensitivity vasculitis**. - This type of vasculitis is more centered around **smaller vessels**, particularly venules, rather than the larger venous systems. *Capillaries* - Capillaries are involved in many vascular conditions, but hypersensitivity vasculitis particularly correlates with **venular structures**. - The immune response seen in hypersensitivity vasculitis is more pronounced in **postcapillary venules**, leading to specific symptoms. *Aerioles* - "Aerioles" may refer to arterioles, which are primarily associated with **hypertensive and ischemic events** rather than vasculitis. - Hypersensitivity vasculitis is primarily due to **post-capillary venule** inflammation rather than changes in arterioles. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 514-515. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 278-279.
Question 6: Which of the following is NOT a large vessel vasculitis?
- A. Giant cell arteritis
- B. Aortitis
- C. PAN (Correct Answer)
- D. Takayasu disease
Explanation: ***PAN*** - **Polyarteritis Nodosa (PAN)** is a **medium-sized vessel vasculitis** that causes necrotizing inflammation of the muscular arteries [4]. - It specifically spares arterioles, capillaries, and venules, distinguishing it from large vessel vasculitides [4]. - PAN typically presents with **systemic symptoms**, **renal involvement**, **peripheral neuropathy**, and **skin manifestations** [1]. *Giant cell arteritis* - **Giant cell arteritis (GCA)**, or temporal arteritis, is a **large vessel vasculitis** affecting the aorta and its major branches, particularly the temporal artery [2]. - It commonly presents in individuals over 50 years old with symptoms like **headache**, **jaw claudication**, and **vision loss** [3]. *Aortitis* - **Aortitis** refers to inflammation of the aorta, which is the body's largest artery, making it by definition a **large vessel vasculitis**. - It can be seen in conditions like **Takayasu arteritis** [3] or **syphilis**, affecting the vessel wall. *Takayasu disease* - **Takayasu arteritis** is a chronic inflammatory condition primarily affecting the **aorta** and its main branches, classifying it as a **large vessel vasculitis** [3]. - It often affects young women and can lead to **stenosis** or **aneurysm formation** in the affected vessels [3]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 687-688. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 516-517. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 688-689. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 517-518.
Question 7: A patient presents with pulmonary hemorrhage and is P-ANCA positive. What is the most likely diagnosis?
- A. Churg-Strauss syndrome
- B. Microscopic polyangiitis (Correct Answer)
- C. Wegener granulomatosis
- D. Polyarteritis nodosa (PAN)
Explanation: ***Microscopic polyangiitis*** - This condition is characterized by **pulmonary hemorrhage** (often manifesting as diffuse alveolar hemorrhage) and **P-ANCA positivity**, which is typically associated with antibodies against **myeloperoxidase (MPO)**. [1] - It is a **small-vessel vasculitis** that frequently affects the kidneys (glomerulonephritis) and lungs without granuloma formation. *Churg-Strauss syndrome* - While Churg-Strauss syndrome (now known as **Eosinophilic Granulomatosis with Polyangiitis**, EGPA) can be P-ANCA positive, it is typically associated with a history of **asthma**, **allergic rhinitis**, and **eosinophilia**. [1] - Pulmonary involvement often includes **infiltrates** and nodules, but diffuse alveolar hemorrhage with severe pulmonary hemorrhage is less common as the primary presentation compared to MPA. *Wegener granulomatosis* - Wegener granulomatosis (now known as **Granulomatosis with Polyangiitis**, GPA) primarily presents with **upper and lower respiratory tract granulomatous inflammation** and **glomerulonephritis**. - It is typically associated with **C-ANCA positivity** (antibodies against proteinase 3, PR3), not P-ANCA. *Polyarteritis nodosa (PAN)* - Polyarteritis nodosa is a **medium-vessel vasculitis** that typically affects the **kidneys, gastrointestinal tract, skin, and nervous system**. [1] - It is classically **ANCA-negative** and does not typically cause pulmonary hemorrhage or diffuse alveolar hemorrhage.
Question 8: Which of the following is a 'Small Vessel Vasculitis':
- A. Takayasu's Disease
- B. Polyaeritis Nodosa (PAN)
- C. Microscopic polyangitis (Correct Answer)
- D. Giant cell vasculitis
Explanation: ***Microscopic polyangitis*** - This is a form of **ANCA-associated vasculitis** that primarily affects **small vessels** (capillaries, venules, and arterioles) [1]. - It is characterized by **necrotizing vasculitis** within these small vessels, often presenting with features like **glomerulonephritis** and **pulmonary hemorrhage** [1]. *Takayasu's Disease* - This is a **large vessel vasculitis** that primarily affects the **aorta** and its major branches [1]. - It often presents with symptoms related to **ischemia** in the upper limbs or head, such as claudication or syncope. *Polyaeritis Nodosa (PAN)* - This is a **medium-sized vessel vasculitis** that typically spares capillaries, venules, and arterioles, distinguishing it from small vessel vasculitis [1]. - It classically presents as a **necrotizing vasculitis** affecting multiple organs, often without affecting the lungs or glomeruli significantly. *Giant cell vasculitis* - Also known as **Temporal Arteritis**, this is a **large vessel vasculitis** affecting the aorta and its major branches, particularly the branches of the **carotid artery** [1]. - It is characterized by the presence of **giant cells** in the inflamed vessel wall and is a common cause of **headache**, **jaw claudication**, and **vision loss** in older adults.
Question 9: A 12-year-old boy presents with weak pulses in the upper limbs, a blood pressure of 90/60 mmHg , and retinal hemorrhages. What is the most likely diagnosis?
- A. Henoch-Schönlein purpura (HSP)
- B. Polyarteritis nodosa (PAN)
- C. Takayasu arteritis (Correct Answer)
- D. Microscopic polyangiitis
Explanation: ***Takayasu arteritis*** - **Weak pulses** in the upper limbs, **lower blood pressure** (90/60 mmHg), and **retinal hemorrhages** are classic signs of Takayasu arteritis, which primarily affects the aortic arch and its major branches. [1] - This condition is also known as "pulseless disease" due to the significant narrowing of peripheral arteries, leading to diminished or absent pulses. [1] *Henoch-Schönlein purpura (HSP)* - HSP is characterized by a **palpable purpuric rash**, **arthralgia**, **abdominal pain**, and **renal involvement** (hematuria/proteinuria), none of which are explicitly mentioned here. - It typically affects **small vessels** and does not cause weak pulses in the upper limbs or systemic hypotension in this manner. *Polyarteritis nodosa (PAN)* - PAN is a **necrotizing vasculitis** of medium-sized arteries, often presenting with **fever**, **weight loss**, **myalgia**, and visceral infarcts. - While it can affect various organs, it does not typically cause the specific pattern of weak upper limb pulses and retinal hemorrhages observed here, which points to large vessel involvement. *Microscopic polyangiitis* - This is a **small-vessel vasculitis** characterized by **glomerulonephritis** and **pulmonary capillaritis**, often presenting with hemoptysis and rapidly progressive renal failure. - It does not cause the large vessel symptoms like weak upper limb pulses or significant systemic hypotension seen in the patient.
Question 10: Fibrinoid necrosis with neutrophilic infiltration is seen in ?
- A. Polyarteritis Nodosa (PAN) (Correct Answer)
- B. Giant Cell Arteritis
- C. Takayasu Arteritis
- D. Wegener's Granulomatosis
Explanation: ***PAN*** - **Fibrinoid necrosis** with **neutrophilic infiltration** is characteristic of Polyarteritis Nodosa (PAN), which primarily affects medium-sized arteries [1]. - The necrosis is often seen in the context of **systemic vasculitis**, where it leads to damage and inflammation of vessel walls [3]. *Takayasu arteritis* - Primarily affects **large vessels** like the aorta and its major branches, typically presenting with **pulselessness** or **claudication**. - It shows **granulomatous inflammation** rather than fibrinoid necrosis with neutrophilic infiltration. *Giant cell arteritis* - Predominantly affects large and medium arteries, especially the **temporal artery**, often leading to headaches and visual disturbances. - It is associated with **giant cells** and lymphocytic infiltration rather than fibrinoid necrosis. *Wegener's granulomatosis* - Characterized by **granulomatous inflammation** and vasculitis affecting small to medium vessels, particularly in the lungs and kidneys. - It does not typically present with **fibrinoid necrosis**; instead, it shows necrotizing granulomas [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 517-518. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 518-519. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 687-688.
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