Vascular Pathology

Vascular Pathology Indian Medical PG Question 1: A 45-year-old man presents with intermittent pain in the chest, radiating to the left arm, aggravated by exertion, and relieved by rest. What is the most appropriate initial investigation?

• A. Chest X-ray
• B. Cardiac enzymes
• C. ECG (Correct Answer)
• D. Echocardiogram

Vascular Pathology Explanation: ***ECG*** - An **ECG** is the most appropriate initial investigation for suspected **angina pectoris** due to its rapid availability and ability to detect signs of **myocardial ischemia** or infarction [1]. - It can reveal changes such as **ST-segment depression** or elevation, **T-wave inversion**, or pathological Q waves [1]. *Chest X-ray* - A **chest X-ray** is useful for evaluating conditions like **pneumonia**, **pneumothorax**, or **heart failure** (cardiomegaly, pulmonary edema). - It is generally not the first-line diagnostic tool for **ischemic heart disease** as it cannot directly visualize coronary arteries or myocardial ischemia. *Cardiac enzymes* - **Cardiac enzymes** (e.g., troponin, CK-MB) are crucial for diagnosing **acute myocardial infarction** but are typically elevated hours after the onset of chest pain. - While important for confirming an MI, they are not the *initial* investigation for transient, exertion-related chest pain suggestive of **stable angina** [1]. *Echocardiogram* - An **echocardiogram** provides detailed information about **cardiac structure** and function, including **wall motion abnormalities**, valve function, and overall ejection fraction [1]. - While valuable, it is usually performed after an ECG to further evaluate the heart's pumping ability and identify **regional wall motion abnormalities** indicative of ischemia, rather than as the very first step [1].

Vascular Pathology Indian Medical PG Question 2: Falsely elevated ankle brachial index is used for evaluation of?

• A. Deep vein thrombosis
• B. Acute limb ischemia
• C. Calcified vessels (Correct Answer)
• D. Chronic venous insufficiency

Vascular Pathology Explanation: A falsely elevated **ankle-brachial index (ABI)**, often >1.3, indicates that the **ankle arteries are non-compressible** due to calcification [1]. This calcification is common in conditions like **diabetes** and **end-stage renal disease**, where the vessels become stiff and resist compression, leading to inaccurate pressure readings [1].

Vascular Pathology Indian Medical PG Question 3: Which HLA antigen is associated with thromboangitis obliterans?

• A. HLA-B27
• B. HLA-DR4
• C. HLA-B5 (Correct Answer)
• D. HLA-DR2

Vascular Pathology Explanation: HLA-B5 - **HLA-B5** (specifically **HLA-B51**) has been associated with an increased risk of **thromboangiitis obliterans (Buerger's disease)** in some populations. - This association suggests a potential genetic predisposition, although the disease's primary risk factor remains **smoking**. *HLA-B27* - **HLA-B27** is strongly associated with **spondyloarthropathies**, such as **ankylosing spondylitis** and **reactive arthritis**, not thromboangiitis obliterans [1]. - Its presence indicates a genetic susceptibility to inflammatory arthritic conditions primarily affecting the spine and sacroiliac joints [1]. *HLA-DR4* - **HLA-DR4** is a well-known genetic marker associated with **rheumatoid arthritis**, particularly severe forms. - It is also linked to other autoimmune diseases like **Type 1 Diabetes**, but not thromboangiitis obliterans. *HLA-DR2* - **HLA-DR2** is associated with an increased risk of several autoimmune diseases, most notably **multiple sclerosis** and **narcolepsy**. - While it plays a role in immune regulation, it is not specifically linked to thromboangiitis obliterans.

Vascular Pathology Indian Medical PG Question 4: Which of the following statements are correct regarding Buerger's disease? 1. It involves small to medium arteries. 2. It is common in smokers. 3. It commonly involves lower limb vessels. 4. Cessation of smoking reverses the disease process.

• A. 1, 2 and 3 (Correct Answer)
• B. 1, 3 and 4
• C. 1, 2 and 4
• D. 2, 3 and 4

Vascular Pathology Explanation: ***1, 2 and 3*** - Buerger's disease, or **thromboangiitis obliterans**, primarily affects **small to medium-sized arteries and veins** in the upper and lower extremities. - It is **strongly associated with tobacco use** and commonly affects the **distal arteries** of the limbs, leading to ischemia and potential gangrene. *1, 3 and 4* - While Buerger's disease involves small to medium arteries and commonly affects lower limb vessels, **cessation of smoking does not reverse the disease process** but rather stops its progression. - The damage caused to the vessels by inflammation and thrombosis is largely irreversible. *1, 2 and 4* - This option incorrectly states that cessation of smoking reverses the disease process, which is not true. - While smoking cessation is crucial for preventing progression, existing vascular damage is permanent. *2, 3 and 4* - This option misses that Buerger's disease involves **small to medium arteries**, which is a key characteristic of the condition. - Additionally, it incorrectly suggests that smoking cessation reverses the disease.

Vascular Pathology Indian Medical PG Question 5: The treatment of acute myocardial infarction includes which of the following?

• A. Oral anticoagulants
• B. Aspirin (Correct Answer)
• C. Heparin
• D. Alteplase

Vascular Pathology Explanation: ***Aspirin*** - **Aspirin** is a cornerstone of acute myocardial infarction treatment due to its **antiplatelet effects**, which reduce thrombus formation in the coronary arteries [4]. - It works by **irreversibly inhibiting cyclooxygenase-1 (COX-1)**, thereby preventing the synthesis of thromboxane A2, a potent platelet aggregator [4]. *Heparin* - **Heparin** (unfractionated or low molecular weight) is an **anticoagulant** often used adjunctively in acute MI, particularly in patients undergoing percutaneous coronary intervention (PCI) or with concurrent atrial fibrillation [1]. - Its primary role is to **prevent further clot formation** rather than directly dissolving existing clots, making it not the initial, primary treatment for MI itself. *Alteplase* - **Alteplase** is a **fibrinolytic agent** used in acute ST-elevation myocardial infarction (STEMI) to **dissolve existing clots** and restore blood flow [3]. - While effective, it is not universally indicated for *all* acute MI cases and has specific contraindications, making it a secondary rather than primary initial treatment choice in many scenarios when compared to aspirin [2]. *Oral anticoagulants* - **Oral anticoagulants** (e.g., warfarin, direct oral anticoagulants) are primarily used for **long-term prevention** of thromboembolic events, such as in atrial fibrillation or after venous thromboembolism. - They are generally **not used in the immediate acute phase of MI** as the primary treatment due to their slower onset of action and different mechanisms compared to antiplatelet drugs like aspirin.

Vascular Pathology Flashcard 1 of 5

Question: _____ arteritis is a granulomatous thickening and narrowing of the aortic arch and proximal great vessels

Answer: Takayasu

Vascular Pathology Flashcard 2 of 5

Question: _____ and turbulence of blood flow increases risk for thrombosis

Answer: Stasis

Vascular Pathology Flashcard 3 of 5

Question: Fibrinoid necrosis is characteristic of _____ hypertension, vasculitis (e.g. PAN), and preeclampsia

Answer: malignant

Vascular Pathology Flashcard 4 of 5

Question: Polyarteritis nodosa (PAN) is necrotizing arteritis of the _____-sized blood vessels.

Answer: medium and small::Size

Vascular Pathology Flashcard 5 of 5

Question: _____ of medium and large-sized vessels leads to atherosclerosis in diabetic patients

Answer: Non-enzymatic glycosylation