Vascular Pathology Practice Questions

Q: Red infarct is seen in which organ?

Lung. **Explanation:** Infarcts are classified into two types based on their color and the amount of hemorrhage: **Red (Hemorrhagic)** and **White (Anemic)** [1]. **Why Lung is the Correct Answer:** Red infarcts occur in tissues with a **dual blood supply** or loose textures that allow blood to collect in the infarcted area [1]. The lung has a dual blood supply from the **Pulmonary arteries** and **Bronchial arteries** [2]. When a pulmonary artery branch is obstructed, the bronchial arteries continue to pump blood into the necrotic area, but the damaged capillaries cannot contain it, leading to extensive hemorrhage [1]. This results in a firm, red-colored wedge-shaped infarct. **Analysis of Incorrect Options:** * **Kidney (Option B):** This is a classic example of a **White (Anemic) Infarct**. It occurs in solid organs with **end-artery circulation**, where the density of the tissue limits the amount of hemorrhage into the area of ischemic necrosis [1]. * **Liver (Option A):** While the liver has a dual blood supply (Portal vein and Hepatic artery), true infarction is **rare** due to this protective mechanism. When it does occur, it is usually pale or variegated, but it is not the classic textbook example of a red infarct compared to the lung. * **Brain (Option C):** Brain infarcts typically undergo **liquefactive necrosis**. While they can sometimes be hemorrhagic (especially after an embolic stroke with reperfusion), the primary classification for **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Hemodynamic Disorders, Thromboembolic Disease, and Shock, p. 140. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Hemodynamic Disorders, Thromboembolic Disease, and Shock, pp. 137-138.

Q: Migratory thrombophlebitis is seen in which of the following conditions?

Disseminated cancer. **Explanation:** **Migratory thrombophlebitis**, also known as **Trousseau syndrome**, is a clinical condition characterized by recurrent episodes of superficial venous thrombosis that appear at different sites over time [3]. **1. Why Disseminated Cancer is Correct:** The underlying mechanism is a **paraneoplastic syndrome** associated with occult or disseminated malignancy [2]. Cancer cells (especially **adenocarcinomas**) release procoagulants such as tissue factor and mucins into the circulation [3]. These substances trigger the extrinsic coagulation pathway and cause platelet aggregation, leading to a hypercoagulable state [1]. While most classically associated with **pancreatic carcinoma** (body and tail), it is also seen in lung, gastric, and colon cancers [3]. **2. Why Other Options are Incorrect:** * **Rheumatic Heart Disease (RHD):** While RHD can lead to atrial fibrillation and subsequent systemic embolism, it does not typically cause migratory superficial venous thrombosis. * **Libman-Sacks Endocarditis:** This is a form of non-bacterial verrucous endocarditis seen in Systemic Lupus Erythematosus (SLE). While SLE is a hypercoagulable state (often via Antiphospholipid Syndrome), Libman-Sacks itself refers to sterile vegetations on heart valves, not migratory thrombophlebitis. **Clinical Pearls for NEET-PG:** * **Classic Association:** Pancreatic Adenocarcinoma (High-yield: Look for a patient with weight loss, jaundice, and migrating skin nodules/redness) [4]. * **Trousseau Sign vs. Trousseau Syndrome:** Do not confuse *Trousseau syndrome* (migratory thrombophlebitis) with *Trousseau sign of latent tetany* (carpal spasm induced by BP cuff inflation in hypocalcemia). * **Management:** The definitive treatment is managing the underlying malignancy; however, **Low Molecular Weight Heparin (LMWH)** is the preferred anticoagulant, as these patients often respond poorly to Warfarin.

Question 1

Which of the following are seen in malignant hypertension?

Accepted Answer

Replacement by necrotizing arteriolitis and atherosclerosis

Answer

Atherosclerosis

Answer

Hyalinised arterioles and replacement by necrotizing arteriolitis

Answer

Hyalinised arterioles and atherosclerosis

Question 2

A 77-year-old man has had progressive dementia and gait ataxia for the past 9 years. He succumbs to bronchopneumonia. Autopsy shows that the thoracic aorta has a dilated root and arch, giving the intimal surface a "tree-bark" appearance. The microscopic examination of the aorta shows an obliterative endarteritis of the vasa vasorum. Which of the following laboratory findings is most likely to be recorded in this patient's medical history?

Accepted Answer

Antibodies against Treponema pallidum

Answer

Double-stranded DNA titer positive at 1 :512

Answer

Ketonuria of 4+

Answer

P-ANCA positive at 1 :1024

Question 3

Red infarct is seen in which organ?

Accepted Answer

Lung

Answer

Liver

Answer

Kidney

Answer

Brain

Question 4

In aortic dissection, through which layer does blood initially enter?

Accepted Answer

Media

Answer

Intima

Answer

Adventitia

Answer

Any of the above layers

Question 5

Tree bark-like calcification on a chest X-ray is characteristically seen in which of the following conditions?

Accepted Answer

Syphilitic aortitis

Answer

Takayasu arteritis

Answer

Neurofibromatosis

Answer

Atherosclerosis

Question 6

Which of the following statements is FALSE regarding fibromuscular dysplasia?

Accepted Answer

It is most common in young males.

Answer

The most common histologic subtype is medial fibroplasia.

Answer

It mostly affects medium-sized vessels.

Answer

A 'string of beads' appearance is seen on angiography.

Question 7

Which of the following vascular lesions is commonly seen in Turner syndrome?

Accepted Answer

Cavernous lymphangioma

Answer

Nevus flammeus

Answer

Pyogenic granuloma

Answer

Capillary hemangioma

Question 8

A 21-year-old female presented with aortic arch aneurysm. She underwent resection, and the specimen was sent for histopathological examination. It showed involvement of all three layers with the presence of giant cells. What is the probable diagnosis?

Accepted Answer

Nonspecific aortitis

Answer

Tubercular aortitis

Answer

Wegener's granulomatosis

Answer

Giant cell arteritis

Question 9

A segment of the aerial intima of a coronary vessel is observed at autopsy in a 56-year old man who died suddenly on rising in the morning. Which of the following abnormalities is considered a major risk factor for the development of this lesion?

Accepted Answer

Hypercholesterolemia

Answer

Congenital vascular muscle weakness

Answer

Cystic medial necrosis

Answer

Syphilis

Question 10

Migratory thrombophlebitis is seen in which of the following conditions?

Accepted Answer

Disseminated cancer

Answer

Rheumatic heart disease

Answer

Libman-Sacks endocarditis

Answer

All of the above

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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