Vascular Pathology Practice Questions

Q: A 71-year-old woman presents with a 3-month history of headaches, fatigue, and weight loss. The headaches are new and not severe. She also experiences jaw claudication. Two days prior, she experienced transient partial vision loss in her left eye, with no other neurological symptoms. Examination reveals a supple neck, normal fundi, and a normal neurological exam. Prednisone 60 mg/day was initiated, and a biopsy was performed to confirm the diagnosis. Which of the following is the most likely finding on the biopsy to confirm the diagnosis?

Arteritis with giant cells. ### Explanation The clinical presentation of a 71-year-old patient with new-onset headaches, jaw claudication, constitutional symptoms (weight loss, fatigue), and transient monocular vision loss (amaurosis fugax) is classic for **Giant Cell Arteritis (GCA)**, also known as Temporal Arteritis. **1. Why the Correct Answer is Right:** GCA is a systemic granulomatous vasculitis [1]. The gold standard for diagnosis is a temporal artery biopsy [1]. The characteristic histopathological finding is **panarteritis** featuring inflammatory infiltrates (macrophages, lymphocytes, and T-cells) with **fragmentation of the internal elastic lamina** and the presence of **multinucleated giant cells** [1]. **2. Why Incorrect Options are Wrong:** * **A. Immune complex deposition:** This is characteristic of Type III hypersensitivity reactions (e.g., Systemic Lupus Erythematosus or Polyarteritis Nodosa), whereas GCA is a T-cell-mediated (Type IV) hypersensitivity. * **C. Lymphocytic infiltration:** While lymphocytes are present in GCA, this is a non-specific finding seen in many inflammatory conditions [1]. The presence of giant cells and granulomatous inflammation is the pathognomonic feature for GCA. * **D. Type II muscle fiber atrophy:** This is a common finding in **Corticosteroid-induced myopathy** or disuse atrophy, not a diagnostic feature of vasculitis. **3. Clinical Pearls for NEET-PG:** * **Association:** ~50% of GCA patients also have **Polymyalgia Rheumatica (PMR)** (proximal muscle pain/stiffness) [1]. * **Diagnosis:** Elevated ESR (often >100 mm/hr) and CRP are highly sensitive [1]. * **Management:** If GCA is suspected, **start high-dose steroids immediately** to prevent permanent blindness; do not wait for biopsy results [1]. * **Biopsy Fact:** Due to "skip lesions," a long segment of the artery (3–5 cm) should be biopsied to avoid false negatives [1].

Question 1

Medial thickening of arteries with an onion-skin appearance on biopsy is diagnostic of which condition in an elderly male presenting with uncontrolled hypertension and signs of renal failure?

Accepted Answer

Hyperplastic arteriosclerosis

Answer

Thromboangiitis obliterans

Answer

Arteriosclerosis obliterans

Answer

Hyaline arteriosclerosis

Question 2

A 78-year-old male presents with headache, visual disturbance, and tenderness over his right temporal region. A biopsy taken from his right temporal artery is most likely to show what?

Accepted Answer

Granulomatous inflammation with giant cells

Answer

Acute organizing thrombus formation

Answer

Luminal thrombosis

Answer

Aneurysmal dilatation with subintimal inflammation

Question 3

Which of the following is NOT seen in malignant hypertension?

Accepted Answer

Hyaline arteriosclerosis

Answer

Fibrinoid necrosis

Answer

Necrotizing glomerulonephritis

Answer

Hyperplastic arteriosclerosis

Question 4

Polyarteritis Nodosa (PAN) typically involves which of the following?

Accepted Answer

Small- or medium-sized muscular arteries

Answer

Large elastic arteries

Answer

Arterioles

Answer

Capillaries

Question 5

A 45-year-old man presents with hematuria. Renal biopsy demonstrates a focal necrotizing glomerulitis with crescent formation. The patient has a history of intermittent hemoptysis and intermittent chest pain of moderate intensity. A previous chest x-ray had demonstrated multiple opacities, some of which were cavitated. The patient also has chronic cold-like nasal symptoms. Which of the following is the most likely diagnosis?

Accepted Answer

Wegener's granulomatosis

Answer

Aspergillosis

Answer

Polyarteritis nodosa

Answer

Renal carcinoma metastatic to the lung

Question 6

Which of the following statements regarding aneurysms is FALSE?

Accepted Answer

Saccular aneurysms involve the entire circumference of the vessel wall.

Answer

A true aneurysm contains all three layers of the arterial wall.

Answer

In dissecting aneurysms, the media layer is defective.

Answer

Charcot-Bouchard aneurysms are typically found in the brain.

Question 7

Which of the following are risk factors for Angiosarcoma?

Accepted Answer

All of the above

Answer

Polyvinyl chloride

Answer

Arsenic

Answer

Thorotrast

Question 8

Which infective agent is implicated in causing atherosclerosis?

Accepted Answer

Chlamydia pneumoniae

Answer

Mycoplasma pneumoniae

Answer

Haemophilus influenzae

Answer

Corynebacterium diphtheriae

Question 9

A 71-year-old woman presents with a 3-month history of headaches, fatigue, and weight loss. The headaches are new and not severe. She also experiences jaw claudication. Two days prior, she experienced transient partial vision loss in her left eye, with no other neurological symptoms. Examination reveals a supple neck, normal fundi, and a normal neurological exam. Prednisone 60 mg/day was initiated, and a biopsy was performed to confirm the diagnosis. Which of the following is the most likely finding on the biopsy to confirm the diagnosis?

Accepted Answer

Arteritis with giant cells

Answer

Immune complex deposition

Answer

Lymphocytic infiltration

Answer

Type II muscle fiber atrophy

Question 10

Hypersensitivity vasculitis typically involve which of the following vascular structures?

Accepted Answer

Postcapillary venules

Answer

Capillaries

Answer

Arterioles

Answer

Medium-sized arteries

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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