Vascular Pathology Practice Questions

Q: The image shows presence of:

Monckeberg arteriosclerosis. ***Monckeberg arteriosclerosis*** - This condition is characterized by **calcification of the media of muscular arteries**, without significant luminal narrowing. - It is often an incidental finding on imaging or autopsy and is typically **non-obstructive**. *Atheroma* - An atheroma is a **plaque** formed within the arterial wall, primarily composed of **lipids, inflammatory cells, smooth muscle cells, and fibrous connective tissue**. - It leads to **luminal narrowing** and can cause ischemia or thrombosis. *Hyaline arteriosclerosis* - This involves **homogenous, amorphous, pink hyaline thickening of the arteriolar walls** [3], often seen in benign hypertension and diabetes. - It results from **plasma protein leakage** across damaged endothelial cells and increased extracellular matrix production. *Hyperplastic arteriosclerosis* - Characterized by **"onion-skin" concentric thickening of arteriolar walls** due to smooth muscle cell proliferation and reduplication of the basement membrane [1][2]. - It is typically associated with **severe or malignant hypertension** [1] and can lead to luminal obliteration. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 498-499. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 945. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 943-945.

Q: Which is true about the image shown?

Hyperplastic arteriosclerosis. ***Hyperplastic arteriosclerosis*** - This condition is characterized by **concentric, laminated thickening** of the arteriolar walls, often described as an **"onion-skin" appearance** [1][2]. - It is typically seen in severe **malignant hypertension** and involves proliferation of smooth muscle cells and reduplication of the basement membrane [1][2]. *Hyaline arteriosclerosis* - This involves **homogeneous, pink, amorphous thickening** of arteriolar walls, often due to plasma protein leakage and increased extracellular matrix deposition [3]. - It is commonly associated with **benign hypertension** and diabetes mellitus, and does not show the "onion-skin" pattern [3]. *Monckeberg's arteriosclerosis* - This is characterized by **calcific deposits** in the media of muscular arteries, particularly in the elderly. - It does not narrow the vessel lumen significantly and is typically **asymptomatic**, unlike the changes seen in the image. *Fibrinoid necrosis* - This refers to the deposition of **fibrin-like material** in the vessel walls, often seen in malignant hypertension or immune-mediated vasculitis. - While it can occur in severe hypertension, the primary feature in the image is the **cellular proliferation and lamination**, not just amorphous fibrin deposition. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 945. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 498-499. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 943-945.

Q: The histological image shows a blood vessel with characteristic changes. What is the most likely diagnosis?

Hyaline arteriolosclerosis. ***Hyperplastic arteriosclerosis*** - The image likely shows **onion-skinning** of the arteriolar wall, which is characteristic of hyperplastic arteriosclerosis [1][2]. - This condition is typically seen in severe or **malignant hypertension** due to proliferation of smooth muscle cells and thickening of the basement membrane [1][2]. *Monckeberg's arteriosclerosis* - This involves **calcification of the media** of muscular arteries, without significant luminal narrowing. - It is typically asymptomatic and does not present with the **onion-skinning** appearance. *Hyaline arteriosclerosis* - Characterized by **homogeneous, pink, hyaline thickening** of arteriolar walls with luminal narrowing. - It is associated with benign hypertension and diabetes, but does not show the **concentric lamellar** appearance. *Fibrinoid necrosis* - This involves **deposition of fibrin-like material** in the vessel wall, often seen in malignant hypertension or vasculitis [3]. - While it can occur in severe hypertension, the primary image finding described as **onion-skinning** is more specific to hyperplastic arteriosclerosis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 945. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 498-499. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 276-277.

Q: Which is true about the image shown?

Mönckeberg's Arteriosclerosis. ***Monckeberg's Arteriosclerosis*** - This condition involves **calcification of the media of muscular arteries**, typically in individuals over 50 years old. - It is characterized by **ring-like calcifications** in the vessel wall, which can be seen on imaging or histology, and is usually not clinically significant as it does not narrow the lumen. *Hyaline Arteriosclerosis* - This type is characterized by **homogeneous, pink, hyaline thickening** of the walls of arterioles, with narrowing of the lumen. - It is typically seen in **benign hypertension** and **diabetes mellitus**, affecting small arteries and arterioles. *Hyperplastic Arteriosclerosis* - This condition is associated with **malignant hypertension** and is characterized by **concentric, laminated thickening** of the arteriole walls, often described as "onion-skinning." [1] - It involves proliferation of smooth muscle cells and reduplication of the basement membrane, leading to severe luminal narrowing [1]. *Fibrinoid necrosis* - This is a form of **necrosis** seen in the walls of blood vessels, characterized by deposition of **fibrin-like material** that stains intensely eosinophilic. - It is typically associated with **malignant hypertension** [2], **vasculitis**, or immune-mediated vascular damage, and is not a primary form of arteriosclerosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 945. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 276-277.

Q: Which of the following are correct about glomus tumour? 1. It arises from Suquet-Hoyer canals. 2. Its usual site is nail bed. 3. It is usually a small purple nodule. 4. It is painless.

1, 2 and 3. ***1, 2 and 3*** - Glomus tumors originate from the **Suquet-Hoyer canals**, specialized arteriovenous anastomoses involved in thermoregulation. - They are most frequently found in the **nail bed** (especially subungual region) as small, **purple** (reddish-blue) nodules and are typically very painful. - The classic triad includes severe pain, cold sensitivity, and point tenderness. *1, 2 and 4* - This option incorrectly states that glomus tumors are **painless**. In fact, they are characterized by severe pain due to their rich innervation. - While correct that they arise from Suquet-Hoyer canals and are found in the nail bed, the **painlessness** aspect is inaccurate. *2, 3 and 4* - This option incorrectly includes the statement that glomus tumors are **painless**, which contradicts a key distinguishing feature. - Although glomus tumors are typically found in the nail bed and appear as purple nodules, pain is a characteristic clinical feature, not absence of pain. *1, 3 and 4* - This option incorrectly states that glomus tumors are **painless** and omits the correct statement about the usual nail bed location. - While they do arise from Suquet-Hoyer canals and can be small purple nodules, their characteristic severe pain makes this option incorrect.

Q: Berry aneurysm most commonly occurs due to?

Medial layer and internal elastic lamina defect. ***Medial layer and internal elastic lamina defect*** - **Berry aneurysms** are most commonly saccular dilatations that occur at arterial bifurcations in the **Circle of Willis** [1]. - These aneurysms result from a congenital or acquired weakness in the **tunica media** and the **internal elastic lamina** at these bifurcation points, making the vessel wall susceptible to high pressures [1]. *Muscle and adventitial layer defect* - Defects primarily in the **muscle layer** (media) and **adventitia** are less commonly the primary cause of berry aneurysms. - While all layers contribute to vessel integrity, the specific absence in the medial and internal elastic lamina is key for berry aneurysms [1]. *Endothelial injury of vessel due to HTN* - While hypertension is a significant **risk factor** for aneurysm formation and rupture, it primarily exacerbates existing structural weaknesses rather than being the direct cause of the initial structural defect. - **Endothelial injury alone** is not the primary anatomical defect responsible for generating berry aneurysms; it contributes to atherosclerosis, which can lead to other types of aneurysms. *Adventitia defect* - A defect solely in the **adventitia** is not the primary predisposing factor for berry aneurysms. - The adventitia provides external support, but the integrity of the media and internal elastic lamina is crucial for maintaining the vessel's structural strength against intraluminal pressure [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1272-1273.

Q: Which is associated with vasculitis of medium sized vessels

Polyarteritis nodosa. ***Polyarteritis nodosa*** - **Polyarteritis nodosa (PAN)** is a **necrotizing vasculitis** of **medium-sized or small arteries**, but not arterioles, capillaries, or venules [1]. - It classically affects the **renal and visceral arteries**, sparing the pulmonary circulation, and is associated with **aneurysms** and stenoses. *Temporal arteritis* - This is a form of **large-vessel vasculitis** primarily affecting the **temporal and other cranial arteries** [1]. - It is typically seen in older adults and can cause **headache**, **jaw claudication**, and **blindness**. *Wegener's granulomatosis* - Now known as **Granulomatosis with Polyangiitis (GPA)**, this vasculitis affects **small vessels** and is characterized by a **granulomatous inflammation** of the upper and lower respiratory tracts and kidneys [1]. - It is associated with **PR3-ANCA (c-ANCA)** positivity. *Henoch-Schönlein purpura* - This is an **IgA vasculitis** affecting **small vessels**, typically presenting with **palpable purpura**, arthritis, abdominal pain, and renal involvement (nephritis) [1]. - It is the most common form of vasculitis in children.

Question 1

The image shows presence of:

Accepted Answer

Monckeberg arteriosclerosis

Answer

Atheroma

Answer

Hyaline arteriosclerosis

Answer

Hyperplastic arteriosclerosis

Question 2

Which is true about the image shown?

Accepted Answer

Hyperplastic arteriosclerosis

Answer

Hyaline arteriosclerosis

Answer

Monckeberg's arteriosclerosis

Answer

Fibrinoid necrosis

Question 3

The histological image shows a blood vessel with characteristic changes. What is the most likely diagnosis?

Accepted Answer

Hyaline arteriolosclerosis

Answer

Monckeberg's arteriosclerosis

Answer

Fibrinoid necrosis

Answer

Hyperplastic arteriosclerosis

Question 4

Which is true about the image shown?

Accepted Answer

Mönckeberg's Arteriosclerosis

Answer

Hyaline Arteriosclerosis

Answer

Hyperplastic Arteriosclerosis

Answer

Fibrinoid necrosis

Question 5

Which of the following are the malignancies associated with lymphoedema?
I. Kaposi Sarcoma
II. Squamous cell carcinoma
III. Malignant melanoma
IV. Leukaemia

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Question 6

Which of the following are correct about glomus tumour?

1. It arises from Suquet-Hoyer canals.
2. Its usual site is nail bed.
3. It is usually a small purple nodule.
4. It is painless.

Accepted Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 7

The malignancy associated with Stewart-Treves syndrome is

Accepted Answer

Lymphangiosarcoma

Answer

Basal cell carcinoma

Answer

Liposarcoma

Answer

Malignant melanoma

Question 8

A 50-year-old man presents with headache, chest discomfort, and blurred vision. His headache started 2 days ago and has not improved. He describes it as severe, throbbing, localized to the occipital part of the head and worse at the end of the day. He says he has associated nausea but denies any vomiting. Past medical history is significant for hypertension diagnosed 15 years ago, managed with beta-blockers until the patient self d/c’ed them a month ago. He has not seen a physician for the past 2 years. Family history is significant for hypertension and an ST-elevation myocardial infarction in his father and diabetes mellitus in his mother. Vitals signs are a blood pressure of 200/110 mm Hg, a pulse rate of 100/min and respiratory rate of 18/min Ophthalmoscopy reveals arteriolar nicking and papilledema. His ECG is normal. Laboratory findings are significant for a serum creatinine of 1.4 mg/dL and a blood urea nitrogen of 25 mg/dL. Urinalysis has 2+ protein.  He is started on intravenous nitroprusside. Which of the following best explains the pathophysiology responsible for the neovascular changes present in this patient?

Accepted Answer

Smooth muscle hyperplasia and duplication of the basement membrane

Answer

Protein deposition in the vascular lumen

Answer

Transmural calcification of arterial walls

Answer

Weakening of vessel wall following endothelial injury

Answer

Cholesterol deposition in the vascular lumen

Question 9

Berry aneurysm most commonly occurs due to?

Accepted Answer

Medial layer and internal elastic lamina defect

Answer

Muscle and adventitial layer defect

Answer

Endothelial injury of vessel due to HTN

Answer

Adventitia defect

Question 10

Which is associated with vasculitis of medium sized vessels

Accepted Answer

Polyarteritis nodosa

Answer

Wegener's granulomatosis

Answer

Temporal arteritis

Answer

Henoch-Schönlein purpura

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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