Vascular Pathology Practice Questions

Q: Which of the following is not a large vessel vasculitis?

Churg-Strauss syndrome. **Churg-Strauss syndrome** - Also known as **Eosinophilic Granulomatosis with Polyangiitis (EGPA)**, this is primarily a **small-to-medium vessel vasculitis**. [1] - It classically presents with **asthma**, **eosinophilia**, and **granulomatous inflammation** affecting various organs. [1] *Takayasu arteritis* - This is a **large vessel vasculitis** that predominantly affects the **aorta** and its major branches. - It is often seen in **younger women** and can cause absent pulses and vascular stenoses. *Cogan syndrome* - This is a **large vessel vasculitis** characterized by **interstitial keratitis** and **vestibuloauditory dysfunction**, often impacting the aorta and great vessels. - While it can involve multiple vessel sizes, its systemic manifestations and potential for aortic involvement classify it within the spectrum of large vessel vasculitis. *Giant cell arteritis* - This is a **large vessel vasculitis** that primarily affects the **temporal artery** and other branches of the carotid artery. - It is typically seen in **older adults** and can cause headaches, jaw claudication, and vision loss. **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.

Q: A woman shows symptoms of massive pulmonary thromboembolism. Based on the gross appearance of the liver autopsy, which of the following statements best characterizes the patient’s condition?

Chronic passive congestion with centrilobular necrosis. ***Colonic adenocarcinoma with metastasis*** - The presence of **massive pulmonary thromboembolism** often indicates **underlying malignancy** [2], particularly with **colonic adenocarcinoma** known to metastasize to the liver [1]. - This condition may present with **liver lesions** at autopsy, consistent with metastatic disease [1], supporting this diagnosis. *Metastasis from PE* - Pulmonary embolism (PE) itself does not typically give rise to **metastatic disease**; instead, it commonly arises from **deep vein thrombosis** (DVT) [2]. - This onfuses the cause of PE with its potential effects, lacking the **specificity** of a primary cancer origin. *Locally invaded hepatocellular carcinoma* - This option indicates a primary liver cancer impacting the liver directly, which would not cause **massive pulmonary thromboembolism** as its primary feature. - While hepatocellular carcinoma can cause some vascular complications, it does not correlate with **colonic adenocarcinoma** or metastatic patterns indicative of PE. *Angiosarcoma* - Though angiosarcoma is a **primary liver tumor**, it is rare and does not typically present with **massive pulmonary embolism** as a hallmark manifestation. - This type of cancer generally has a different clinical picture and distinct risk factors compared to **colonic adenocarcinoma**, making it an **unlikely option** in this context. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 282. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 705.

Q: The tissue of origin of the Kaposi's sarcoma is

Vascular. ***Vascular*** - Kaposi's sarcoma originates from the **vascular tissue**, specifically from endothelial cells lining blood vessels [2]. - The lesions are characterized by **angiogenesis**, leading to the formation of vascular tumors with dilated endothelial cell-lined vascular spaces [1]. *Muscular* - Muscular tissue is involved in **voluntary** and **involuntary movements** but is not related to the etiology of Kaposi's sarcoma. - This condition does not arise from **muscle cells** or any muscular components. *Neural* - Neural tissue consists of **neurons** and **glial cells**, which are not implicated in Kaposi's sarcoma. - Kaposi's sarcoma does not originate from any **neural structures** or pathologies. *Lymphoid* - Lymphoid tissue primarily concerns the immune system, particularly the **lymphatic system**, and does not give rise to Kaposi's sarcoma. - This malignancy does not derive from **lymphoid components** like lymphocytes or lymph nodes. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 526-527. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 282-283.

Q: Which of the following is a type of small vessel vasculitis?

Granulomatosis with polyangiitis (GPA). ***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.

Q: Obliterative endarteritis in vasa vasorum is seen in -

Tertiary Syphilis. ***Tertiary Syphilis*** - **Obliterative endarteritis** of the **vasa vasorum** is a hallmark pathological finding in tertiary syphilis, particularly affecting the **aorta**. - This inflammation and occlusion of the small blood vessels supplying the aorta lead to **ischemic injury** of the aortic wall, causing **aneurysms** and **aortic regurgitation**. *Essential Hypertension* - While hypertension can lead to vascular changes like **arteriolosclerosis** and **hyperplastic arteriolosclerosis**, it does not typically involve obliterative endarteritis of the vasa vasorum. - The vascular damage in essential hypertension is more generalized to smaller arteries and arterioles, not specifically the vasa vasorum. *Systemic Lupus Erythematosus* - SLE is an **autoimmune disease** that can cause **vasculitis**, but the specific pattern of obliterative endarteritis of the vasa vasorum is not characteristic. - Vascular involvement in SLE is diverse, ranging from small vessel vasculitis to accelerated atherosclerosis, but distinct from syphilitic changes. *Pulmonary Tuberculosis* - Tuberculosis is primarily an **infectious granulomatous disease** affecting the lungs and other organs; it does not typically cause obliterative endarteritis of the vasa vasorum. - Although it can cause vascular complications like **aneurysms** (e.g., Rasmussen's aneurysm) due to erosion, the underlying mechanism is not the same as syphilitic changes.

Q: Which type of artery is most commonly involved in PAN?

Muscular. ***Muscular*** - **Polyarteritis nodosa (PAN)** predominantly affects **medium to small-sized muscular arteries**, leading to inflammation, necrosis, and microaneurysms [1]. - This involvement often causes **organ ischemia** and symptoms related to the affected organs, such as the kidneys, gastrointestinal tract, and skin [1]. *Elastic* - **Elastic arteries**, such as the aorta and its major branches, are typically spared in PAN due to their larger size and distinct histological structure. - Diseases like **Takayasu arteritis** or **Giant cell arteritis** are more commonly associated with vasculitis affecting large elastic arteries. *Arterioles* - While arterioles can be affected in various forms of vasculitis, they are not the primary target in classic PAN. - Involvement of arterioles is more characteristic of **microscopic polyangiitis** or **Churg-Strauss syndrome** [2]. *Capillaries* - **Capillaries** are the smallest blood vessels, and their involvement is rare in PAN. - Conditions like **Henoch-Schönlein purpura** or some drug-induced vasculitides more typically affect capillaries, often resulting in palpable purpura [2].

Q: Which of the following changes is NOT seen in atherosclerotic plaque at the time of rupture?

Thick fibrous cap. ***Smooth muscle cell hypertrophy*** - **Smooth muscle cell hypertrophy** is generally associated with stable plaques and does not typically occur in ruptured atherosclerotic plaques [2]. - At rupture, there is **loss of smooth muscle cells** and thinning of the fibrous cap, leading to plaque instability [2]. *Thin fibrosis cap* - A **thin fibrous cap** is a critical feature of vulnerable plaques, making them prone to rupture [2]. - It indicates a **weakened structure** that can no longer withstand the pressure of the underlying lipid core [2]. *Cell debris* - **Cell debris** is often found at the site of rupture, resulting from the necrosis of foam cells and smooth muscle cells. - This indicates **plaque instability** and contributes to the thrombus formation at the rupture site. *Multiple foam cap* - The presence of **multiple foam cells** reflectsing lipid accumulation in the plaque but does not contribute to the phenomenon of plaque rupture directly. - While foam cells are associated with rupture, a **foam cap** is not a recognized pathological finding at the time of rupture. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 271-272. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 268-270.

Q: All of the following are true regarding fibromuscular dysplasia EXCEPT:

OCPs predispose. ***OCPs predispose*** - **Oral contraceptive pills (OCPs)** are not identified as a predisposing factor for fibromuscular dysplasia (FMD). FMD is largely considered a sporadic condition with some genetic predisposition, but not linked to OCP use [1]. - While hormonal influences are suspected given its higher prevalence in women, direct causation or exacerbation by OCPs has not been established [1]. *Medium size vessels are affected* - Fibromuscular dysplasia (FMD) predominantly affects **medium-sized arteries**, most commonly the renal and carotid arteries [1]. - This involvement leads to characteristic stenoses, aneurysms, or dissections in those vessels. *Aneurysm may occur* - The abnormal arterial wall architecture in FMD, characterized by alternating areas of stenosis and dilation, can lead to the formation of **aneurysms**. - These aneurysms are usually **intracranial** or within the affected renal and carotid arteries, and represent a significant risk of rupture or dissection. *Irregular hyperplasia* - FMD involves **irregular fibrous or fibromuscular hyperplasia** of the arterial wall layers (intima, media, or adventitia). - This abnormal cellular proliferation and connective tissue deposition result in the characteristic "string of beads" appearance on angiography. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 493-494.

Q: Which HLA antigen is associated with thromboangitis obliterans?

HLA-B5. 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.

Q: Fibrinoid necrosis with neutrophilic infiltration is seen in ?

Polyarteritis Nodosa (PAN). ***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.

Question 1

Which of the following is not a large vessel vasculitis?

Accepted Answer

Churg-Strauss syndrome

Answer

Takayasu arteritis

Answer

Giant cell arteritis

Answer

Cogan syndrome

Question 2

A woman shows symptoms of massive pulmonary thromboembolism. Based on the gross appearance of the liver autopsy, which of the following statements best characterizes the patient’s condition?

Accepted Answer

Chronic passive congestion with centrilobular necrosis

Answer

Primary liver angiosarcoma

Answer

Locally invaded hepatocellular carcinoma

Answer

Colonic adenocarcinoma with liver metastasis

Question 3

The tissue of origin of the Kaposi's sarcoma is

Accepted Answer

Vascular

Answer

Lymphoid

Answer

Neural

Answer

Muscular

Question 4

Which of the following is a type of small vessel vasculitis?

Accepted Answer

Granulomatosis with polyangiitis (GPA)

Answer

Classical PAN

Answer

Giant cell arteritis

Answer

None of the options

Question 5

Obliterative endarteritis in vasa vasorum is seen in -

Accepted Answer

Tertiary Syphilis

Answer

Essential Hypertension

Answer

Systemic Lupus Erythematosus

Answer

Pulmonary Tuberculosis

Question 6

Which type of artery is most commonly involved in PAN?

Accepted Answer

Muscular

Answer

Capillaries

Answer

Elastic

Answer

Arterioles

Question 7

Which of the following changes is NOT seen in atherosclerotic plaque at the time of rupture?

Accepted Answer

Thick fibrous cap

Answer

Inflammatory cell infiltration

Answer

Cell debris

Answer

Smooth muscle cell atrophy

Question 8

All of the following are true regarding fibromuscular dysplasia EXCEPT:

Accepted Answer

OCPs predispose

Answer

Medium size vessels are affected

Answer

Aneurysm may occur

Answer

Irregular hyperplasia

Question 9

Which HLA antigen is associated with thromboangitis obliterans?

Accepted Answer

HLA-B5

Answer

HLA-B27

Answer

HLA-DR4

Answer

HLA-DR2

Question 10

Fibrinoid necrosis with neutrophilic infiltration is seen in ?

Accepted Answer

Polyarteritis Nodosa (PAN)

Answer

Giant Cell Arteritis

Answer

Takayasu Arteritis

Answer

Wegener's Granulomatosis

Vascular Pathology — MCQs

Vascular Pathology — MCQs

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