Vascular Pathology (Atherosclerosis, Vasculitis, Aneurysm) MCQs

Pathology · 73 free questions with answers & explanations.

1. A 55-year-old hypertensive man has a descending thoracic aortic aneurysm. Histology shows loss of medial smooth muscle cells, elastin fragmentation, and an inflammatory infiltrate. The most common causative treatable organism in luetic (syphilitic) aortitis — the classic cause of thoracic aortic aneurysm — acts by:
2. Takayasu arteritis is a granulomatous large-vessel vasculitis predominantly affecting the aorta and its primary branches in young women. The histological finding in the arterial wall during active disease is:
3. A 28-year-old woman of East Asian descent presents with unequal upper limb blood pressures, absent radial pulse on the left, and elevated ESR. Aortography shows stenosis of the left subclavian and left common carotid arteries with a 'skip lesion' pattern. ANCA and ANA are negative. Which pathological type of arteritis best explains this?
4. A 60-year-old hypertensive smoker presents with acute-onset tearing back pain radiating to the flanks. CT aortogram reveals an abdominal aortic aneurysm (AAA) of 8 cm diameter with retroperitoneal hematoma. Prior to emergent surgery, which pathological mechanism is most responsible for AAA formation?
5. Takayasu arteritis and giant cell arteritis (GCA) are both granulomatous large-vessel vasculitides. A distinguishing feature that helps differentiate Takayasu from GCA pathologically is:
6. Marfan syndrome predisposes to aortic root dilation and dissection due to FBN1 (fibrillin-1) mutations. Beyond structural weakness, a key pathophysiological mechanism involves signaling dysregulation that can be targeted therapeutically:
7. A 50-year-old woman has granulomatous vasculitis involving the aorta and its major branches with elevated ESR, asymmetric arm blood pressure, and absent radial pulse. Biopsy of temporal artery is normal. The most likely diagnosis and the key distinguishing feature from giant cell arteritis (GCA) is:
8. A 65-year-old hypertensive man develops an acute aortic dissection. CT shows an intimal tear in the ascending aorta. The underlying histological change in the aortic media that predisposes to dissection is:
9. In the pathogenesis of atherosclerosis, oxidized LDL (oxLDL) plays a central role. Which specific receptor on macrophages binds oxLDL and is primarily responsible for foam cell formation?
10. Takayasu arteritis affects large vessels in young women and is classified as a large-vessel vasculitis. The characteristic histological finding in the active phase is:
11. Takayasu arteritis (pulseless disease) is a granulomatous large-vessel vasculitis predominantly affecting the aorta and its major branches in young Asian women. The CD8+ T-cell mediated destruction of medial smooth muscle cells and elastic lamina leads to which pathological outcome that explains absent radial pulse?
12. A 65-year-old man with a 6.5 cm infrarenal abdominal aortic aneurysm (AAA) undergoes repair. Pathology of the aortic wall shows thinning and fragmentation of elastic lamellae with marked infiltration of lymphocytes, macrophages, and plasma cells in the adventitia, plus increased MMP (matrix metalloproteinase) expression. Which MMPs are MOST responsible for elastin and collagen degradation in AAA pathogenesis?
13. Giant cell arteritis (temporal arteritis) affects large and medium vessels in elderly patients. The characteristic histological finding on temporal artery biopsy in active disease is:
14. A 60-year-old hypertensive man has a dissecting aortic aneurysm. Microscopy of the aortic media shows loss of elastic and smooth muscle fibers with pools of basophilic ground substance material, no inflammatory cells. This is:
15. A 68-year-old hypertensive man with poorly controlled dyslipidemia undergoes carotid endarterectomy. The specimen shows a fibrous cap with a necrotic lipid core and evidence of previous plaque hemorrhage. The most important determinant of plaque 'vulnerability' (tendency to rupture) is:
16. A 35-year-old woman of Asian descent presents with blood pressure difference between arms, diminished left brachial pulse, and elevated ESR. MRI angiography shows segmental stenosis and wall thickening of the aortic arch and its main branches. This large-vessel vasculitis affects which layer of the arterial wall as the primary site of inflammation?
17. Cystic medial necrosis of the aorta is seen in Marfan syndrome and other aortopathies. The histological finding described by this term actually consists of:
18. ANCA-associated vasculitides (AAV) include granulomatosis with polyangiitis (GPA), eosinophilic GPA (EGPA), and microscopic polyangiitis (MPA). The predominant ANCA target antigen and histological features distinguish these conditions. Which pairing is CORRECT?
19. Giant cell arteritis (GCA) affects large and medium vessels, particularly the superficial temporal, ophthalmic, and posterior ciliary arteries in patients over 50. The most feared complication is irreversible vision loss. Which histological finding in a temporal artery biopsy is most specific for GCA versus other granulomatous vasculitides?
20. Abdominal aortic aneurysms (AAA) are predominantly infrarenal and associated with atherosclerosis. However, the pathogenesis of AAA involves more than just atherosclerotic narrowing. Which molecular mechanism explains medial degeneration and loss of structural integrity in AAA?
21. Giant cell arteritis (GCA) characteristically involves the extracranial branches of the carotid artery. The pathological hallmark is granulomatous transmural inflammation with medial necrosis. The vessel wall layer where the granulomatous inflammation is most concentrated and where the characteristic giant cells form in GCA is:
22. In Kawasaki disease, a form of medium-vessel vasculitis predominantly affecting coronary arteries in children, the pathological sequence leading to coronary aneurysm formation involves:
23. A 65-year-old hypertensive man is found to have a 5.5 cm infrarenal aortic aneurysm on CT. Pathology of resected aortic wall shows transmural destruction of the media with loss of smooth muscle cells and elastic lamellae, adventitial lymphoplasmacytic infiltration, and abundant matrix metalloproteinase (MMP) expression. What is the primary pathogenic mechanism responsible for medial degeneration in abdominal aortic aneurysm (AAA)?
24. A 28-year-old woman develops claudication of the upper extremities, absent upper limb pulses, and a 'pulseless disease' syndrome. Aortogram shows long smooth stenosis of the aortic arch and subclavian arteries. Biopsy of the involved vessel shows panarteritis with granulomatous inflammation in the media, giant cells, and intimal proliferation. ESR is elevated. What is the diagnosis, and what vessel-size classification does it belong to?
25. Takayasu arteritis (TA) predominantly affects the aorta and its major branches in young women. Histologically, the active phase shows granulomatous panarteritis with lymphoplasmacytic and giant cell infiltration of the media and adventitia. Which immunological mechanism drives the granulomatous destruction of the elastic arterial wall?
26. A 60-year-old man with poorly controlled hypertension has an incidental finding of a 5.5 cm infrarenal abdominal aortic aneurysm (AAA). Pathological examination of a resected specimen shows thinned and disrupted elastic laminae, smooth muscle cell depletion, and atherosclerosis, with inflammatory infiltration and neovascularization of the adventitia. Which enzymatic mechanism is primarily responsible for elastic lamina destruction in AAA?
27. In the response-to-retention hypothesis of atherosclerosis, which lipoprotein modification within the subendothelial intima is the critical initial pro-atherogenic step that precedes oxidation?
28. A 45-year-old woman of Asian descent presents with upper limb claudication, diminished radial pulses, and carotidynia. ESR is markedly elevated. Angiography shows skip lesions with stenosis and aneurysmal dilation of the aorta and its major branches. The most likely diagnosis and the primary cell type mediating vascular damage is:
29. A 60-year-old hypertensive patient develops a dissection of the ascending aorta. Pathology of the aortic wall shows loss of elastic lamellae, smooth muscle cell dropout, and accumulation of basophilic ground substance (proteoglycans) in the media. What is this pathological change and which connective tissue disease most specifically features this?
30. A 70-year-old man develops sudden severe chest/back pain. CT angiography shows an infrarenal aortic aneurysm (7 cm) with surrounding inflammatory infiltrate and fibrosis. Biopsy shows lymphoplasmacytic infiltrate with giant cells and IgG4+ plasma cells. This 'inflammatory aortic aneurysm' is now classified within:
31. Polyarteritis nodosa (PAN) is a necrotizing vasculitis of medium-sized arteries. Which feature distinguishes PAN from granulomatosis with polyangiitis (GPA, formerly Wegener) on pathological examination, and what is the serological marker for GPA?
32. In the pathogenesis of Marfan syndrome-associated aortic root aneurysm, mutations in FBN1 (fibrillin-1) lead to aortic disease not just by structural weakness but also through dysregulated cytokine signaling. Which signaling pathway is pathologically activated due to reduced fibrillin-1 sequestration of the cytokine precursor?
33. Kawasaki disease is an acute self-limiting vasculitis of medium-sized arteries in children. The most feared complication is:
34. A 70-year-old male with longstanding hypertension develops a thoracic aortic aneurysm. Histology shows 'cystic medial degeneration' with loss of smooth muscle cells and elastic lamina fragmentation. The molecular mediator primarily responsible for elastic tissue destruction is:
35. A 55-year-old man with hypertension is found at autopsy to have a saccular aortic aneurysm at the infrarenal segment. Histology shows focal destruction of the media with loss of elastic laminae and smooth muscle, chronic inflammatory infiltrate with adventitial fibrosis. Which pathological mechanism is MOST responsible for the medial destruction?
36. A 65-year-old woman develops jaw claudication, temporal headache, and sudden vision loss in the right eye. ESR is 120 mm/hr. Temporal artery biopsy shows granulomatous inflammation with giant cells at the media-intima junction, fragmentation of internal elastic lamina, and luminal narrowing. What is the MOST feared complication if untreated?
37. Takayasu arteritis (pulseless disease) is a granulomatous vasculitis affecting large vessels. It predominantly affects which vessels and which demographic?
38. An abdominal aortic aneurysm (AAA) specimen shows replacement of the medial layer with atherosclerotic plaque, loss of smooth muscle cells, and fragmentation of elastic laminae. The key protease that destroys the extracellular matrix of the aortic wall in AAA is:
39. Takayasu arteritis affects large vessels (aorta and its branches) in young women. It is classified as a vasculitis affecting which size of vessels?
40. An abdominal aortic aneurysm in a 70-year-old man is found to measure 5.5 cm. Which pathological process is MOST responsible for its development?
41. A 60-year-old man with longstanding hypertension develops a pulsatile abdominal mass. Imaging reveals a 6 cm fusiform abdominal aortic aneurysm below the renal arteries. The histopathological hallmark in the wall of an AAA that distinguishes it from a saccular aortic aneurysm from syphilis is:
42. A 70-year-old woman has a temporal headache, jaw claudication, and visual disturbance. ESR is 110 mm/hr. Temporal artery biopsy shows transmural granulomatous inflammation with giant cells at the intima-media junction and fragmentation of the internal elastic lamina. This condition predominantly affects which calibre of vessels?
43. In the pathogenesis of atherosclerosis, oxidised LDL (oxLDL) entering the intima is taken up by macrophages via which non-regulated scavenger receptor, leading to foam cell formation?
44. Giant cell (temporal) arteritis preferentially involves which layer of the vessel wall, and which cellular finding is pathognomonic?
45. A 65-year-old hypertensive man has a thoracic aortic aneurysm (TAA). Unlike abdominal aortic aneurysms (AAA), TAA in hypertensives most commonly results from:
46. Which feature histologically distinguishes a true aortic aneurysm from an aortic dissection?
47. Takayasu arteritis is a granulomatous vasculitis affecting large vessels (aorta and its major branches) predominantly in young women. The histological hallmark is:
48. A 65-year-old man with a pulsatile abdominal mass has CT showing a 5.5 cm infrarenal aortic aneurysm with mural thrombus. The pathological process underlying most abdominal aortic aneurysms is:
49. A 35-year-old woman presents with fever, absent radial pulses bilaterally, elevated ESR, and aortic arch narrowing on angiography. The vasculitis affects large vessels and granulomatous inflammation is found in the vessel wall. The diagnosis is:
50. Polyarteritis nodosa (PAN) is a necrotizing vasculitis that affects which type of vessels and typically spares which organ?
51. A 65-year-old man with a history of hypertension and atherosclerosis presents acutely with severe tearing chest/back pain radiating to the abdomen. CT shows a false lumen in the thoracic aorta. The underlying histological change predisposing to aortic dissection is:
52. Takayasu arteritis is a granulomatous inflammation of large vessels primarily affecting young Asian women. Which layer of the aorta and its branches shows the predominant inflammatory infiltrate?
53. Takayasu arteritis preferentially involves which type of vessels and which age/sex group?
54. A 65-year-old hypertensive smoker has sudden tearing back pain. CT shows a dissection flap beginning just distal to the left subclavian artery with no involvement of the ascending aorta. This is classified as:
55. A 70-year-old woman develops jaw claudication and sudden vision loss. ESR 95 mm/h. Temporal artery biopsy shows granulomatous inflammation with giant cells and fragmentation of the internal elastic lamina. The primary cellular mediator driving this vasculitis is:
56. A 40-year-old woman presents with hypertension, diminished upper extremity pulses, fever, and elevated ESR. Aortic arch angiography shows irregular stenosis of the aorta and its major branches. Biopsy shows panarteritis with multinucleated giant cells and inflammatory infiltrate in the outer media and adventitia. The diagnosis is:
57. Fibromuscular dysplasia preferentially affects which arteries, in which demographic, and by which pathological mechanism?
58. A 68-year-old male with a long history of hypertension is found at autopsy to have a 7 cm fusiform dilatation of the abdominal aorta below the renal arteries. The adventitia contains a dense inflammatory infiltrate with plasma cells and lymphocytes. Histologically, the media shows loss of smooth muscle cells and elastic laminae with replacement by fibrous tissue. The most important risk factor for development of abdominal aortic aneurysm (AAA) is:
59. Polyarteritis nodosa (PAN) characteristically spares which type of vessels, differentiating it from other forms of systemic vasculitis?
60. An abdominal aortic aneurysm (AAA) is most commonly located infrarenally. The predominant mechanism of aneurysm expansion involves:
61. A 70-year-old hypertensive man is found to have a 6 cm abdominal aortic aneurysm (AAA). The aneurysmal wall on histology shows marked loss of medial smooth muscle cells and elastic laminae with chronic inflammatory infiltrate (T cells, macrophages, B cells) and proteolytic matrix degradation. The most important protease family responsible for medial elastic tissue destruction in AAA is:
62. A 28-year-old woman has new-onset hypertension, diminished radial pulses, and constitutional symptoms. ESR is 95 mm/h. CT angiography shows wall thickening and luminal narrowing of the aortic arch and its branches. Biopsy of the aortic wall reveals granulomatous inflammation with giant cells in the media. The diagnosis is:
63. Fibromuscular dysplasia (FMD) of the renal artery is a non-inflammatory, non-atherosclerotic arterial disease causing renovascular hypertension in young women. The most common histological type of FMD shows a characteristic angiographic appearance called 'string of beads'. Which arterial layer is predominantly affected in the most common type?
64. Kawasaki disease is an acute self-limited vasculitis of childhood affecting medium-sized vessels, particularly coronary arteries. The feared complication is coronary artery aneurysm. Which pathological sequence explains aneurysm formation in Kawasaki disease?
65. The 'vulnerable' atherosclerotic plaque most prone to rupture and acute thrombosis is characterized by:
66. Giant cell (temporal) arteritis most commonly affects which vessels, and what is the feared complication of untreated disease?
67. A 65-year-old man is found to have an aortic aneurysm. Histology shows cystic medial necrosis with loss of elastic fibers and smooth muscle cells in the tunica media. This pattern is most characteristic of which aortic aneurysm etiology?
68. Temporal (giant cell) arteritis most commonly involves which artery, and which vessel-associated risk is most feared as a complication?
69. A 35-year-old woman with a history of middle ear infections presents with a 'string of beads' appearance on renal angiography. She has hypertension. Which underlying vascular disease is responsible?
70. In Kawasaki disease (mucocutaneous lymph node syndrome), the most dangerous complication is coronary artery aneurysm. The primary mechanism of aneurysm formation involves:
71. Polyarteritis nodosa (PAN) characteristically spares pulmonary vessels and affects medium-sized muscular arteries. ANCA (anti-neutrophil cytoplasmic antibody) serology in PAN is typically:
72. A 65-year-old man with a history of smoking has a 6 cm infrarenal aortic aneurysm found incidentally on CT. The risk of rupture correlates most with which parameter?
73. An abdominal aortic aneurysm (AAA) occurs most commonly infrarenally and is associated with atherosclerosis. The key pathological mechanism causing vessel wall weakening is: