MCQ: Here are all 40 questions rewritten with even A/B/C/D

Question 1

A 55-year-old obese woman develops painful, dilated, tortuous veins in her lower legs after three pregnancies. What is the primary mechanism of their development?

Accepted Answer

Prolonged increased intraluminal pressure causing venous wall weakening and valve incompetence — Varicose veins result from prolonged elevated intraluminal pressure causing progressive venous wall dilation and valve incompetence — worsened by obesity and pregnancy compressing the IVC.

Question 2

A patient with longstanding varicose veins develops brownish discolouration and a non-healing ulcer above the medial malleolus. What is the correct term and mechanism for the skin discolouration?

Accepted Answer

Erythema nodosum from immune complex deposition in venous endothelium — Stasis dermatitis (brawny induration) results from chronic venous congestion → extravasation of RBCs → haemolysis → haemosiderin deposition → brawny discolouration and fibrosis.

Question 3

A 45-year-old male with pancreatic cancer develops painful superficial thrombophlebitis in his right leg, which resolves, then recurs in his left arm two weeks later. What eponym describes this phenomenon and its mechanism?

Accepted Answer

Trousseau syndrome — migratory thrombophlebitis from occult visceral malignancy secreting procoagulant factors — Trousseau syndrome is migratory thrombophlebitis classically associated with occult visceral malignancy. Tumours (especially pancreatic and GI) secrete tissue factor and mucins that activate coagulation.

Question 4

Which statement correctly distinguishes superficial varicose veins from deep vein thrombosis regarding pulmonary embolism risk?

Accepted Answer

DVT is the major source of PE; embolism from superficial varicose veins is very rare — Embolism from superficial varicose veins is very rare. DVT — particularly in popliteal, femoral, and iliac veins — is the major source of potentially fatal pulmonary embolism.

Question 5

A 30-year-old woman has painful red streaks running from a wound on her finger toward her axilla with tender enlarged nodes. Which outcome is most feared if she is not treated urgently?

Accepted Answer

Bacteraemia and sepsis if bacteria escape the draining lymph nodes into the venous circulation — Lymphangitis (most commonly Group A Streptococcus) tracks bacteria through lymphatics. If not contained within draining nodes, bacteria enter the venous circulation causing bacteraemia and potentially fatal sepsis.

Question 6

A 40-year-old woman who had a left radical mastectomy 8 years ago has a massively swollen, firm, fibrotic left arm with peau d'orange skin changes. Which condition explains this and what long-term complication is associated?

Accepted Answer

Secondary lymphoedema from surgical lymphatic disruption; associated with lymphangiosarcoma — Surgical severing of axillary lymphatics causes secondary lymphoedema. Chronic post-mastectomy lymphoedema carries a risk of lymphangiosarcoma (Stewart-Treves syndrome) developing in the affected arm.

Question 7

Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease) is autosomal dominant. What genes are mutated and what pathway do they affect?

Accepted Answer

ENG (endoglin) or ACVRL1/ALK1 genes — components of the TGF-β signalling pathway in endothelial cells — Osler-Weber-Rendu disease is caused by mutations in ENG or ACVRL1/ALK1 genes, both encoding components of the TGF-β signalling pathway in endothelial cells, leading to widespread telangiectasias present from birth.

Question 8

A child has a bright red raised patch on the forehead that grows rapidly in the first 3 months, then fades progressively. By age 7 the lesion is gone. What is this lesion?

Accepted Answer

Juvenile (strawberry) hemangioma — grows rapidly then completely regresses by age 7 in most cases — Juvenile hemangiomas occur in 1 in 200 births, grow rapidly for a few months, then fade and completely regress by age 7 in most cases — parents should be reassured.

Question 9

A port wine stain in the distribution of the trigeminal nerve is found in a child with seizures, intellectual disability, and skull "tram-track" calcifications. What underlying mutation causes this syndrome?

Accepted Answer

Somatic GNAQ missense mutation in the Gα subunit causing constitutive signalling — Sturge-Weber syndrome (port wine stain + leptomeningeal angiomas + seizures + intellectual disability) is caused by a somatic GNAQ missense mutation occurring early in development — not inherited.

Question 10

A 35-year-old male has a 2 cm vascular lesion in his liver found incidentally. Biopsy shows large dilated cavernous blood-filled spaces with intravascular thrombi and dystrophic calcification. What is most accurate about this lesion?

Accepted Answer

It is a cavernous hemangioma — infiltrative, does not regress, and should never be biopsied percutaneously — Cavernous hemangiomas are infiltrative, do not regress, and can be difficult to distinguish from malignancy on imaging. Percutaneous biopsy risks fatal haemorrhage — diagnosis is usually made radiologically.

Question 11

A child has a soft fluctuant 8 cm mass in the left neck at birth. Histology shows massively dilated lymphatic spaces lined by endothelium with indistinct margins. What is the diagnosis and its key association?

Accepted Answer

Cavernous lymphangioma (cystic hygroma) — strongly associated with Turner syndrome (45,X) — Cystic hygromas are cavernous lymphangiomas with indistinct unencapsulated margins in the neck/axilla. They are strongly associated with Turner syndrome and difficult to resect completely due to poor margins.

Question 12

A patient presents with an exquisitely painful small lesion under his thumbnail. Excision reveals a tumour composed of modified smooth muscle cells surrounding arteriovenous channels. What is the cell of origin and key distinguishing feature?

Accepted Answer

Glomus tumour — modified smooth muscle cells of glomus bodies; NOT endothelial; excision curative — Glomus tumours arise from modified smooth muscle cells (NOT endothelial) of glomus bodies. They are exquisitely painful, found under fingernails, and are completely cured by excision.

Question 13

A 32-year-old HIV-positive male with CD4 count of 45 develops red papules on his skin. Biopsy shows capillary proliferation with epithelioid endothelial cells, scattered neutrophils, and granular eosinophilic material. Warthin-Starry silver stain reveals bacilli. What is the diagnosis and the causative organism?

Accepted Answer

Bacillary angiomatosis — Bartonella species causing vascular proliferation in immunocompromised hosts — Bacillary angiomatosis is caused by Bartonella species (B. henselae or B. quintana) in immunocompromised patients. Warthin-Starry stain reveals the causative bacteria — distinguishing it critically from Kaposi sarcoma.

Question 14

Bartonella henselae causes different diseases depending on immune status. Which statement correctly describes this difference?

Accepted Answer

henselae causes cat-scratch disease in immunocompetent and bacillary angiomatosis in immunocompromised — B. henselae (reservoir: domestic cats) causes self-limiting necrotising granulomatous lymphadenopathy (cat-scratch disease) in immunocompetent hosts, but vascular proliferative bacillary angiomatosis in immunocompromised patients.

Question 15

Which virus causes Kaposi sarcoma and through what molecular mechanism does latent infection promote tumour growth?

Accepted Answer

HHV8 — viral cyclin D homologue disrupts cell cycle controls and viral proteins inhibit p53 — HHV8 (KSHV) causes KS. During latent infection, a viral cyclin D homologue disrupts cell cycle checkpoints and viral proteins inhibit p53, providing infected cells with growth and survival advantages.

Question 16

A 70-year-old man of Ashkenazic Jewish descent has slowly progressive red-purple nodular lesions on both ankles present for 10 years. He is HIV-negative. What form of Kaposi sarcoma does he have?

Accepted Answer

Classic KS — older Mediterranean/Eastern European men; indolent; localised to skin; excellent prognosis — Classic KS affects older men of Mediterranean, Middle Eastern, or Eastern European descent. It is NOT HIV-associated, runs an indolent course, and typically remains confined to the skin.

Question 17

A prepubertal child in sub-Saharan Africa has Kaposi sarcoma with extensive lymph node and visceral involvement. What is the expected prognosis?

Accepted Answer

Poor — nearly 100% mortality within 3 years for this severe endemic African form in children — The severe endemic African KS in prepubertal children with lymph node and visceral involvement carries nearly 100% mortality within 3 years — one of the most aggressive forms of KS.

Question 18

A renal transplant patient on tacrolimus develops Kaposi sarcoma with mucosal and visceral involvement. What is the most appropriate first management step?

Accepted Answer

Reduce or withdraw immunosuppression, accepting the risk of allograft rejection — Transplant-associated KS is driven by T-cell immunosuppression. The first step is reducing or withdrawing immunosuppression — lesions may regress spontaneously, though organ rejection is a risk.

Question 19

The three progressive morphologic stages of Kaposi sarcoma are patch, plaque, and nodule. What does the nodular stage specifically herald?

Accepted Answer

Lymph node and visceral involvement signalling progression from localised to systemic disease — The nodular stage — sheets of plump spindle cells with slitlike vascular spaces — heralds lymph node and visceral involvement, marking progression to systemic disease.

Question 20

A 62-year-old woman develops a rapidly growing fleshy scalp mass with blurring margins. Biopsy shows atypical endothelial cells forming poorly organised vascular channels. CD31 is positive. What is the diagnosis and prognosis?

Accepted Answer

Angiosarcoma — malignant endothelial neoplasm; 5-year survival approximately 30% — Angiosarcoma is a malignant endothelial neoplasm confirmed by CD31 positivity. It is locally invasive, readily metastasises, and carries an approximately 30% 5-year survival.

Question 21

Hepatic angiosarcoma is specifically associated with three carcinogenic exposures with long latency periods. Which combination is correct?

Accepted Answer

Arsenic, Thorotrast (radioactive contrast agent), and polyvinyl chloride — Hepatic angiosarcoma is specifically linked to arsenic (pesticides), Thorotrast (formerly used radioactive contrast agent, now banned), and polyvinyl chloride (PVC) — all with characteristically long latency periods of 15–40 years.

Question 22

A 55-year-old woman develops a new lesion in her right arm 6 years after right mastectomy and axillary clearance. Her arm has been massively swollen since surgery. Biopsy reveals malignant endothelial cells (CD31 positive). What is the diagnosis?

Accepted Answer

Lymphangiosarcoma (Stewart-Treves syndrome) arising in chronic post-mastectomy lymphoedema — Post-mastectomy lymphangiosarcoma (Stewart-Treves syndrome) arises in the chronically lymphoedematous arm years after radical mastectomy — a well-recognised complication of secondary lymphoedema.

Question 23

Spider telangiectasias are most commonly associated with which clinical states and what is their distinguishing physical examination feature?

Accepted Answer

Hyperestrogenic states (pregnancy, cirrhosis); they are pulsatile and blanch with direct pressure — Spider telangiectasias are associated with hyperestrogenic states. Composed of dilated subcutaneous arterioles, they are characteristically pulsatile and blanch completely with direct pressure.

Question 24

A patient with Osler-Weber-Rendu disease presents with recurrent severe nosebleeds and bloody stools. What is the mechanism of bleeding?

Accepted Answer

Spontaneous rupture of widely distributed telangiectasias — malformations of dilated capillaries and venules — In Osler-Weber-Rendu disease, telangiectasias (malformations of dilated capillaries and venules present from birth) are widely distributed including throughout the GI tract and nasopharynx, and can spontaneously rupture.

Question 25

A 3-year-old boy has a large vascular mass overlying his sacrum, associated with high-output cardiac failure. Biopsy shows mature vascular channels of arterial and venous type bypassing the capillary bed. What is the diagnosis?

Accepted Answer

Arteriovenous malformation (AVM) — high-flow shunting causing cardiac strain — Arteriovenous malformations (AVMs) are direct connections between arteries and veins bypassing the capillary bed. Large AVMs (e.g., in sacrum, brain) cause significant high-output cardiac failure due to shunting.

Question 26

A patient with atherosclerosis has a blood pressure reading of 160/90 mmHg. Which statement about isolated systolic hypertension in the elderly is correct?

Question 27

What is the most common cause of sustained hypertension?

Accepted Answer

Pheochromocytoma — Essential (idiopathic) hypertension, without an identifiable secondary cause, accounts for 90-95% of all cases of hypertension.

Question 28

Renal artery stenosis causes hypertension primarily through which mechanism?

Accepted Answer

Activation of the renin-angiotensin-aldosterone system (RAAS) due to reduced renal perfusion — Renal artery stenosis reduces blood flow to the juxtaglomerular apparatus, which stimulates renin release, activating the RAAS and causing hypertension. This is secondary hypertension.

Question 29

Which of the following is NOT typically considered a potential complication of hypertension?

Accepted Answer

Hypertrophic cardiomyopathy (non-obstructive type) — Hypertrophic cardiomyopathy (HCM) is a primary genetic myocardial disorder, distinct from the left ventricular hypertrophy (LVH) that can result from chronic hypertension. LVH is a common complication of hypertension.

Question 30

What is the primary mechanism by which chronic lymphatic obstruction, such as in filariasis, leads to lymphoedema?

Accepted Answer

Elevated hydrostatic pressure in distal lymphatic channels causing oedema and eventual fibrosis — Filariasis (Wuchereria bancrofti) obstructs lymphatic channels → distal hydrostatic pressure rises → chronic oedema → progressive fibrosis → brawny induration. It is the most common worldwide cause of massive lymphoedema.

Question 31

A woman develops chylous ascites after surgery for ovarian cancer. What does the presence of chylous (milky) fluid specifically indicate?

Accepted Answer

Rupture of dilated lymphatics from obstruction allowing lymph to accumulate in the abdomen — Chylous ascites results from rupture of dilated lymphatics caused by obstruction (tumour, surgery) — allowing lymph to accumulate in the peritoneal cavity. The milky appearance reflects its high lipid content.

Question 32

Malignant vascular tumours require immunohistochemistry to confirm their endothelial cell origin. Which markers confirm endothelial derivation?

Accepted Answer

CD31 and von Willebrand factor — endothelial cell-specific markers confirming vascular origin — CD31 (PECAM-1) and von Willebrand factor (Factor VIII-related antigen) are endothelial cell-specific markers used to confirm endothelial origin of malignant vascular tumours, including angiosarcoma.

Question 33

An intermediate-grade vascular neoplasm — epithelioid hemangioendothelioma — is found around a medium-sized vein. What is its expected clinical behaviour?

Accepted Answer

Variable — most cured by excision, but up to 40% recur and 20–30% eventually metastasise — EHE has variable, intermediate behaviour: most are cured by excision, but up to 40% recur, 20–30% eventually metastasise, and ~15% of patients die of their disease.

Question 34

Port wine stain differs from other forms of nevus flammeus in which important way?

Accepted Answer

Port wine stains grow during childhood, progressively thicken the overlying skin, and persist permanently — Unlike most nevus flammeus birthmarks that regress, port wine stains grow progressively during childhood, thicken the overlying skin, and persist indefinitely — requiring laser treatment if clinically significant.

Question 35

A 60-year-old male develops an enlarging right upper arm mass with CD31-positive malignant cells on biopsy, arising in an arm that has been chronically swollen since right mastectomy 10 years ago. Which aetiology does this represent?

Accepted Answer

Lymphangiosarcoma from chronic post-mastectomy lymphoedema (Stewart-Treves syndrome) — Angiosarcoma (lymphangiosarcoma/Stewart-Treves) arising in the ipsilateral arm after mastectomy and chronic lymphoedema is a classic, well-recognised aetiology — both radiation and lymphatic obstruction contribute.

Question 36

Large-bore synthetic vascular grafts (≥12 mm) function well in high-flow aortic positions. Why do small-diameter synthetic grafts (≤8 mm) generally fail?

Accepted Answer

Small-bore grafts fail primarily from early thrombosis and late anastomotic intimal hyperplasia — Small-diameter synthetic grafts fail due to early thrombosis and late intimal hyperplasia developing at the anastomotic junction — the reason autologous vessels (saphenous vein, IMA) are preferred for small-bore bypass.

Question 37

The mechanisms by which saphenous vein grafts fail over 10 years include three distinct sequential processes. Which combination correctly identifies all three?

Accepted Answer

Early thrombosis, intimal thickening (months–years), and accelerated vein graft atherosclerosis — Saphenous vein graft failure occurs through three sequential mechanisms: early thrombosis, later SMC-driven intimal thickening (months–years post-op), and eventual accelerated atherosclerosis — sometimes with plaque rupture.

Question 38

Milroy disease is a form of primary lymphoedema. What distinguishes it from secondary lymphoedema?

Accepted Answer

Milroy disease is heredofamilial congenital lymphoedema from hereditary lymphatic agenesis or hypoplasia — Milroy disease (heredofamilial congenital lymphoedema) is caused by hereditary lymphatic agenesis or hypoplasia — present from birth and unrelated to any external acquired cause.

Question 39

AIDS-associated Kaposi sarcoma has declined by more than 80% since ART. How much more common does it remain in HIV-infected individuals compared to the general population?

Accepted Answer

1000-fold more common, even with ART lowering the absolute incidence substantially — AIDS-associated KS remains 1000-fold more common than in the general population and 300-fold more common than in transplant recipients — despite the 80% reduction in incidence achieved with antiretroviral therapy.

Question 40

A child has a rapidly growing pedunculated red gingival mass. His mother is 6 months pregnant and has an identical lesion. Biopsy shows immature vascular proliferation resembling granulation tissue. What is the correct diagnosis and management?

Accepted Answer

Pyogenic granuloma — benign; may regress, fibrose, or become a peripheral ossifying fibroma; treat by excision — Pyogenic granulomas are benign vascular proliferations common in pregnant women (granuloma gravidarum) and children. Despite rapid growth, they are benign and managed by complete excision. Recurrence is possible.

MCQ: Here are all 40 questions rewritten with even A/B/C/D

Questions, Answers & Explanations