Cardiac Pathology Practice Questions

Q: What type of cardiomyopathy is characterized by this arrangement of myofibrils?

Hypertrophic cardiomyopathy. ***Hypertrophic cardiomyopathy*** - **Myofibrillar disarray** (chaotic, disorganized arrangement of cardiac myofibers) is the **pathognomonic histological hallmark** of hypertrophic cardiomyopathy. - This characteristic **disorganized pattern** distinguishes HCM from other cardiomyopathies and is essential for definitive diagnosis. *Dilated cardiomyopathy* - Shows **hypertrophy** and **fibrosis** but maintains **normal myofibrillar organization** without the characteristic disarray. - Histologically characterized by **enlarged chambers** with **thinned walls**, not disorganized myofibrils. *Constrictive cardiomyopathy* - This is not a recognized form of **primary cardiomyopathy** but rather refers to **constrictive pericarditis**. - **Pericardial thickening** and **calcification** are the main features, not myofibrillar changes. *Fibroelastic cardiomyopathy* - Also known as **endomyocardial fibrosis**, characterized by **subendocardial fibrosis** and **thickening**. - Shows **organized fibrotic tissue** deposition rather than **myofibrillar disarray** pattern.

Q: McCallum's patch is diagnostic of which condition?

Rheumatic endocarditis. **Explanation:** **MacCallum’s patch** is a characteristic lesion pathonomonic for **Acute Rheumatic Carditis**. It presents as a map-like, thickened, and wrinkled area of the endocardium, typically located in the **posterior wall of the left atrium**, just above the posterior leaflet of the mitral valve [1]. The underlying mechanism involves subendocardial inflammation (endocarditis) caused by the regurgitant jet of blood hitting the atrial wall (due to mitral valve involvement) and the inflammatory process itself. Histologically, these patches contain **Aschoff bodies**, which are the hallmark granulomatous lesions of Rheumatic Heart Disease [1]. **Analysis of Incorrect Options:** * **Infective Endocarditis:** Characterized by "vegetations" (friable, bulky thrombi) on valve leaflets, not endocardial patches [2]. * **Myocardial Infarction:** Presents with coagulative necrosis and subsequent scarring (fibrosis) of the myocardium, typically involving the ventricles rather than the atrial endocardium. * **Tetralogy of Fallot (ToF):** A congenital cyanotic heart disease characterized by four structural defects (VSD, Overriding aorta, Pulmonary stenosis, RVH); it does not feature MacCallum’s patches. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Most common in the **Left Atrium** (Posterior wall). * **Aschoff Bodies:** The pathognomonic microscopic feature of Rheumatic Fever, consisting of Anitschkow cells ("caterpillar cells") [1]. * **Pancarditis:** Rheumatic fever affects all three layers (Endocardium, Myocardium, Pericardium) [1]. * **Bread and Butter Pericarditis:** Refers to the fibrinous pericarditis seen in Rheumatic Heart Disease. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 566-567. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568.

Question 1

What type of cardiomyopathy is characterized by this arrangement of myofibrils?

Accepted Answer

Hypertrophic cardiomyopathy

Answer

Dilated cardiomyopathy

Answer

Constrictive cardiomyopathy

Answer

Fibroelastic cardiomyopathy

Question 2

All of the following statements regarding endocarditis are true, except:

Accepted Answer

Vegetations of infective endocarditis occur on both surfaces of cusps.

Answer

Infective endocarditis can develop large friable vegetations.

Answer

Non-bacterial thrombotic endocarditis can develop in disseminated intravascular coagulation.

Answer

All of the above.

Question 3

What is the typical site of lesion in endocarditis of rheumatic heart disease?

Accepted Answer

Along the lines of closure of valves

Answer

Free margin of valves

Answer

Both sides of valves

Answer

Valve cusps

Question 4

Aschoff bodies in the myocardium are the hallmark of carditis associated with which condition?

Accepted Answer

Rheumatic fever

Answer

Infective endocarditis

Answer

Rheumatoid arthritis

Answer

Systemic lupus erythematosus

Question 5

Firm warty vegetations along the line of apposition of heart valves are present in which condition?

Accepted Answer

Rheumatic heart disease

Answer

NBTE

Answer

Bacterial endocarditis

Answer

Libman Sacks endocarditis

Question 6

McCallum's patch is diagnostic of which condition?

Accepted Answer

Rheumatic endocarditis

Answer

Infective endocarditis

Answer

Myocardial infarction

Answer

Tetralogy of Fallot (ToF)

Question 7

A stenotic valve is removed from a 70-year-old man. The valve demonstrates hard nodular masses heaped up within the sinuses of Valsalva. On microscopic section, the acellular masses stain darkly blue with hematoxylin and eosin. Which of the following is the MOST significant constituent of the masses?

Accepted Answer

Calcium phosphates

Answer

Calcium oxalates

Answer

Complexed iron

Answer

Magnesium phosphates

Question 8

A patient developed an anterior wall myocardial infarction and died within 2 hours of symptom onset. An autopsy is being performed, and the involved myocardium is being observed under light microscopy. What pathological finding would be expected?

Accepted Answer

Waviness of myocyte fibers at the border

Answer

Beginning of coagulation necrosis

Answer

Neutrophilic infiltration

Answer

Well-developed phagocytosis of dead cells

Question 9

Aschoff's nodules are seen in which condition?

Accepted Answer

Rheumatic carditis

Answer

Subacute bacterial endocarditis

Answer

Libman-Sacks endocarditis

Answer

Non-bacterial thrombotic endocarditis

Question 10

Non-sterile vegetations are seen in which of the following conditions?

Accepted Answer

Infective endocarditis

Answer

Rheumatic fever

Answer

Non-bacterial thrombotic endocarditis

Answer

Libman-Sacks endocarditis

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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