Cardiac Pathology Practice Questions

Q: Histopathological examination of cardiac tissue from a post-MI patient shows a predominant neutrophilic infiltrate. This finding corresponds to which post-infarction time window?

1-3 days. ***1-3 days*** - During this period, the infarcted myocardium undergoes **coagulative necrosis**, which recruits robust **neutrophilic** infiltration into the interstitium. - This inflammatory response peaks around 48-72 hours, marking the transition from acute ischemia to an established inflammatory process. *2-3 months* - By this stage, the heart tissue is characterized by a fully formed **dense collagenous scar**. - All acute inflammatory cells have disappeared, and the area is stable with **fibrosis**. *12-24 hours* - Histology shows early signs of **coagulative necrosis** with loss of nuclei and striations. - The inflammatory infiltrate is minimal at this stage, with only initial recruitment beginning. *7-10 days* - This timeframe is characterized by the appearance of **macrophages** that clear the necrotic debris, rather than neutrophils. - Proliferation of **granulation tissue** begins at the margins of the infarct.

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.

Question 1

Histopathological examination of cardiac tissue from a post-MI patient shows a predominant
neutrophilic infiltrate. This finding corresponds to which post-infarction time window?

Accepted Answer

1-3 days

Answer

2-3 months

Answer

12-24 hours

Answer

7-10 days

Question 2

A 35-year-old woman from a low socioeconomic background presents with progressive exertional dyspnoea, orthopnoea, and haemoptysis. She gives a history of recurrent sore throats in childhood. Auscultation reveals a mid-diastolic rumble at the apex. The gross pathology specimen of the explanted valve is shown in Image 2. Which of the following pathological mechanisms is most directly responsible for the valvular deformity seen in this image?

Accepted Answer

A. Repeated fibrinous inflammation causing leaflet fusion and fibrocalcific remodelling

Answer

B. Infective endocarditis with vegetation formation and leaflet perforation

Answer

C. Myxomatous degeneration with chordal elongation and leaflet prolapse

Answer

D. Senile calcific degeneration of an anatomically normal tricuspid valve

Question 3

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 4

What is the mechanism of acute rheumatic fever?

Accepted Answer

Cross-reactivity with endogenous antigen

Answer

Innocent bystander effect

Answer

Due to toxin secretion by streptococci

Answer

Release of pyrogenic cytokines

Question 5

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

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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