Cardiac Tumors — MCQs
Cardiotoxicity caused by radiotherapy & chemotherapy is best detected by
Second primary tumor of head and neck is most commonly seen in malignancy of:
Features of rheumatic carditis are all except:
What is the most common type of benign intracavitary cardiac tumor?
A young female presents with chest pain not associated with exercise. Auscultation reveals multiple ejection clicks with a murmur. The most important investigation for diagnosis is:
MRI is superior in all of the following conditions except
In prostatic metastasis, the site most commonly involved is which one?
What is the most common primary tumor of the heart?
Most common malignant tumor of heart in children is-
Which of the following is the most common primary cardiac tumor seen in clinical practice?
Cardiac Tumors Indian Medical PG Practice Questions and MCQs
Question 1: Cardiotoxicity caused by radiotherapy & chemotherapy is best detected by
- A. ECHO (Correct Answer)
- B. Endomyocardial Biopsy
- C. ECG
- D. Radionuclide Scan
Explanation: ***ECHO*** - **Echocardiography (ECHO)** is the primary and most widely used non-invasive method for detecting cardiotoxicity due to its ability to assess **left ventricular ejection fraction (LVEF)**, a key indicator of cardiac function, and structural changes. - It is crucial for **baseline assessment**, monitoring during treatment, and follow-up, identifying both systolic and diastolic dysfunction effectively. *Endomyocardial Biopsy* - While **endomyocardial biopsy** is considered the gold standard for definitive diagnosis of some cardiomyopathies (e.g., myocarditis), it is **invasive** and carries risks such as perforation, tamponade, and arrhythmias. - It is usually reserved for cases where other non-invasive tests are inconclusive and there's a strong clinical suspicion of severe cardiac disease, or for research, not routine monitoring of cardiotoxicity. *ECG* - An **ECG** can detect arrhythmias and ischemic changes but is **not sensitive or specific** enough to reliably detect early or subtle changes in cardiac function characteristic of cardiotoxicity. - It may show changes secondary to heart failure, but it does not directly measure ejection fraction or assess overall cardiac mechanical function. *Radionuclide Scan* - **Radionuclide scans**, specifically **MUGA (Multigated Acquisition)** scans, can accurately measure **LVEF** and are an alternative to ECHO, particularly when ECHO images are suboptimal [1]. - However, they involve **radiation exposure**, making them less ideal for frequent monitoring compared to echocardiography, especially in cancer patients who are already exposed to radiation.
Question 2: Second primary tumor of head and neck is most commonly seen in malignancy of:
- A. Paranasal sinuses
- B. Hypopharynx
- C. Larynx
- D. Oral cavity (Correct Answer)
Explanation: ***Oral cavity*** - Patients with **oral cavity squamous cell carcinoma** (OCSCC) have the highest incidence of developing **second primary tumors** (SPTs) in the head and neck region, often due to shared risk factors like tobacco and alcohol use. - The concept of "**field cancerization**" explains this phenomenon, where prolonged exposure to carcinogens leads to widespread genetic alterations in the mucosal lining, predisposing multiple sites to develop independent primary cancers. *Paranasal sinuses* - While paranasal sinus cancers can be aggressive, they are less commonly associated with the development of **second primary tumors** within the head and neck compared to oral cavity cancers. - The etiology of paranasal sinus cancers is often linked to specific exposures like wood dust or nickel, which are less broadly distributed across the upper aerodigestive tract compared to tobacco and alcohol. *Hypopharynx* - Hypopharyngeal cancers do carry a significant risk of developing **second primary tumors**, particularly in the esophagus and lungs, but the overall incidence of head and neck SPTs is generally considered lower than that for oral cavity cancers. - The anatomical location and typical lymphatic drainage patterns of hypopharyngeal cancers might direct SPTs to different sites compared to oral cavity cancers. *Larynx* - Laryngeal cancers, especially those of the **glottis**, are also strongly associated with tobacco and alcohol. However, the incidence of **second primary tumors** in other head and neck sites is typically reported to be lower than in oral cavity cancer patients. - While laryngeal cancer patients are at risk for SPTs in the lung and esophagus, the synchronous or metachronous development of another primary tumor *within* the head and neck region is more prevalent in oral cavity cases.
Question 3: Features of rheumatic carditis are all except:
- A. Myocardial fibrosis
- B. Intramyocardial microemboli (Correct Answer)
- C. Lymphocytic infiltration
- D. Aschoff nodule
Explanation: ***Intramyocardial microemboli*** - **Intramyocardial microemboli** are not a characteristic feature of rheumatic carditis. Microemboli are typically associated with conditions like infective endocarditis or other hypercoagulable states, leading to obstruction of small coronary arteries. - Rheumatic carditis involves an inflammatory, autoimmune response to cardiac tissues, not embolic events. *Myocardial fibrosis* - **Myocardial fibrosis** can occur in chronic rheumatic heart disease as a reparative process following episodes of acute inflammation and damage to the myocardium. - This fibrosis often leads to stiffening and dysfunction of the cardiac muscle. *Lymphocytic infiltration* - **Lymphocytic infiltration** of the myocardium is a hallmark of acute rheumatic carditis, indicating the inflammatory and autoimmune nature of the disease as immune cells target cardiac tissue [1]. - This cellular infiltration contributes to myocardial damage and dysfunction. *Aschoff nodule* - **Aschoff bodies (or nodules)** are pathognomonic granulomatous lesions found in the myocardium during acute rheumatic carditis [1]. - These nodules consist of fibrinoid necrosis and inflammatory cells, including activated macrophages (Anitschkow cells), reflecting the autoimmune inflammatory process [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 566-567.
Question 4: What is the most common type of benign intracavitary cardiac tumor?
- A. Leiomyoma
- B. Sarcoma
- C. Lipoma
- D. Myxoma (Correct Answer)
Explanation: ***Myxoma*** - **Cardiac myxoma** is the **most common primary benign tumor of the heart**, accounting for approximately 50% of all primary cardiac tumors. - These tumors typically arise in the **atria, especially the left atrium**, and can cause symptoms due to obstruction of blood flow or embolization. *Leiomyoma* - **Leiomyomas** are benign tumors of **smooth muscle origin** and are most commonly found in the uterus (fibroids) or gastrointestinal tract, not typically in the heart. - While they can occur in the heart, they are exceedingly rare as primary cardiac tumors and are not the most common type. *Sarcoma* - **Sarcomas** are **malignant tumors** originating from mesenchymal tissues, and primary cardiac sarcomas are rare but are the most common type of primary malignant cardiac tumor. - The question specifically asks for a **benign intracavitary cardiac tumor**, ruling out sarcomas. *Lipoma* - **Lipomas** are benign tumors composed of **fat tissue** and can occur in various organs, including the heart. - While cardiac lipomas are found, they are far less common than myxomas and do not represent the most common benign intracavitary cardiac tumor.
Question 5: A young female presents with chest pain not associated with exercise. Auscultation reveals multiple ejection clicks with a murmur. The most important investigation for diagnosis is:
- A. ECG
- B. Thallium 201 scan
- C. Echocardiography (Correct Answer)
- D. Tc pyrophosphate scan
Explanation: ***Echocardiography*** - **Echocardiography** is the gold standard for visualizing cardiac structures and valve function, allowing direct assessment of **mitral valve prolapse (MVP)** [1]. - The presence of **multiple ejection clicks** and a murmur in a young female with non-exertional chest pain strongly suggests MVP, which can be confirmed by echocardiography [3]. *ECG* - An **ECG** can detect arrhythmias or signs of ischemia, but it cannot directly visualize the heart valves or diagnose **mitral valve prolapse** [2]. - While some MVP patients may have T-wave abnormalities or QT prolongation, these findings are non-specific and not diagnostic. *Thallium 201 scan* - A **Thallium 201 scan** is a nuclear imaging test primarily used to assess myocardial perfusion and detect areas of ischemia, usually in the context of **coronary artery disease** [4]. - It does not provide detailed anatomical information about heart valves or cardiac chamber morphology, making it unsuitable for diagnosing **mitral valve prolapse**. *Tc pyrophosphate scan* - A **Tc pyrophosphate scan** is primarily used to diagnose **amyloidosis** or evaluate myocardial infarction, particularly for detecting late-phase complications or right ventricular involvement. - It does not offer direct visualization of valvular structures and is not indicated for the diagnosis of **mitral valve prolapse**.
Question 6: MRI is superior in all of the following conditions except
- A. Diagnosis of iron overload cardiomyopathy in a pediatric patient with β-thalassemia major and congestive heart failure.
- B. Serial evaluation of liver functions in a 54-year-old female with metastatic carcinoma breast with doxorubicin chemotherapy (Correct Answer)
- C. Diagnosis of aortic coarctation in a 17-year-old female with hypertension and radiofemoral delay on physical examination.
- D. Diagnosis of arrhythmogenic right ventricular cardiomyopathy in a 24-year-old man who survived recent cardiac arrest.
Explanation: ***Serial evaluation of liver functions in a 54-year-old female with metastatic carcinoma breast with doxorubicin chemotherapy*** - While MRI can assess **liver morphology** and some functional parameters, **liver function** is primarily evaluated through **blood tests** (e.g., liver enzymes, bilirubin, albumin). - Regular biochemical tests are more direct and efficient for monitoring liver function during chemotherapy. *Diagnosis of iron overload cardiomyopathy in a pediatric patient with β-thalassemia major and congestive heart failure.* - **Cardiac MRI with T2* mapping** is the gold standard for quantifying myocardial iron deposition, which leads to iron overload cardiomyopathy. - This is crucial for guiding chelation therapy and preventing irreversible heart damage in **thalassemia patients**. *Diagnosis of aortic coarctation in a 17-year-old female with hypertension and radiofemoral delay on physical examination.* - **MRI angiography** provides excellent detailed anatomical imaging of the aorta, including the site, extent, and severity of coarctation, as well as collateral circulation. - This offers a comprehensive assessment that is superior to echocardiography in older children and adults. *Diagnosis of arrhythmogenic right ventricular cardiomyopathy in a 24-year-old man who survived recent cardiac arrest.* - **Cardiac MRI** is highly effective in diagnosing **ARVC** by detecting characteristic findings such as **fibrofatty replacement** in the right ventricular myocardium, wall motion abnormalities, and regional aneurysms. - These features are often difficult to visualize with other imaging modalities.
Question 7: In prostatic metastasis, the site most commonly involved is which one?
- A. Perivesical nodes
- B. Obturator nodes (Correct Answer)
- C. Pre-sacral nodes
- D. Para-aortic nodes
Explanation: ***Obturator nodes*** - The **obturator nodes** are a primary site for metastatic spread from the prostate due to their close proximity and direct lymphatic drainage pathways. - Prostate cancer cells often spread via the **lymphatic system** to regional lymph nodes before disseminating to distant sites. **Perivesical nodes** * While also regional, perivesical nodes are less frequently the _initial_ or most common site of metastasis compared to the obturator and internal iliac nodes. * Lymphatic drainage from the prostate primarily follows pathways that lead to obturator and internal iliac nodes first. **Pre-sacral nodes** * Pre-sacral nodes are considered more distant regional nodes compared to the obturator nodes and are typically involved later in the metastatic process. * Their involvement often indicates a more advanced stage of nodal metastasis. **Para-aortic nodes** * Para-aortic nodes are considered distant metastases for prostate cancer, indicating widespread disease. * Metastasis to para-aortic nodes usually occurs after involvement of more proximal regional nodes like the obturator and internal iliac nodes.
Question 8: What is the most common primary tumor of the heart?
- A. Leiomyosarcoma
- B. Rhabdomyosarcoma
- C. Myxoma (Correct Answer)
- D. Fibroma
Explanation: ***Myxoma*** - **Myxomas** are the most **common benign primary cardiac tumors**, accounting for approximately 50% of all primary cardiac tumors [1]. - They typically arise in the **atria**, most often the **left atrium**, and can cause symptoms due to obstruction or embolization [1], [2]. *Leiomyosarcoma* - **Leiomyosarcomas** are malignant tumors of **smooth muscle origin** and are rare in the heart. - While they can occur in the great vessels, they are not the most common primary cardiac tumor. *Rhabdomyosarcoma* - **Rhabdomyosarcomas** are highly aggressive **malignant tumors of skeletal muscle origin** that can rarely affect the heart. - They are one of the most common primary malignant cardiac tumors but are less frequent than benign myxomas overall. *Fibroma* - **Fibromas** are **benign mesenchymal tumors** of the heart, commonly found in children. - Although benign, they are far less common than myxomas. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 304-306. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 583-584.
Question 9: Most common malignant tumor of heart in children is-
- A. Angiosarcoma
- B. Lipoma
- C. Rhabdomyoma (benign tumor)
- D. Rhabdomyosarcoma (Correct Answer)
Explanation: ***Rhabdomyosarcoma*** - This is the **most common malignant tumor of the heart in children**, though primary cardiac tumors themselves are rare [1]. - It arises from **striated muscle cells** and can be found in various locations, including the heart [1]. *Angiosarcoma* - While a **malignant cardiac tumor**, angiosarcoma is more common in **adults** and is the most common primary malignant tumor of the heart in adults. - It arises from the cells lining **blood vessels**. *Lipoma* - A lipoma is a **benign tumor** composed of mature fat cells, and it is not a malignant tumor [1]. - Although it can occur in the heart, it is not the most common **malignant** cardiac tumor in children. *Rhabdomyoma (benign tumor)* - Rhabdomyoma is the **most common primary cardiac tumor in children**, but it is a **benign** tumor, not malignant [2]. - It is frequently associated with **tuberous sclerosis**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1222-1225. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 304-306.
Question 10: Which of the following is the most common primary cardiac tumor seen in clinical practice?
- A. Myxoma (Correct Answer)
- B. Rhabdomyosarcoma
- C. Angiosarcoma
- D. Lymphoma
Explanation: ***Myxoma*** - **Myxomas** are the most common **primary cardiac tumors** in adults, accounting for approximately 50% of all cases [1]. - They are typically benign and often originate in the **left atrium** [1], [2]. *Rhabdomyosarcoma* - **Rhabdomyosarcomas** are malignant tumors of skeletal muscle origin and are extremely rare in the heart. - They are one of the most common **pediatric soft tissue sarcomas**, but not common primary cardiac tumors overall [3]. *Angiosarcoma* - **Angiosarcomas** are highly aggressive malignant tumors of vascular endothelial cells. - While they are a relatively common type of **cardiac sarcoma**, they are overall rare and not the most common primary cardiac tumor. *Lymphoma* - **Cardiac lymphoma** is typically a secondary manifestation of systemic lymphoma and rarely presents as a primary cardiac tumor. - When primary, it is often associated with **immunocompromised states**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 304-306. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 583-584. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 481-482.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free