Cardiac Pathology Practice Questions

Q: What is the most common type of pericarditis seen in tuberculosis?

Constrictive. **Explanation:** The correct answer is **Constrictive Pericarditis**. **Why it is correct:** Tuberculosis (TB) is the most common cause of constrictive pericarditis in developing countries. Pathologically, TB causes a chronic inflammatory response characterized by granulomatous inflammation. Over time, the healing process involves extensive **fibrosis and calcification** of the pericardium [1]. This results in a rigid, "shell-like" casing (concretio cordis) that prevents the heart from expanding during diastole, leading to the clinical features of constriction. **Why the other options are incorrect:** * **Hemorrhagic:** While TB can occasionally cause bloody effusions, hemorrhagic pericarditis is most classically associated with **malignancy** (metastatic spread) or post-cardiac surgery [1]. * **Fibrinous:** This is characterized by a "bread and butter" appearance and is most commonly seen in **Acute Myocardial Infarction** (Dressler syndrome) or Uremia. * **Serofibrinous:** This is the most common type of *acute* pericarditis overall, often seen in viral infections or Rheumatic Fever. While TB may start as a serofibrinous exudate, its hallmark and most definitive presentation in pathology exams is the progression to **constriction** [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Imaging:** Chest X-ray may show a "calcified ring" around the heart. * **Clinical Sign:** **Kussmaul’s sign** (paradoxical rise in JVP during inspiration) and a **Pericardial Knock** (early diastolic sound) are classic findings. * **Treatment:** Surgical pericardiectomy is the definitive treatment for symptomatic constrictive pericarditis. * **Gold Standard:** Cardiac catheterization showing the "Square root sign" (dip-and-plateau pattern) in ventricular pressure tracings. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 582-583.

Q: Gross findings of the heart from an 18-year-old female presented with a history of sore throat 3 months back and joint pains have been shown below. On auscultatory finding, a murmur was noted. What is your diagnosis?

Rheumatic carditis. ***Rheumatic carditis*** - History of **sore throat** 3 months prior followed by joint pains suggests **Group A Streptococcal** infection leading to **acute rheumatic fever** with carditis. - Gross pathology shows characteristic **small warty vegetations** along the **line of closure** of mitral valve leaflets, consistent with **rheumatic valvulitis**. *Libman-Sacks endocarditis* - Associated with **systemic lupus erythematosus (SLE)**, not preceded by streptococcal throat infection. - Vegetations occur on **both surfaces** of valve leaflets (atrial and ventricular), unlike the linear pattern in rheumatic carditis. *Infective endocarditis* - Characterized by **large, irregular, friable vegetations** that can embolize, not small warty ones. - Typically presents with **fever, positive blood cultures**, and constitutional symptoms, which are absent in this case. *Marantic carditis* - Also known as **non-bacterial thrombotic endocarditis (NBTE)**, associated with **debilitating illnesses** like cancer. - Occurs in patients with **hypercoagulable states** or **cachexia**, not in healthy young individuals following streptococcal infection.

Question 1

Infarcts involving which part of the myocardium cause aneurysm as a post-myocardial infarction complication?

Accepted Answer

Anterior transmural MI

Answer

Posterior transmural MI

Answer

Subendocardial MI

Answer

Inferior wall MI

Question 2

What is the characteristic cardiac lesion in SLE?

Accepted Answer

Verrucous endocarditis

Answer

Pericarditis

Answer

Myocardial fibrosis

Answer

Valvular incompetence

Question 3

Aschoff bodies in Rheumatic heart disease show all of the following features, except?

Accepted Answer

Epithelioid cells

Answer

Anitschkow cells

Answer

Giant cells

Answer

Fibrinoid necrosis

Question 4

Troponin T is a marker of which of the following conditions?

Accepted Answer

Myocardial infarction

Answer

Renal disease

Answer

Muscular dystrophy

Answer

Cirrhosis of the liver

Question 5

What is the most common type of pericarditis seen in tuberculosis?

Accepted Answer

Constrictive

Answer

Hemorrhagic

Answer

Fibrinous

Answer

Serofibrinous

Question 6

Concentric hypertrophy of the heart is caused by:

Accepted Answer

Hypertrophic cardiomyopathy

Answer

Congestive heart failure

Answer

Systemic hypertension

Answer

Mitral regurgitation

Question 7

Gross findings of the heart from an 18-year-old female presented with a history of sore throat 3 months back and joint pains have been shown below. On auscultatory finding, a murmur was noted. What is your diagnosis?

Accepted Answer

Rheumatic carditis

Answer

Libman-Sacks endocarditis

Answer

Infective endocarditis

Answer

Marantic carditis

Question 8

What is the average time taken for a myocardial infarction to be completely healed?

Accepted Answer

6 weeks

Answer

3 weeks

Answer

12 weeks

Answer

15 weeks

Question 9

A 36-year-old man with a history of long-standing rheumatic heart disease and mitral stenosis dies during cardiac surgery. Autopsy findings are consistent with mitral stenosis and reveal the presence of "heart failure cells." What process leads to the observation of "heart failure cells"?

Accepted Answer

Chronic passive congestion of the lungs.

Answer

Activation of the coagulation cascade.

Answer

Hypoxic myocardial injury.

Answer

Myocardial hyperemia.

Question 10

At the time of autopsy of a 39-year-old female who died of complications of systemic lupus erythematosus, several medium-sized vegetations are found on both sides of the mitral valve and tricuspid valve. These cardiac vegetations are most likely the result of?

Accepted Answer

Presence of an anticardiolipin antibody

Answer

Turbulent blood flow through an incompetent mitral valve

Answer

Abnormal secretion of a vasoactive amine

Answer

Bacterial colonization of an abnormal valve

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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