Cardiac Pathology Practice Questions

Q: A 17-year-old high school student dies suddenly while playing basketball. Autopsy and histologic sections are provided. What is the most likely diagnosis?

Hypertrophic cardiomyopathy. ***Hypertrophic cardiomyopathy*** - **Sudden cardiac death** in young athletes is classically associated with **hypertrophic cardiomyopathy**, which causes **outflow tract obstruction** during exercise. - Histologically shows **myofiber disarray**, **myocyte hypertrophy**, and **interstitial fibrosis** - pathognomonic features of HCM. *Dilated cardiomyopathy* - Presents with **progressive heart failure** and **reduced ejection fraction**, not sudden death in asymptomatic young athletes. - Histology shows **dilated chambers** with **thin walls** and **myocyte atrophy**, contrasting with the hypertrophic features seen here. *Constrictive cardiomyopathy* - Actually refers to **restrictive cardiomyopathy**, which causes **diastolic dysfunction** with preserved systolic function. - Results from **infiltrative diseases** like **amyloidosis** or **sarcoidosis**, not seen in healthy teenagers. *Secondary cardiomyopathy* - Develops due to **systemic conditions** like **hypertension**, **diabetes**, or **chemotherapy toxicity**. - Unlikely in a previously healthy 17-year-old without underlying medical conditions or drug exposure.

Q: Metastasis to the heart is most commonly from which primary site?

Breast. **Explanation:** Metastatic involvement of the heart is significantly more common (about 15–30 times) than primary cardiac tumors [1]. The correct answer is **Breast** because of its high incidence and anatomical proximity to the mediastinum. 1. **Why Breast is Correct:** Metastasis to the heart occurs via three main routes: lymphatic spread, hematogenous spread, or direct extension [1]. Breast cancer, along with **Lung cancer**, represents the most frequent source of cardiac metastasis [1]. This is due to the rich lymphatic drainage from the thoracic wall and the proximity of the breast to the pericardium. In many clinical series, Lung cancer is the most common primary site, but among the options provided, Breast cancer is the leading cause [1]. 2. **Why Incorrect Options are Wrong:** * **Prostate:** While prostate cancer frequently metastasizes to the bone (osteoblastic lesions), it rarely involves the heart. * **Ovary:** Ovarian cancer typically spreads via local seeding (peritoneal carcinomatosis) and rarely involves the myocardium or pericardium. * **All of the above:** This is incorrect as there is a clear hierarchy in the frequency of primary sites. **High-Yield NEET-PG Pearls:** * **Most common primary cardiac tumor:** Myxoma (Adults), Rhabdomyoma (Children). * **Most common site for Myxoma:** Left Atrium (Fossa ovalis). * **Most common malignancy of the heart:** Metastatic disease (Secondary) [1]. * **Highest relative risk:** While Lung/Breast are most common in absolute numbers, **Malignant Melanoma** has the highest *propensity* (percentage of cases) to spread to the heart [1]. * **Clinical Presentation:** Most cardiac metastases are clinically silent, but the most common manifestation is **pericardial effusion** (often hemorrhagic) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 584-586.

Q: A 25-year-old male presented with a growth in the left atrium. What is the most likely diagnosis?

Myxoma. **Explanation:** **Why Myxoma is the correct answer:** Atrial myxoma is the **most common primary cardiac tumor in adults** [2]. Approximately 75–90% of these tumors occur in the **left atrium**, typically arising from the interatrial septum near the fossa ovalis [1], [2]. Clinically, they often present with a "wrecking ball" effect, potentially obstructing the mitral valve (mimicking mitral stenosis) or causing embolic events and constitutional symptoms (fever, weight loss) due to IL-6 production [1], [2]. **Analysis of Incorrect Options:** * **A. Rhabdomyoma:** This is the most common primary cardiac tumor in **children/infants** and is strongly associated with Tuberous Sclerosis [2]. It most frequently involves the ventricles rather than the left atrium. * **C. Metastasis:** While metastatic tumors (from lung, breast, or melanoma) are the most common tumors found in the heart overall, the question asks for a specific growth in the left atrium in a young male. In the context of primary cardiac masses, Myxoma is the classic "textbook" presentation for this location. * **D. Papillary fibroelastoma:** These are small, sea-anemone-like growths typically found on **cardiac valves** (most commonly the aortic valve) rather than the atrial wall. **High-Yield NEET-PG Pearls:** * **Histology:** Myxoma cells (lepidic cells) are embedded in a "sea" of acid mucopolysaccharide ground substance (myxoid stroma) [1]. * **Carney Complex:** An autosomal dominant syndrome characterized by cardiac myxomas, skin pigmentation (lentigines), and endocrine overactivity. * **Auscultation:** A characteristic "tumor plop" may be heard during diastole as the mass drops into the mitral orifice. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 583-584. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 304-306.

Question 1

Which of the following conditions is NOT associated with increased risk of infective endocarditis?

Accepted Answer

Infective endocarditis

Answer

Sickle cell disease

Answer

Celiac disease

Answer

Thrombocythemia

Question 2

What type of exudate is characteristic of rheumatic fever?

Accepted Answer

Fibrinous

Answer

Serous

Answer

Purulent

Answer

Myxomatous

Question 3

A young female presents with verrucous vegetations on the surface of mitral valve cusps. What is the most likely diagnosis?

Accepted Answer

Libman Sacks Endocarditis

Answer

Rheumatic Fever

Answer

Marantic Endocarditis

Answer

Infective Endocarditis

Question 4

Which of the following causes the 'no-reflow' phenomenon in acute myocardial infarction, contributing to reperfusion injury?

Accepted Answer

Leukocyte aggregation

Answer

Myocyte hypercontracture

Answer

Free radicals

Answer

Complement activation

Question 5

Which of the following is not commonly associated with non-bacterial thrombotic endocarditis (NBTE)?

Accepted Answer

Intravenous drug abuse

Answer

Systemic lupus erythematosus (SLE)

Answer

Antiphospholipid antibody syndrome (APLAS)

Answer

Mucinous adenocarcinoma

Question 6

A 17-year-old high school student dies suddenly while playing basketball. Autopsy and histologic sections are provided. What is the most likely diagnosis?

Accepted Answer

Hypertrophic cardiomyopathy

Answer

Dilated cardiomyopathy

Answer

Constrictive cardiomyopathy

Answer

Secondary cardiomyopathy

Question 7

In essential hypertension, what cardiac changes are typically observed?

Accepted Answer

Cardiac cell hypertrophy

Answer

Cardiac cell hyperplasia

Answer

Increase in the mitochondrial number

Answer

Increase in the size of mitochondria

Question 8

All of the following statements regarding subendocardial infarction are true, except?

Accepted Answer

These may result in aneurysm

Answer

These are multifocal in nature

Answer

These often result from hypotension or shock

Answer

Epicarditis is not seen

Question 9

Metastasis to the heart is most commonly from which primary site?

Accepted Answer

Breast

Answer

Prostate

Answer

Ovary

Answer

All of the above

Question 10

A 25-year-old male presented with a growth in the left atrium. What is the most likely diagnosis?

Accepted Answer

Myxoma

Answer

Rhabdomyoma

Answer

Metastasis

Answer

Papillary fibroelastoma

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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