Cardiac Pathology Practice Questions

Q: All of the following are true regarding marantic endocarditis except?

Affects damaged valves. Explanation: Marantic endocarditis, also known as **Non-Bacterial Thrombotic Endocarditis (NBTE)**, is characterized by the deposition of small, sterile thrombi (fibrin and platelets) on cardiac valves. **Why Option C is the correct answer (The Exception):** Unlike Subacute Bacterial Endocarditis (SBE), which typically occurs on previously damaged or deformed valves, NBTE characteristically occurs on **previously normal valves**. The pathogenesis is not related to structural valve disease or infection, but rather to systemic hypercoagulability or endothelial trauma [1]. **Analysis of other options:** * **Option A:** The vegetations in NBTE are **friable** and loosely attached because there is no significant underlying inflammation or organization. Therefore, they frequently break off and **embolize** to the brain, kidneys, or spleen. * **Option B:** Similar to Rheumatic Heart Disease, the vegetations in NBTE are typically small (1–5 mm) and occur **along the line of closure** of the valve leaflets (most commonly the mitral valve) [1]. * **Option D:** NBTE is strongly associated with **hypercoagulable states**. It is frequently seen in patients with advanced malignancies (especially mucinous adenocarcinomas—known as **Trousseau syndrome**) or profound debilitation (wasting/marasmus) [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** Vegetations are sterile, bland, and do not cause significant valvular destruction (unlike Infective Endocarditis) [1]. * **Associations:** Look for keywords like "Adenocarcinoma of Pancreas," "Disseminated Intravascular Coagulation (DIC)," or "Cachexia." * **Libman-Sacks Endocarditis vs. NBTE:** Both are sterile, but Libman-Sacks (associated with SLE) features vegetations on *both* sides of the valve leaflets and chordae tendineae [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568.

Q: What are the upper limits for ventricular wall thickness?

Left ventricle - 1.5 cm, right ventricle 5 mm. The thickness of the ventricular walls is a direct reflection of the pressure against which each chamber must pump (afterload). **Explanation of the Correct Answer (D):** In a healthy adult heart, the **Left Ventricle (LV)** is the high-pressure pump, maintaining systemic circulation. Its normal wall thickness ranges from 0.6 to 1.1 cm, but the **upper limit of normal is 1.5 cm**. Any thickness beyond 1.5 cm is diagnostic of Left Ventricular Hypertrophy (LVH). The **Right Ventricle (RV)** is a low-pressure pump supplying the pulmonary circulation. Its wall is significantly thinner, with an **upper limit of 0.5 cm (5 mm)**. Thickness exceeding 5 mm indicates Right Ventricular Hypertrophy (RVH). **Analysis of Incorrect Options:** * **Options A & B:** These underestimate the upper physiological limits. While 1.0–1.2 cm are "average" measurements for the LV, they do not represent the threshold for pathology. * **Option C:** While 1.3 cm is within the normal range for the LV, 5 mm is the correct limit for the RV. However, the question asks for the standard established upper limits used in pathology and anatomy textbooks (like Gray’s and Robbins). **High-Yield Clinical Pearls for NEET-PG:** * **Ratio:** The LV wall is typically **3 times thicker** than the RV wall. * **LVH Causes:** Most commonly caused by systemic hypertension or aortic stenosis. * **RVH Causes:** Most commonly caused by pulmonary hypertension or mitral stenosis (due to back pressure). * **Concentric vs. Eccentric:** Pressure overload (e.g., HTN) leads to *concentric* hypertrophy (thick walls), while volume overload (e.g., Regurgitation) leads to *eccentric* hypertrophy (dilated chamber).

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

Rheumatic endocarditis. **MacCallum’s Patch** is a classic morphological feature of **Rheumatic Heart Disease (RHD)** [1]. It represents an area of endocardial thickening caused by the mechanical trauma of regurgitant blood jets. 1. **Why Rheumatic Endocarditis is correct:** In Acute Rheumatic Fever, endocarditis primarily affects the valves, but it can also involve the mural endocardium [1]. MacCallum’s patch is typically found in the **posterior wall of the left atrium**, just above the posterior leaflet of the mitral valve. It occurs due to subendocardial inflammation (Aschoff bodies) followed by fibrosis, exacerbated by the "jet effect" of mitral regurgitation [1]. [1] 2. **Why other options are incorrect:** * **Infective Endocarditis:** Characterized by large, friable, and bulky **vegetations** (verrucae) on the valve leaflets, which may lead to perforation or abscess, but not MacCallum’s patches [1]. * **Myocardial Infarction:** Involves coagulative necrosis of the myocardium due to ischemia. * **Tetralogy of Fallot:** A congenital cyanotic heart disease characterized by four specific anatomical defects (VSD, pulmonary stenosis, overriding aorta, and RVH). **High-Yield Clinical Pearls for NEET-PG:** * **Aschoff Bodies:** The pathognomonic microscopic feature of RHD (contains Anitschkow cells/Caterpillar cells) [1]. * **Location:** MacCallum’s patch is most common in the **Left Atrium**. * **Vegetations in RHD:** Small, sterile, friable, and arranged in a **row along the line of closure** of the valves [1]. * **Fish-mouth/Button-hole deformity:** Refers to the chronic stage of RHD with mitral valve stenosis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 566-568.

Question 1

Calcification of the aortic valve is seen in which of the following conditions?

Accepted Answer

Syphilis

Answer

Hurler syndrome

Answer

Marfan syndrome

Answer

None of the above

Question 2

Hemorrhagic pericarditis occurs in all of the following conditions except?

Accepted Answer

Constrictive pericarditis

Answer

Transmural myocardial infarction

Answer

Dissecting aneurysm of aorta

Answer

Metastatic disease of pericardium

Question 3

What is the earliest event in ischemic cardiac myocytes?

Accepted Answer

Loss of contractility

Answer

Microvascular injury

Answer

Irreversible cell injury

Answer

ATP reduction to 50% of normal

Question 4

A 25-year-old man suffers a sudden cardiac arrest and is resuscitated. His vital signs are normal on examination. Echocardiography reveals a normal left ventricle but marked thinning and dilation of the right ventricle. MRI of his chest shows extensive fibrofatty replacement of the myocardium without inflammation. What is the most likely cause for these findings?

Accepted Answer

Arrhythmogenic right ventricular cardiomyopathy

Answer

Chagas disease

Answer

Hypertension

Answer

Long QT syndrome

Question 5

In which of the following conditions are vegetations friable and easily detachable from the cardiac valves?

Accepted Answer

Infective endocarditis

Answer

Rheumatic fever

Answer

Rheumatoid heart disease

Answer

Systemic lupus erythematosus (SLE)

Question 6

All of the following are true regarding marantic endocarditis except?

Accepted Answer

Affects damaged valves

Answer

Vegetation may embolize

Answer

Vegetations along the line of closure of leaflets

Answer

May be associated with hypercoagulable states

Question 7

What are the upper limits for ventricular wall thickness?

Accepted Answer

Left ventricle - 1.5 cm, right ventricle 5 mm

Answer

Left ventricle - 1 cm, right ventricle 3 mm

Answer

Left ventricle - 1.2 cm, right ventricle 3 mm

Answer

Left ventricle - 1.3 cm, right ventricle 5 mm

Question 8

McCallum's patch is diagnostic of which condition?

Accepted Answer

Rheumatic endocarditis

Answer

Infective endocarditis

Answer

Myocardial infarction

Answer

Tetralogy of Fallot

Question 9

Which of the following is true about Libman-Sacks endocarditis?

Accepted Answer

Vegetations are on either side of the valve leaflet

Answer

Vegetations are along the line of valve closure

Answer

Vegetations are non-friable

Answer

Organisms are consistently seen in the vegetations

Question 10

All the statements regarding atherosclerosis are true, except:

Accepted Answer

Common site is the anterior wall of the right ventricle.

Answer

Naked eye changes are not visible for the first 12 hours.

Answer

Triphenyl tetrazolium chloride can help in detecting infracted area.

Answer

Most commonly involves the left coronary artery.

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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