Cardiac Pathology Practice Questions

Q: Atrial myxoma commonly arises from?

Left atrium. **Explanation:** Atrial myxoma is the most common primary cardiac tumor in adults. It is a benign, mesenchymal tumor that typically presents with the "classic triad" of constitutional symptoms (fever, weight loss), embolic phenomena, and obstructive symptoms mimicking mitral stenosis. **Why the Left Atrium is Correct:** Approximately **75-80% of cardiac myxomas arise in the left atrium**. They most commonly originate from the **interatrial septum**, specifically at the border of the **fossa ovalis**. Their location allows them to frequently prolapse through the mitral valve during diastole, causing a characteristic "tumor plop" sound on auscultation. **Why the Other Options are Incorrect:** * **Right Atrium (Option D):** This is the second most common site, accounting for about 15-20% of cases. While significant, it is far less frequent than left atrial involvement. * **Ventricles (Options A & C):** Ventricular myxomas are rare, representing less than 5% of all cases. Primary tumors in the ventricles are more likely to be rhabdomyomas (especially in children) or fibromas. **High-Yield Clinical Pearls for NEET-PG:** * **Carney Complex:** An autosomal dominant syndrome (PRKAR1A gene mutation) characterized by atrial myxomas, spotty skin pigmentation (lentigines), and endocrine overactivity. * **Diagnosis:** Transthoracic Echocardiography (TTE) is the initial screening tool of choice; Transesophageal Echocardiography (TEE) provides better detail. * **Treatment:** Prompt surgical excision is the treatment of choice due to the high risk of systemic embolization or sudden cardiac death. * **Histology:** Features "myxoma cells" (stellate or spindle-shaped) embedded in a glycosaminoglycan-rich stroma.

Q: What is the characteristic position of vegetations on the heart valve in non-bacterial thrombotic endocarditis?

Along the line of valve closure. **Non-Bacterial Thrombotic Endocarditis (NBTE)**, also known as marantic endocarditis, is characterized by the formation of small, sterile, friable thrombi (vegetations) composed of fibrin and platelets. **Why the correct answer is right:** The vegetations in NBTE typically occur **along the line of valve closure** [1]. This is because the mechanical stress and minor endothelial trauma at the point where the valve leaflets meet act as a nidus for platelet deposition, especially in patients with hypercoagulable states (e.g., advanced malignancy or systemic inflammation). Unlike infective endocarditis, these vegetations are non-invasive and do not cause significant valve destruction. **Why the incorrect options are wrong:** * **Within the valve leaflets:** Vegetations are surface phenomena (exophytic), not intramural. * **On the atrial side of the cusps:** This is the characteristic location for vegetations in **Infective Endocarditis** (on the "upstream" side of the valves) [1]. * **On the ventricular side of the cusps:** This is also more typical of Infective Endocarditis (on the ventricular side of the aortic valve). **High-Yield Facts for NEET-PG:** * **Association:** Strongly associated with **mucinous adenocarcinomas** (Trousseau sign/migratory thrombophlebitis) and wasting diseases (Marasmus). * **Morphology:** Small (1–5 mm), sterile, bland, and loosely attached [1]. * **Complication:** High risk of **systemic embolization** (e.g., stroke) because they are very friable. * **Comparison:** * **Rheumatic Fever:** Small, firm verrucae along the line of closure [1]. * **Libman-Sacks (SLE):** Small vegetations on **both sides** of the valve leaflets (undersurface and chordae) [1]. * **Infective Endocarditis:** Large, bulky, friable, and destructive vegetations [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568.

Question 1

Which of the following is a characteristic finding in acute rheumatic fever?

Accepted Answer

Pancarditis

Answer

Endocarditis

Answer

Myocarditis

Answer

Pericarditis

Question 2

Atrial myxoma commonly arises from?

Accepted Answer

Left atrium

Answer

Left ventricle

Answer

Right ventricle

Answer

Right atrium

Question 3

A 60-year-old male presented with acute chest pain of 4 hours duration. Electrocardiographic examination revealed a new Q wave with ST segment depression. He succumbed to his illness within 24 hours of admission. The heart revealed the presence of a transmural hemorrhagic area over the septum and anterior wall of the left ventricle. Light microscopic examination is most likely to reveal what?

Accepted Answer

Necrotic myofibers with presence of neutrophils

Answer

Edema in between normal myofibers

Answer

Coagulative necrosis of the myocytes with presence of granulation tissue

Answer

Infiltration by histiocytes with hemosiderin laden macrophages

Question 4

What is the true statement about rheumatization of the mitral valve?

Accepted Answer

Fusion and shortening of chordae tendineae in mitral stenosis

Answer

Calcification of the mitral valve

Answer

Aortic dilation

Answer

Annular involvement

Question 5

Amyloidosis of the heart presents with which of the following?

Accepted Answer

AV block

Answer

Arrhythmia

Answer

Increased mass/voltage

Answer

Hypertrophic cardiomyopathy

Question 6

Which of the following is NOT a typical manifestation of infective endocarditis?

Accepted Answer

Left atrial thrombus

Answer

Bulky friable vegetations

Answer

Myocardial abscess

Answer

Septal perforation

Question 7

A 59-year-old man suffers a massive heart attack and expires 24 hours later due to ventricular arrhythmia. Histologic examination of the affected heart muscle at autopsy would show an abundance of which of the following inflammatory cells?

Accepted Answer

Neutrophils

Answer

Fibroblasts

Answer

Lymphocytes

Answer

Macrophages

Question 8

What causes the tigroid appearance of the myocardium?

Accepted Answer

Fat deposition

Answer

Malignant change

Answer

Rheumatic fever

Answer

Myocarditis

Question 9

What is the characteristic position of vegetations on the heart valve in non-bacterial thrombotic endocarditis?

Accepted Answer

Along the line of valve closure

Answer

Within the valve leaflets

Answer

On the atrial side of the cusps

Answer

On the ventricular side of the cusps

Question 10

Anitschow cells are found in all of the following conditions except:

Accepted Answer

Thalassemia

Answer

Sickle cell anemia

Answer

Aphthous ulcer

Answer

Rheumatic heart disease

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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