Cardiac Pathology Practice Questions

Q: Rheumatoid arthritis pericarditis is typically characterized by which type of inflammation?

Fibrinous pericarditis. **Explanation:** **Rheumatoid Arthritis (RA)** is a systemic autoimmune disorder where extra-articular manifestations are common [1]. Cardiac involvement occurs in approximately 30–50% of patients, though it is often clinically silent. **Why Fibrinous Pericarditis is Correct:** The hallmark of RA-associated pericardial involvement is **fibrinous or "bread-and-butter" pericarditis**. Pathologically, this involves the deposition of fibrin on the pericardial surfaces due to chronic inflammation. While many patients are asymptomatic, those who are symptomatic present with pleuritic chest pain and a pericardial friction rub. Histologically, it may show rheumatoid nodules or non-specific granulomatous inflammation. **Analysis of Incorrect Options:** * **A. Serous pericarditis:** Typically seen in non-infectious inflammatory conditions like Uremia or early viral infections. It lacks the thick fibrin exudate characteristic of RA. * **C. Serofibrinous pericarditis:** While there is an overlap, "Fibrinous" is the specific pathological descriptor most associated with the classic "shaggy" appearance of the pericardium in RA and Uremia. * **D. Adhesive pericarditis:** This is a late-stage sequela where the pericardial layers stick together, often following suppurative or tuberculous pericarditis, rather than the primary inflammatory stage of RA. **High-Yield Clinical Pearls for NEET-PG:** * **Pericardial Fluid Analysis in RA:** Characteristically shows **very low glucose levels** (<30 mg/dL), low complement levels (C3, C4), and high LDH. This "low glucose" profile is a classic exam favorite. * **Most Common Cardiac Manifestation in RA:** Pericarditis (though usually asymptomatic). * **Most Common Cause of Death in RA:** Ischemic Heart Disease (due to accelerated atherosclerosis). * **Other Fibrinous Pericarditis Causes:** Post-MI (Dressler Syndrome), Uremia, and Systemic Lupus Erythematosus (SLE).

Q: What is the most common tumor of the heart?

Myxoma. **Explanation:** The most common primary tumor of the heart in adults is the **Myxoma** [1]. While metastatic tumors (from lung, breast, or melanoma) are technically more common than primary cardiac tumors, among primary tumors, Myxoma accounts for approximately 50%. **Why Myxoma is correct:** Myxomas are benign mesenchymal tumors [1]. About 75-80% occur in the **left atrium**, typically attached to the interatrial septum near the fossa ovalis [2]. They often present with a "tumor plop" sound on auscultation and can cause "ball-valve" obstruction of the mitral valve, mimicking mitral stenosis [2]. Histologically, they are characterized by stellate "myxoma cells" in a mucopolysaccharide stroma [2]. **Why other options are incorrect:** * **Rhabdomyosarcoma:** This is the most common primary **malignant** cardiac tumor in adults, but it is far less frequent than the benign myxoma. * **Fibroma:** These are benign connective tissue tumors, much rarer than myxomas, and are typically seen in the pediatric population (often associated with Gorlin syndrome). * **Leiomyosarcoma:** A rare malignant tumor of smooth muscle origin; it is not a common primary cardiac neoplasm. **High-Yield Clinical Pearls for NEET-PG:** * **Most common primary tumor in children:** Rhabdomyoma (strongly associated with Tuberous Sclerosis) [1]. * **Carney Complex:** An autosomal dominant syndrome featuring multiple cardiac myxomas, skin pigmentation (lentigines), and endocrine overactivity. * **Positional Symptoms:** Myxoma symptoms often change with body position due to the mobile nature of the pedunculated mass [2]. * **Most common site for metastases:** Pericardium (presenting as hemorrhagic pericardial effusion). **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 1

A 26-year-old man died while playing. His autopsy of the heart revealed myocyte hypertrophy. What is the most likely diagnosis?

Accepted Answer

Hypertrophic Obstructive Cardiomyopathy (HOCM)

Answer

Dilated Cardiomyopathy (DCM)

Answer

Arrhythmogenic Cardiomyopathy

Answer

Restrictive Cardiomyopathy

Question 2

Troponin-T is preferable to CPK-MB in the diagnosis of acute myocardial infarction (MI) in all of the following situations except?

Accepted Answer

Reinfarction after 4 days

Answer

Bedside diagnosis of MI

Answer

Postoperatively (after CABG)

Answer

Small infarcts

Question 3

Rheumatoid arthritis pericarditis is typically characterized by which type of inflammation?

Accepted Answer

Fibrinous pericarditis

Answer

Serous pericarditis

Answer

Serofibrinous pericarditis

Answer

Adhesive pericarditis

Question 4

An 11-year-old boy presented with a sore throat, no cough, tonsillar exudates, and a fever of 38.3°C three weeks ago. A throat culture was positive for group A beta-hemolytic Streptococcus. On follow-up examination, the child is afebrile. His pulse is 85/min, respirations are 18/min, and blood pressure is 90/50 mm Hg. On auscultation, a diastolic mitral murmur is audible, and there are diffuse rales over both lungs. Over the next 2 days, he has several episodes of atrial fibrillation accompanied by signs of acute left ventricular failure. Which of the following pathologic changes occurring in this child's heart is most likely to be the cause of the left ventricular failure?

Accepted Answer

Myocarditis

Answer

Amyloidosis

Answer

Fibrinous pericarditis

Answer

Mitral valve fibrosis

Question 5

A 45-year-old man receives a cardiac allograft for dilated cardiomyopathy. Five years later, he has worsening exercise tolerance with increasing dyspnea and peripheral edema. Echocardiography shows a reduced ejection fraction of 35%. Which of the following pathologic abnormalities has he most likely developed in the allograft?

Accepted Answer

Coronary arteriopathy

Answer

Amyloidosis

Answer

Constrictive pericarditis

Answer

Non-Hodgkin lymphoma

Question 6

What is the most common site for myocardial infarction?

Accepted Answer

Left ventricle

Answer

Left atrium

Answer

Right atrium

Answer

Right ventricle

Question 7

To which of the following cell types do 'heart failure' cells belong?

Accepted Answer

Macrophages

Answer

Myocytes

Answer

Adipocytes

Answer

Pacemaker cells

Question 8

What is the most common tumor of the heart?

Accepted Answer

Myxoma

Answer

Rhabdomyosarcoma

Answer

Fibroma

Answer

Leiomyosarcoma

Question 9

Histopathological examination (HPE) of mitral valve in mitral valve prolapse syndrome (MVPS) typically shows which of the following types of degeneration?

Accepted Answer

Myxomatous degeneration

Answer

Hyaline degeneration

Answer

Elastic degeneration

Answer

Fibrinoid necrosis

Question 10

What is the most common tumor of the heart?

Accepted Answer

Secondaries (metastatic tumors)

Answer

Myxoma

Answer

Papillary fibroelastoma

Answer

Rhabdomyomas

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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