Cardiac Pathology Practice Questions

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

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 2

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

Question 3

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 4

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 5

What factor is responsible for cardiac hypertrophy?

Accepted Answer

c-myc

Answer

ANF

Answer

TNF alpha

Answer

TGF beta

Question 6

What is the diagnostic feature of Rheumatic Heart Disease (RHD)?

Accepted Answer

Aschoff nodules

Answer

McCallam patch

Answer

Shaggy vegetations

Answer

Bread and butter pericarditis

Question 7

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 8

Mitral valve vegetations do not usually embolize to which of the following organs?

Accepted Answer

Lung

Answer

Brain

Answer

Liver

Answer

Spleen

Question 9

What is the most common site for myocardial infarction?

Accepted Answer

Left ventricle

Answer

Left atrium

Answer

Right atrium

Answer

Right ventricle

Question 10

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

Accepted Answer

Macrophages

Answer

Myocytes

Answer

Adipocytes

Answer

Pacemaker cells

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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