Cardiac Pathology Practice Questions

Q: A 60-year-old man presents with chest pain lasting 6 hours, diagnosed as acute myocardial infarction. Angiography showed involvement of the anterior descending branch of the left coronary artery. What is the most probable site of infarct?

Anterolateral wall. **Explanation:** The distribution of myocardial infarction (MI) is directly determined by the specific coronary artery occluded. In this case, the occlusion involves the **Left Anterior Descending (LAD) artery**, which is the most common site of coronary occlusion (40-50%). 1. **Why Anterolateral wall is correct:** The LAD supplies the anterior wall of the left ventricle, the anterior 2/3rd of the interventricular septum, and the apex [1]. When the LAD is occluded, it typically results in an **Anterolateral** or **Anteroapical** infarct [1]. In many clinical contexts and exam patterns, "Anterolateral" is used to describe the broad territory affected by a proximal LAD lesion. 2. **Why other options are incorrect:** * **Posterior wall:** Usually results from occlusion of the **Right Coronary Artery (RCA)** or the Left Circumflex Artery (LCX), depending on dominance [1]. * **Inferior wall:** Primarily caused by occlusion of the **RCA** (in 80% of "right-dominant" hearts) [1]. * **Septal:** While the LAD does supply the anterior septum, a purely septal infarct is less common than a combined anteroseptal or anterolateral presentation. In the context of this question, "Anterolateral" represents the most significant bulk of the affected ventricular wall. **NEET-PG High-Yield Pearls:** * **LAD (40-50%):** "The Widow Maker." Leads to Anterior/Anterolateral wall MI (V1-V6 leads on ECG). * **RCA (30-40%):** Leads to Inferior wall MI (Leads II, III, aVF) and Posterior wall MI. * **LCX (15-20%):** Leads to Lateral wall MI (Leads I, aVL, V5, V6). * **Earliest microscopic change (0-4 hrs):** Usually none, or wavy fibers [1]. * **First gross change (4-12 hrs):** Dark mottling [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 550-552.

Q: Anitschkow cells are modified:

Macrophages. **Explanation:** **Anitschkow cells** (also known as "caterpillar cells") are pathognomonic features of **Acute Rheumatic Carditis**. They are specialized, **activated macrophages** found within **Aschoff bodies** [1], which are the characteristic granulomatous lesions of Rheumatic Heart Disease (RHD). 1. **Why Macrophages are Correct:** Anitschkow cells are derived from the mononuclear phagocyte system. Under microscopy, they exhibit abundant cytoplasm and a central, longitudinal nucleus [1]. The chromatin is condensed into a central wavy ribbon, resembling a "caterpillar" in longitudinal section and an "owl’s eye" in cross-section. When these macrophages fuse, they form multinucleated **Aschoff giant cells**. 2. **Why Other Options are Incorrect:** * **Neutrophils (A):** These are markers of acute bacterial inflammation. While they may be present in early stages, they do not transform into Anitschkow cells. * **Lymphocytes (C):** While T-lymphocytes are present within the Aschoff body, they do not undergo the specific nuclear remodeling seen in Anitschkow cells [1]. * **Eosinophils (D):** These are associated with parasitic infections or Type I hypersensitivity (e.g., Löffler endocarditis), not the Type II/IV hypersensitivity seen in RHD. **High-Yield Clinical Pearls for NEET-PG:** * **Aschoff Bodies:** These are the hallmark of RHD and represent a form of granulomatous inflammation [1]. They are most commonly found in the **myocardium**. * **Pancarditis:** RHD affects all three layers. Look for **McCallum patches** (subendocardial thickening, usually in the left atrium) and "bread and butter" pericarditis. * **Molecular Mimicry:** RHD is caused by antibodies against **Group A Beta-hemolytic Streptococci (M-protein)** cross-reacting with cardiac self-antigens [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 566-567.

Question 1

A 60-year-old man presents with chest pain lasting 6 hours, diagnosed as acute myocardial infarction. Angiography showed involvement of the anterior descending branch of the left coronary artery. What is the most probable site of infarct?

Accepted Answer

Anterolateral wall

Answer

Posterior wall

Answer

Inferior wall

Answer

Septal

Question 2

Libman-Sacks endocarditis is associated with?

Accepted Answer

Systemic lupus erythematosus

Answer

Rheumatic heart disease

Answer

Carcinoma

Answer

None of the above

Question 3

The "Me Callum patch" is typically seen in which chamber of the heart?

Accepted Answer

Left atrium

Answer

Right atrium

Answer

Left ventricle

Answer

Right ventricle

Question 4

Anitschkow cells are modified:

Accepted Answer

Macrophages

Answer

Neutrophils

Answer

Lymphocytes

Answer

Eosinophils

Question 5

All of the following are clinical features of myxoma, EXCEPT:

Accepted Answer

Hypertension

Answer

Fever

Answer

Clubbing

Answer

Embolic phenomenon

Question 6

Sterile vegetations are seen in all except?

Accepted Answer

Infective endocarditis

Answer

Systemic Lupus Erythematosus (SLE)

Answer

Rheumatic fever

Answer

Marantic endocarditis

Question 7

Aschoff bodies in rheumatic heart disease show all of the following features, except?

Accepted Answer

Epithelioid cells

Answer

Anitschkow cells

Answer

Giant cells

Answer

Fibrinoid necrosis

Question 8

Which condition is characterized by large way vegetation?

Accepted Answer

Subacute Bacterial Endocarditis (SBE)

Answer

Systemic Lupus Erythematosus (SLE)

Answer

Both

Answer

None

Question 9

In carcinoid syndrome, which part of the right ventricle is most affected?

Accepted Answer

Inflow tract of RV

Answer

Outflow tract of RV

Answer

Inflow tract of LV

Answer

Outflow tract LV

Question 10

Which of the following cardiac valves is not commonly involved in rheumatic fever?

Accepted Answer

Pulmonary

Answer

Mitral

Answer

Aortic

Answer

Tricuspid

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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