Cardiac Pathology Practice Questions

Q: All the following statements about atrial myxomas are true, except?

Most myxomas are familial.. **Explanation:** Atrial myxomas are the most common primary cardiac tumors in adults. Understanding their epidemiological and clinical profile is crucial for NEET-PG. **Why Option D is the correct answer (The False Statement):** The vast majority of atrial myxomas (**approximately 90%**) are **sporadic**, not familial. Familial cases account for only about 10% of instances and are often associated with **Carney Complex** (an autosomal dominant condition involving spotty skin pigmentation, endocrine overactivity, and myxomas). **Analysis of Incorrect Options (True Statements):** * **Option A:** The **left atrium** (specifically the interatrial septum near the fossa ovalis) is the most common site, accounting for ~75-80% of cases. * **Option B:** While they can occur at any age, they are most frequently diagnosed in adults aged 30–60. However, in the context of primary cardiac tumors, they are a classic "younger" presentation compared to metastatic disease. (Note: Some texts specify a female predilection in middle age). * **Option C:** Myxomas are histologically **benign**. While they can cause "tumor emboli" (fragmentation leading to stroke), true distant metastasis (secondary growth) is extremely rare. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Triad:** Constitutional symptoms (fever, weight loss due to IL-6 release), Embolic phenomena, and Obstructive symptoms. * **Auscultation:** A characteristic **"Tumor Plop"** may be heard during diastole as the pedunculated mass drops into the mitral orifice. * **Histology:** Features "Stellate" or "Myxoma cells" embedded in a glycosaminoglycan-rich stroma. * **Diagnosis:** Echocardiography is the gold standard for initial visualization.

Q: Contractile dysfunction is the dominant feature of which of the following types of cardiomyopathies?

Dilated cardiomyopathy. The core of this question lies in distinguishing between **systolic** and **diastolic** dysfunction. **1. Why Dilated Cardiomyopathy (DCM) is correct:** DCM is characterized by ventricular chamber enlargement and wall thinning, leading to **systolic dysfunction**. The primary pathology is a decrease in myocardial contractility (low ejection fraction). Because the heart muscle is stretched and weak, it cannot pump blood effectively, making **contractile dysfunction** its dominant feature [1]. **2. Why the other options are incorrect:** * **Hypertrophic Cardiomyopathy (HCM):** The primary issue is a "thick" and non-compliant muscle. This leads to **diastolic dysfunction** (impaired filling) due to a stiff left ventricle. Contractility is usually normal or even hyperdynamic (high ejection fraction). * **Restrictive Cardiomyopathy (RCM):** This is characterized by rigid ventricular walls that resist stretching. Like HCM, the dominant feature is **diastolic dysfunction** (impaired ventricular filling) while the systolic contractile function remains relatively preserved until late stages. * **Infiltrative Cardiomyopathy:** This is a sub-type of restrictive cardiomyopathy (e.g., Amyloidosis, Sarcoidosis). The pathology involves the deposition of abnormal substances in the myocardium, leading to stiffness and **diastolic failure**. **High-Yield Clinical Pearls for NEET-PG:** * **DCM:** Most common type of cardiomyopathy; often idiopathic or due to Alcohol, Coxsackie B virus, or Beriberi [1]. * **HCM:** Most common cause of sudden cardiac death in young athletes; characterized by asymmetrical septal hypertrophy and "S4" heart sound. * **RCM:** Often associated with Amyloidosis (look for "low voltage ECG" despite thick walls on Echo). * **Mnemonic:** **D**ilated = **D**efect in pumping (Systolic); **R**estrictive/**H**ypertrophic = **F**illing defect (Diastolic).

Q: Which of the following is NOT a cause of myocarditis?

Mycobacterium tuberculosis. **Explanation:** The correct answer is **B. Mycobacterium tuberculosis**. While *Mycobacterium tuberculosis* (TB) frequently involves the heart, it characteristically affects the **pericardium** (causing chronic constrictive pericarditis), not the myocardium [2]. Myocarditis is defined as inflammation of the heart muscle, and TB is an extremely rare cause of primary myocardial inflammation. **Analysis of Options:** * **A. Trichinosis:** *Trichinella spiralis* is the most common helminthic cause of myocarditis worldwide. It typically presents with eosinophilic infiltration of the myocardium. * **C. Corynebacterium diphtheriae:** This is a classic bacterial cause of myocarditis. The damage is mediated by the **diphtheria exotoxin**, which inhibits protein synthesis (via ADP-ribosylation of EF-2), leading to fatty change and necrosis of myocytes in up to 25% of patients. * **D. Systemic Lupus Erythematosus (SLE):** SLE is a well-known non-infectious cause of myocarditis [2]. It can cause inflammation across all layers of the heart (pancarditis), though **Libman-Sacks endocarditis** (sterile vegetations) is its most characteristic cardiac manifestation. **NEET-PG High-Yield Pearls:** * **Most common cause of myocarditis:** Viral infections, specifically **Coxsackievirus B** [1]. * **Chagas Disease:** Caused by *Trypanosoma cruzi*; it is a major cause of myocarditis in South America [1]. * **Giant Cell Myocarditis:** A rare, rapidly fatal form characterized by multinucleated giant cells and extensive necrosis [1]. * **Hypersensitivity Myocarditis:** Often drug-induced (e.g., sulfonamides, diuretics) and histologically marked by **eosinophils** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 578-579. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 581-582.

Q: Fibrous scar in myocardial infarction is well established by which time frame?

6 weeks. The healing process of Myocardial Infarction (MI) follows a predictable chronological sequence of inflammation, repair, and remodeling [1]. **Explanation of the Correct Answer:** **Option A (6 weeks)** is correct because the replacement of necrotic myocardium with a **dense, fibrous collagenous scar** is typically well-established by the end of the 6th to 8th week [1]. By this stage, the highly vascularized granulation tissue has been replaced by relatively acellular, white collagenous tissue, marking the completion of the healing phase [1]. **Analysis of Incorrect Options:** * **Option C (6 days):** At this stage, the heart is characterized by **early granulation tissue** at the edges, extensive macrophage infiltration, and the beginning of collagen deposition [1]. The tissue is soft and structurally weak, making this the peak period for myocardial rupture [1]. * **Option D (30 days):** By one month, the scar is forming and maturing, but the process of collagen cross-linking and contraction is still ongoing [1]. It is not considered "well-established" until the 6-week mark. * **Option B (6 months):** While the scar may undergo further thinning or remodeling over months, the definitive fibrous scar is already fully formed much earlier (by 6–8 weeks) [1]. **High-Yield Clinical Pearls for NEET-PG:** * **0–24 hours:** Coagulative necrosis and wavy fibers [1]. * **1–3 days:** Peak neutrophilic infiltration (Yellow-tan center) [1]. * **3–7 days:** Peak macrophage activity; highest risk of **free wall rupture**, VSD, or papillary muscle rupture [1]. * **1–2 weeks:** Maximum granulation tissue formation [1]. * **Modification:** Factors like large infarct size, advanced age, or steroid use can delay this healing timeline. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 552-554.

Q: All of the following are causes of myocarditis except:

Mycobacterium tuberculosis. **Explanation:** The correct answer is **B. Mycobacterium tuberculosis**. In pathology, **myocarditis** is defined as an inflammation of the heart muscle (myocardium) that causes injury without an underlying ischemic cause [1]. While *Mycobacterium tuberculosis* (TB) frequently involves the cardiovascular system, it characteristically causes **pericarditis** (specifically chronic constrictive pericarditis) rather than primary myocarditis. While rare myocardial tuberculomas can occur, TB is not classified as a standard cause of infectious myocarditis in medical literature or standard textbooks like Robbins Pathology. **Analysis of Incorrect Options:** * **A. Trichinosis:** *Trichinella spiralis* is the most common helminthic cause of myocarditis worldwide. * **C. Borrelia:** *Borrelia burgdorferi* (Lyme disease) is a well-known cause of "Lyme Carditis," which often manifests as conduction blocks (AV blocks) due to myocardial inflammation. * **D. CMV:** Cytomegalovirus is a significant viral cause of myocarditis, particularly in immunocompromised patients and post-transplant recipients [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause overall:** Viral infections, specifically **Coxsackievirus B** [1]. * **Chagas Disease:** Caused by *Trypanosoma cruzi*; it is the most common cause of myocarditis in endemic areas (South America) [1]. * **Diphtheritic Myocarditis:** Caused by the *Corynebacterium diphtheriae* exotoxin; it is a major cause of death in diphtheria patients. * **Hypersensitivity Myocarditis:** Characterized by an **eosinophilic infiltrate**, usually due to drug reactions (e.g., sulfonamides) [1]. * **Giant Cell Myocarditis:** A rare, aggressive form with a poor prognosis, characterized by multinucleated giant cells and extensive necrosis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 578-581.

Question 1

Non-sterile vegetations are seen in which of the following conditions?

Accepted Answer

Infective endocarditis

Answer

Rheumatic fever

Answer

Non-bacterial thrombotic endocarditis

Answer

Libman-Sacks endocarditis

Question 2

All the following statements about atrial myxomas are true, except?

Accepted Answer

Most myxomas are familial.

Answer

Most common site is the left atrium.

Answer

Most common in young individuals.

Answer

Distant metastasis are rare.

Question 3

Contractile dysfunction is the dominant feature of which of the following types of cardiomyopathies?

Accepted Answer

Dilated cardiomyopathy

Answer

Restrictive cardiomyopathy

Answer

Hypertrophic cardiomyopathy

Answer

Infiltrative cardiomyopathy

Question 4

Which of the following is NOT a cause of myocarditis?

Accepted Answer

Mycobacterium tuberculosis

Answer

Trichinosis

Answer

Corynebacterium diphtheriae

Answer

Systemic lupus erythematosus

Question 5

All are true about cardiac manifestations of carcinoid syndrome, EXCEPT:

Accepted Answer

Cardiac failure is not a feature of carcinoid syndrome.

Answer

The cardiac disease in carcinoid syndrome is due to the formation of fibrotic plaques involving the endocardium.

Answer

Fibrous deposits are most commonly on the ventricular aspect of the tricuspid valve.

Answer

Mitral valve lesions are less extensive and frequently affect the tricuspid valve.

Question 6

Fibrous scar in myocardial infarction is well established by which time frame?

Accepted Answer

6 weeks

Answer

6 months

Answer

6 days

Answer

30 days

Question 7

A woman has septic abortion with vegetation on the tricuspid valve. Where are septic emboli most likely to travel?

Accepted Answer

Septic infarcts to the lungs

Answer

The liver

Answer

Splenic infarcts

Answer

Emboli to the brain

Question 8

Flat vegetations in pockets of valves are due to?

Accepted Answer

Rheumatic heart disease

Answer

Non-bacterial thrombotic endocarditis (NBTE)

Answer

Infective endocarditis

Question 9

All of the following are causes of myocarditis except:

Accepted Answer

Mycobacterium tuberculosis

Answer

Trichinosis

Answer

Borrelia

Answer

CMV

Question 10

A 66-year-old woman collapses and expires suddenly of cardiac arrest. Her past medical history is significant for long-standing type 2 diabetes mellitus. Her relatives note that she had complained of chest heaviness and shortness of breath for the past 2 weeks. Sterile fibrinous pericarditis and pericardial effusion are observed at autopsy. What additional finding would be expected during autopsy of this patient?

Accepted Answer

Myocardial infarct

Answer

Endocardial fibroelastosis

Answer

Marantic endocarditis

Answer

Mitral valve prolapse

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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