Cardiac Pathology — MCQs
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Vegetations on under surface of cusps are found in:
Features of rheumatic carditis are all except:
Diagnostic feature in rheumatic heart disease is:
What is the most common primary tumor of the heart?
Most common malignant tumor of heart in children is-
Large, irregular and friable vegetations are seen in?
McCallum patches/plaques are usually seen in which chamber of the heart?
Which chamber of the heart is enlarged first in a patient with McCallum patch?
Characteristic feature of hypertrophic obstructive cardiomyopathy is:
Microscopic examination of the reperfused myocardium is likely to have which of the following findings?
Cardiac Pathology Indian Medical PG Practice Questions and MCQs
Question 211: Vegetations on under surface of cusps are found in:
- A. Libman-Sacks endocarditis (Correct Answer)
- B. SABE
- C. Rheumatic fever
- D. Infective endocarditis
Explanation: ***Libman-Sacks endocarditis*** - This condition is characterized by **sterile vegetations** composed of immune complexes and fibrin, typically found on the **undersurface of the mitral and aortic valve cusps**. [1] - It is a prominent cardiac manifestation of **systemic lupus erythematosus (SLE)**. *SABE* - **Subacute bacterial endocarditis (SABE)** refers to infection of an already damaged heart valve, causing slowly progressive vegetations. - While it causes vegetations, they are typically on the **closure line** or ventricular side of the valve, and are not sterile but contain bacteria. [1] *Rheumatic fever* - Acute rheumatic fever causes **small, verrucous vegetations** primarily along the **closure lines of the valve leaflets (especially mitral)**, due to fibrin deposition. [1] - These are caused by an autoimmune reaction to streptococcal infection and are not found on the undersurface of the cusps. *Infective endocarditis* - **Infective endocarditis** involves vegetations formed from thrombus and microorganisms on heart valves, typically on the **atrial surface of the mitral valve** or the **ventricular surface of the aortic valve**. [1] - These vegetations are large and destructive, containing active infection, unlike the sterile vegetations of Libman-Sacks endocarditis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568.
Question 212: Features of rheumatic carditis are all except:
- A. Myocardial fibrosis
- B. Intramyocardial microemboli (Correct Answer)
- C. Lymphocytic infiltration
- D. Aschoff nodule
Explanation: ***Intramyocardial microemboli*** - **Intramyocardial microemboli** are not a characteristic feature of rheumatic carditis. Microemboli are typically associated with conditions like infective endocarditis or other hypercoagulable states, leading to obstruction of small coronary arteries. - Rheumatic carditis involves an inflammatory, autoimmune response to cardiac tissues, not embolic events. *Myocardial fibrosis* - **Myocardial fibrosis** can occur in chronic rheumatic heart disease as a reparative process following episodes of acute inflammation and damage to the myocardium. - This fibrosis often leads to stiffening and dysfunction of the cardiac muscle. *Lymphocytic infiltration* - **Lymphocytic infiltration** of the myocardium is a hallmark of acute rheumatic carditis, indicating the inflammatory and autoimmune nature of the disease as immune cells target cardiac tissue [1]. - This cellular infiltration contributes to myocardial damage and dysfunction. *Aschoff nodule* - **Aschoff bodies (or nodules)** are pathognomonic granulomatous lesions found in the myocardium during acute rheumatic carditis [1]. - These nodules consist of fibrinoid necrosis and inflammatory cells, including activated macrophages (Anitschkow cells), reflecting the autoimmune inflammatory process [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 566-567.
Question 213: Diagnostic feature in rheumatic heart disease is:
- A. Adeno Carcinoma
- B. Aschoff's nodule (Correct Answer)
- C. Alveolar cell Carcinoma
- D. MacCallum patch
Explanation: ***Aschoff's nodule*** - **Aschoff's nodules** are pathognomonic granulomatous lesions found in the myocardium of patients with **rheumatic fever** and **rheumatic heart disease** [1]. - They consist of a central area of fibrinoid necrosis surrounded by a cuff of inflammatory cells, including **Anitschkow cells** (caterpillar cells) which are specialized histiocytes [1]. *Adeno Carcinoma* - This is a type of **malignant tumor** that originates in glandular tissue in various organs like the lungs, colon, or breast. - It has no relevance to the inflammatory process of **rheumatic heart disease**. *Alveolar cell Carcinoma* - Also known as **lung adenocarcinoma** with lepidic growth, this is a subtype of lung cancer originating from alveolar epithelial cells. - It is a **neoplastic process** and is unrelated to cardiac inflammation caused by rheumatic fever. *MacCallum patch* - **MacCallum patches** are irregular, thickened endocardial lesions found in the left atrium in chronic **rheumatic heart disease**. - While associated with rheumatic heart disease, **Aschoff's nodules** are the definitive diagnostic histological feature in active inflammation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 566-567.
Question 214: What is the most common primary tumor of the heart?
- A. Leiomyosarcoma
- B. Rhabdomyosarcoma
- C. Myxoma (Correct Answer)
- D. Fibroma
Explanation: ***Myxoma*** - **Myxomas** are the most **common benign primary cardiac tumors**, accounting for approximately 50% of all primary cardiac tumors [1]. - They typically arise in the **atria**, most often the **left atrium**, and can cause symptoms due to obstruction or embolization [1], [2]. *Leiomyosarcoma* - **Leiomyosarcomas** are malignant tumors of **smooth muscle origin** and are rare in the heart. - While they can occur in the great vessels, they are not the most common primary cardiac tumor. *Rhabdomyosarcoma* - **Rhabdomyosarcomas** are highly aggressive **malignant tumors of skeletal muscle origin** that can rarely affect the heart. - They are one of the most common primary malignant cardiac tumors but are less frequent than benign myxomas overall. *Fibroma* - **Fibromas** are **benign mesenchymal tumors** of the heart, commonly found in children. - Although benign, they are far less common than myxomas. **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 215: Most common malignant tumor of heart in children is-
- A. Angiosarcoma
- B. Lipoma
- C. Rhabdomyoma (benign tumor)
- D. Rhabdomyosarcoma (Correct Answer)
Explanation: ***Rhabdomyosarcoma*** - This is the **most common malignant tumor of the heart in children**, though primary cardiac tumors themselves are rare [1]. - It arises from **striated muscle cells** and can be found in various locations, including the heart [1]. *Angiosarcoma* - While a **malignant cardiac tumor**, angiosarcoma is more common in **adults** and is the most common primary malignant tumor of the heart in adults. - It arises from the cells lining **blood vessels**. *Lipoma* - A lipoma is a **benign tumor** composed of mature fat cells, and it is not a malignant tumor [1]. - Although it can occur in the heart, it is not the most common **malignant** cardiac tumor in children. *Rhabdomyoma (benign tumor)* - Rhabdomyoma is the **most common primary cardiac tumor in children**, but it is a **benign** tumor, not malignant [2]. - It is frequently associated with **tuberous sclerosis**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1222-1225. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 304-306.
Question 216: Large, irregular and friable vegetations are seen in?
- A. Infective endocarditis (Correct Answer)
- B. Rheumatic heart disease
- C. Non-bacterial thrombotic endocarditis (NBTE)
- D. Libman-sacks endocarditis
Explanation: ***Infective endocarditis*** - **Large, irregular, and friable vegetations** are characteristic of infective endocarditis, formed by a mesh of **platelets, fibrin, microorganisms**, and inflammatory cells [1]. - These vegetations can lead to serious complications such as **embolization** and destruction of heart valves [2]. *Rheumatic heart disease* - Characterized by **small, warty vegetations** that are typically located on the lines of closure of the heart valves, not large and friable [1]. - These vegetations are sterile and result from inflammation and fibrin deposition, usually not involving active microbial infection. *Non-bacterial thrombotic endocarditis (NBTE)* - Features **small, sterile vegetations** composed of fibrin and platelets, often found on previously undamaged valves [1]. - These vegetations are typically **firm** and non-inflammatory, distinct from the friable and infected vegetations of infective endocarditis. *Libman-sacks endocarditis* - Manifests as **sterile, verrucous vegetations** that can occur on either side of the valve leaflets (aortic or mitral) in patients with **systemic lupus erythematosus (SLE)** [1]. - While they can be large, they are usually not described as friable in the same manner as infective endocarditis and are sterile. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 295-296.
Question 217: McCallum patches/plaques are usually seen in which chamber of the heart?
- A. Right atrium
- B. Left ventricle
- C. Left atrium (Correct Answer)
- D. Right ventricle
Explanation: Left atrium - **McCallum patches** are typically found in the **left atrium**, predominantly on the left atrial endocardium [1]. - They are associated with the regurgitant jet of **rheumatic mitral valve disease**, leading to endocardial thickening and fibrosis [1]. Right atrium - While rheumatic heart disease can affect the right side of the heart, particularly the tricuspid valve, **McCallum patches have a specific association with the left atrium** due to mitral valve involvement [1]. - Endocardial changes in the right atrium are less commonly described as McCallum patches. Left ventricle - The left ventricle is primarily a pumping chamber; while it can undergo hypertrophy or dilation in rheumatic heart disease, **McCallum patches are specific endocardial lesions of the atrium** [1]. - **Jet lesions** can occur in the ventricle due to aortic regurgitation, but these are distinct from atrial McCallum patches. Right ventricle - The right ventricle is also a pumping chamber, and endocardial changes here are not typically referred to as McCallum patches. - Rheumatic involvement of the tricuspid valve can cause right heart strain, but **McCallum patches are characteristic of left atrial involvement** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 566.
Question 218: Which chamber of the heart is enlarged first in a patient with McCallum patch?
- A. Left atrium (Correct Answer)
- B. Left ventricle
- C. Right atrium
- D. Right ventricle
Explanation: ***Left atrium*** - A **McCallum patch** is a thickened, often irregular endocardial lesion found in the **left atrium**. - It results from the jet lesion of **mitral regurgitation**, indicating the left atrium has been subjected to increased volume and pressure leading to enlargement [1]. *Left ventricle* - While **mitral regurgitation** can eventually lead to **left ventricular enlargement** (due to volume overload), the primary chamber affected by the regurgitant jet causing the McCallum patch is the left atrium. - Left ventricular enlargement is a later consequence, not the first chamber to show this specific lesion. *Right atrium* - The **right atrium** is affected by conditions like **tricuspid regurgitation** or **pulmonary hypertension**, which are unrelated to mitral valve disease or McCallum patches. - It handles systemic venous return, separate from the left-sided circulation involved in mitral pathology. *Right ventricle* - The **right ventricle** is primarily impacted by conditions affecting the **pulmonary circulation** or **tricuspid valve**. - It fills from the right atrium and pumps blood to the lungs, making it unlikely to be the first chamber enlarged in the context of a McCallum patch from mitral regurgitation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 533-534.
Question 219: Characteristic feature of hypertrophic obstructive cardiomyopathy is:
- A. Increased size of ventricle
- B. Asymmetric septal hypertrophy (Correct Answer)
- C. Normal myofiber arrangement
- D. Increased size of atria
Explanation: ***Asymmetric septal hypertrophy*** - This is the hallmark feature of **hypertrophic obstructive cardiomyopathy (HOCM)**, where the **interventricular septum** thickens disproportionately more than the free wall of the left ventricle [1], [2]. - This septal thickening can lead to **left ventricular outflow tract obstruction**, particularly during systole, obstructing blood flow out of the heart [1]. *Increased size of ventricle* - While the left ventricle may appear enlarged in some dimensions due to hypertrophy, the primary characteristic is specifically **asymmetric thickening of the septum**, not a generalized increase in ventricular size [2]. - In other forms of cardiomyopathy, such as dilated cardiomyopathy, a global increase in ventricular size is observed, which is distinct from HOCM. *Normal myofiber arrangement* - A characteristic microscopic feature of HOCM is **myocardial disarray**, where cardiac muscle fibers are abnormally arranged instead of their usual parallel alignment [1]. - This disorganized arrangement contributes to the impaired function and electrical instability seen in HOCM. *Increased size of atria* - While **left atrial enlargement** can be a secondary finding in HOCM due to increased left ventricular end-diastolic pressure and impaired diastolic filling, it is not the primary or characteristic feature defining the condition [1]. - The fundamental pathology of HOCM lies in the specific hypertrophy of the ventricular myocardium, particularly the septum. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 577-578. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 303-304.
Question 220: Microscopic examination of the reperfused myocardium is likely to have which of the following findings?
- A. Neutrophilic infiltration
- B. Contraction band necrosis (Correct Answer)
- C. Cardiac myocyte swelling
- D. Waviness of fibers
Explanation: ***Contraction band necrosis*** - This lesion is characteristic of **reperfusion injury**, resulting from the reintroduction of **calcium** into ischemic cells, causing hypercontraction of sarcomeres [1]. - The bands represent irreversibly contracted sarcomeres and are a hallmark of cell death in the setting of restored blood flow [1]. *Neutrophilic infiltration* - While present in myocardial infarction, **neutrophilic infiltration** primarily begins hours after injury and is part of the inflammatory response to necrotic tissue, not a specific marker of reperfusion itself [2]. - It's a general feature of **acute inflammation** and necrosis but doesn't specifically distinguish reperfused myocardium from non-reperfused ischemic injury in the acute phase [2]. *Waviness of fibres* - **Waviness of fibers** is an early microscopic change in **ischemic myocardium**; it's due to the stretching of dead or dying muscle fibers adjacent to healthy, contracting fibers [2]. - This finding is typically seen within the first few hours of ischemia, before significant reperfusion injury is evident. *Cardiac myocyte swelling* - **Cardiac myocyte swelling** (cellular edema) is an early and non-specific sign of **ischemic injury** due to the failure of ion pumps, leading to intracellular accumulation of water [2]. - While present in ischemia, it's not a unique characteristic of reperfusion injury; reperfusion leads to more specific changes like contraction band necrosis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 554-556. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 552.
Practice by Chapter
Congenital Heart Disease
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Ischemic Heart Disease
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Hypertensive Heart Disease
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Valvular Heart Disease
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Myocarditis and Cardiomyopathies
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Pericardial Disease
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Cardiac Tumors
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Heart Failure Pathophysiology
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Cardiac Transplantation Pathology
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Endocarditis
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