Cardiac Pathology Practice Questions

Q: A 25-year-old bodybuilder was using anabolic steroids and started having puffy feet for the last 2 months. He died suddenly during a workout. A post-mortem heart biopsy specimen is shown below. What is the diagnosis?

Dilated cardiomyopathy. ***Dilated cardiomyopathy*** - **Anabolic steroids** cause **myocyte hypertrophy** followed by **myocyte degeneration** and **interstitial fibrosis**, leading to dilated cardiomyopathy with reduced ejection fraction and sudden cardiac death. - The **puffy feet** indicate **peripheral edema** from heart failure, and the biopsy would show **dilated ventricles** with **thin walls** and **myocardial fibrosis**. *Restrictive cardiomyopathy* - Characterized by **impaired ventricular filling** with **preserved systolic function**, not the systolic dysfunction seen with anabolic steroid toxicity. - Would show **increased wall thickness** with **stiff myocardium**, not the dilated thin-walled appearance of steroid-induced cardiomyopathy. *Hypertrophic cardiomyopathy* - Features **asymmetric septal hypertrophy** and **preserved or hyperdynamic systolic function**, contrasting with the dilated failing heart from steroid use. - While it can cause sudden death in athletes, it doesn't typically present with **peripheral edema** or the **systolic heart failure** pattern seen here. *Athlete's heart* - Represents **physiologic adaptation** to exercise with **mild ventricular enlargement** and **normal systolic function** without heart failure symptoms. - Would not cause **peripheral edema**, **sudden cardiac death**, or the **pathologic myocardial changes** (fibrosis, degeneration) associated with anabolic steroid toxicity.

Q: A 29-year-old male athlete suddenly collapsed and died during a football game. Autopsy revealed a specific gross examination finding. He had a history of two similar deaths in the family. What is the most likely cause of death?

Hypertrophic cardiomyopathy. ***Hypertrophic cardiomyopathy*** - **Sudden cardiac death** in a young athlete with **family history** strongly suggests hypertrophic cardiomyopathy, which is the **leading cause of sudden death** in athletes under 35. - Autopsy reveals characteristic **asymmetric septal hypertrophy** with **small left ventricular cavity**, and the condition follows **autosomal dominant inheritance** explaining the familial deaths. *Rheumatic heart disease* - Typically results from **group A streptococcal infection** causing **valvular damage**, particularly mitral and aortic stenosis. - More common in **developing countries** and rarely causes sudden death in young athletes without prior symptoms of valvular disease. *Coronary heart disease* - Predominantly affects **older individuals** (>40 years) with **atherosclerotic risk factors** like diabetes, hypertension, and smoking. - Uncommon in **healthy young athletes** and lacks the **familial clustering** pattern described in this case. *Dilated cardiomyopathy* - Characterized by **enlarged heart chambers** with **reduced ejection fraction** and typically presents with **heart failure symptoms**. - While it can cause sudden death, it's less common in **asymptomatic young athletes** and doesn't show the specific **septal hypertrophy** pattern seen at autopsy.

Question 1

A 25-year-old bodybuilder was using anabolic steroids and started having puffy feet for the last 2 months. He died suddenly during a workout. A post-mortem heart biopsy specimen is shown below. What is the diagnosis?

Accepted Answer

Dilated cardiomyopathy

Answer

Restrictive cardiomyopathy

Answer

Hypertrophic cardiomyopathy

Answer

Athlete's heart

Question 2

What is the most common tumor of the heart?

Accepted Answer

Myxoma

Answer

Rhabdomyosarcoma

Answer

Fibroma

Answer

Leiomyosarcoma

Question 3

Carcinoid of the heart typically involves which structure?

Accepted Answer

Valvular endocardium of the right atrium

Answer

Valvular endocardium of the left atrium

Answer

Mural endocardium

Answer

Myocardium

Question 4

A 29-year-old male athlete suddenly collapsed and died during a football game. Autopsy revealed a specific gross examination finding. He had a history of two similar deaths in the family. What is the most likely cause of death?

Accepted Answer

Hypertrophic cardiomyopathy

Answer

Rheumatic heart disease

Answer

Coronary heart disease

Answer

Dilated cardiomyopathy

Question 5

Dilated cardiomyopathy is due to which of the following?

Accepted Answer

Mutated titin

Answer

Defective desmosomes

Answer

Mutated β myosin heavy chain

Answer

Mutated osteoglycin

Question 6

Which of the following dissection methods of the heart is most useful for demonstrating the distribution of infarction?

Accepted Answer

Ventricular slicing method

Answer

Inflow outflow method

Answer

Sandwich method

Answer

Perfusion method

Question 7

A 50-year-old woman presents with fatigue and shortness of breath. Physical examination shows evidence of pulmonary edema, enlargement of the left atrium, and calcification of the mitral valve. A CT scan demonstrates a large obstructing mass in the left atrium. Before open heart surgery can be performed to remove the tumor, the patient suffers a stroke and expires. Which of the following hemodynamic disorders best explains the pathogenesis of stroke in this patient?

Accepted Answer

Arterial embolism

Answer

Atherosclerosis

Answer

Cardiogenic shock

Answer

Hypertensive hemorrhage

Question 8

A four-month-old child develops cardiac failure and dies three months later. At autopsy, the heart has no obvious congenital defects, but the cardiac chambers are small and covered with thick, white endocardium. Histological sections of the heart demonstrate regular bands of elastic tissue in the thick fibrous endocardium. Which of the following is the most likely diagnosis?

Accepted Answer

Endocardial fibroelastosis

Answer

Coxsackievirus myocarditis

Answer

Cardiac amyloidosis

Answer

Idiopathic subaortic stenosis

Question 9

Which of the following is the commonest cardiac neoplasm in adults?

Accepted Answer

Metastatic tumour

Answer

Ventricular rhabdomyoma

Answer

Atrial myxoma

Answer

Angiosarcoma

Question 10

Left ventricular hypertrophy is caused by all EXCEPT?

Accepted Answer

Chronic cor pulmonale

Answer

Aortic stenosis

Answer

Chronic kidney disease

Answer

Essential hypertension

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?