Cardiac Pathology Practice Questions

Q: Carcinoid heart disease affects which part of the heart?

Valvular endocardium. **Explanation:** **Carcinoid Heart Disease** is a manifestation of systemic carcinoid syndrome, occurring in approximately 50% of patients with the syndrome. **Why Valvular Endocardium is correct:** The primary pathology involves the deposition of **fibrous, plaque-like thickenings** on the endocardial surfaces of the heart [1]. These plaques are composed of smooth muscle cells and collagen embedded in an acid mucopolysaccharide-rich matrix [1]. The lesions characteristically involve the **valvular endocardium**, leading to thickening, shortening, and rigidity of the valve leaflets [1]. This typically results in **Tricuspid Regurgitation** and **Pulmonary Stenosis** [1]. **Why other options are incorrect:** * **Pericardium & Epicardium:** These are the outer layers of the heart. Carcinoid heart disease is a luminal (internal) pathology mediated by circulating humoral factors; it does not involve the external lining or the pericardial space. [1] * **Myocardium:** While chronic valvular dysfunction can lead to secondary right ventricular hypertrophy or failure, the primary site of the carcinoid-induced lesion is the endocardium, not the cardiac muscle fibers [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Right-sided Predominance:** It primarily affects the **Right Heart** (Tricuspid and Pulmonary valves) [1]. * **Left Heart Sparing:** The Left Heart is usually spared because the lungs contain **Monoamine Oxidase (MAO)**, which inactivates the circulating serotonin (5-HT) and bradykinin before they reach the left atrium. * **Exception:** Left-sided involvement occurs only in the presence of a **Right-to-Left shunt** (e.g., Patent Foramen Ovale) or **Primary Bronchial Carcinoid**. * **Biomarker:** Elevated urinary **5-HIAA** (5-hydroxyindoleacetic acid) is the diagnostic hallmark. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 570-572.

Question 1

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 2

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

Accepted Answer

Metastatic tumour

Answer

Ventricular rhabdomyoma

Answer

Atrial myxoma

Answer

Angiosarcoma

Question 3

What is the characteristic pathological finding in carcinoid heart disease?

Accepted Answer

Fibrous endocardial thickening of the right ventricle, tricuspid valve, and pulmonary valve

Answer

Endocardial thickening of the tricuspid valve with severe tricuspid stenosis

Answer

Collagen-rich, elastic deposits in the endocardium of the right ventricle and pulmonary valve

Answer

Calcification of the tricuspid and pulmonary valves

Question 4

Left ventricular hypertrophy is caused by all EXCEPT?

Accepted Answer

Chronic cor pulmonale

Answer

Aortic stenosis

Answer

Chronic kidney disease

Answer

Essential hypertension

Question 5

What is the most characteristic histological finding of acute rheumatic carditis?

Accepted Answer

Aschoff bodies in myocardium

Answer

Fibrinous pericarditis

Answer

Vegetations on mitral valve leaflets

Answer

Increased vascularity of the valves

Question 6

What are the essential hypertrophy changes seen in the heart?

Accepted Answer

Cardiac cell hypertrophy

Answer

Cardiac cell hyperplasia

Answer

Increase in the mitochondrial number

Answer

Increase in size of mitochondria

Question 7

Carcinoid heart disease affects which part of the heart?

Accepted Answer

Valvular endocardium

Answer

Pericardium

Answer

Myocardium

Answer

Epicardium

Question 8

Aschoff's bodies are seen in which of the following conditions?

Accepted Answer

Rheumatic heart disease

Answer

Libman-Sacks endocarditis

Answer

Bacterial endocarditis

Answer

Marantic endocarditis

Question 9

The light brown perinuclear pigment seen on H&E staining of the cardiac muscle fibres in the grossly normal appearing heart of an 83-year-old man at autopsy is due to deposition of?

Accepted Answer

Lipochrome

Answer

Hemosiderin

Answer

Cholesterol metabolite

Answer

Anthracotic pigment

Question 10

Hemorrhagic pericarditis can be caused by which of the following?

Accepted Answer

All the above

Answer

Tuberculosis

Answer

After cardiac surgery

Answer

Metastatic disease

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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