Cardiac Pathology Practice Questions

Q: Which type of endocarditis typically presents with vegetations on both sides of the valves?

Libman-Sacks endocarditis. **Explanation:** **Libman-Sacks Endocarditis (LSE)** is the correct answer because it is characterized by small, sterile, pinkish-tan vegetations that can occur on **both sides of the valve leaflets** (the surface and the undersurface), as well as on the chordae tendineae and endocardial surfaces [1]. This condition is classically associated with **Systemic Lupus Erythematosus (SLE)** and is a manifestation of immune complex deposition and subsequent inflammation [1]. **Analysis of Incorrect Options:** * **Infective Endocarditis (IE):** Typically presents with large, friable, and destructive vegetations located primarily on the **atrial surface** of AV valves or the **ventricular surface** of semilunar valves (the "flow side") [1]. They do not typically involve both sides of the valve. * **Rheumatic Carditis:** Characterized by small, firm, "wart-like" vegetations called **verrucae** that occur strictly along the **lines of closure** of the valve leaflets [1]. * **Non-Bacterial Thrombotic Endocarditis (NBTE/Marantic):** Presents with small, sterile vegetations along the lines of closure, similar to rheumatic fever, but without the significant underlying inflammation or valve destruction [1]. **NEET-PG High-Yield Pearls:** * **LSE Association:** Strongly linked to SLE and **Antiphospholipid Antibody Syndrome (APS)**. * **Vegetation Nature:** Sterile (non-infective) and composed of fibrin, inflammatory cells, and hematoxylin bodies (the tissue equivalent of LE cells). * **Most Common Valve:** Mitral valve is most frequently involved [1]. * **Key Differentiator:** LSE is the *only* endocarditis where vegetations are commonly found on the undersurface of the valves [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 568, 570.

Q: Ascoff's bodies are seen in which condition?

Rheumatic myocarditis. **Explanation:** **Aschoff bodies** are pathognomonic (diagnostic) histological hallmarks of **Acute Rheumatic Fever (ARF)** [1]. They represent areas of focal interstitial inflammation and are most characteristically found within the **myocardium** [1]. 1. **Why Rheumatic Myocarditis is correct:** Aschoff bodies are granulomatous lesions consisting of a central zone of fibrinoid necrosis surrounded by chronic inflammatory cells (lymphocytes, plasma cells) and characteristic **Anitschkow cells** (caterpillar cells) [1]. While ARF is a pancarditis, these bodies are the classic microscopic finding of rheumatic myocarditis. 2. **Why other options are incorrect:** * **Rheumatic arthritis:** While ARF causes migratory polyarthritis, Aschoff bodies are specific to the heart and are not found in the joints. * **Bacterial endocarditis:** This is characterized by large, friable, destructive **vegetations** containing bacteria and fibrin, not Aschoff bodies. * **Marantic endocarditis (NBTE):** This involves small, sterile, bland thrombi (vegetations) on valve leaflets, typically seen in hypercoagulable states or malignancy. **High-Yield Clinical Pearls for NEET-PG:** * **Anitschkow Cells:** These are activated macrophages found within Aschoff bodies [1]. They feature a "caterpillar-like" chromatin pattern in longitudinal sections and an "owl-eye" appearance in cross-sections [1]. * **McCallum Patch:** A subendocardial thickening, usually in the left atrium, caused by the healing of rheumatic endocarditis. * **Evolution:** Aschoff bodies evolve through three stages: Exudative (early), Proliferative (intermediate/diagnostic), and Healing (fibrotic/polar scar). * **Jones Criteria:** Remember that Carditis is a "Major" criterion for the diagnosis of ARF. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 566-567.

Q: In a patient with myocardial infarction, which valvular lesion is commonly seen?

Mitral regurgitation. **Explanation:** **Why Mitral Regurgitation (MR) is the correct answer:** Myocardial Infarction (MI) commonly leads to Mitral Regurgitation through two primary mechanisms: 1. **Papillary Muscle Dysfunction/Rupture:** The papillary muscles (especially the posteromedial muscle, which has a single blood supply from the RCA) are highly susceptible to ischemia. If they become dysfunctional or rupture (typically 3–5 days post-MI), the mitral valve leaflets fail to coapt, leading to acute, severe MR [1]. 2. **Ventricular Remodeling:** Chronic MI leads to left ventricular dilatation. This "stretches" the mitral valve annulus and displaces the papillary muscles, causing functional MR. **Analysis of Incorrect Options:** * **A. Aortic Stenosis:** This is typically a chronic degenerative or congenital process (e.g., senile calcification or bicuspid valve) and is not caused by acute ischemic events [1]. * **C. Aortic Regurgitation:** This usually results from aortic root dilation (e.g., syphilis, Marfan syndrome) or valve damage (e.g., endocarditis), not myocardial ischemia. * **D. Septal Defect:** While a **Ventricular Septal Rupture (VSR)** is a known complication of MI, it is a structural defect of the wall, not a "valvular lesion" [1]. **High-Yield NEET-PG Pearls:** * **Posteromedial Papillary Muscle:** Most common to rupture because it is supplied solely by the **Right Coronary Artery (RCA)**. * **Timeline:** Papillary muscle rupture typically occurs **3 to 5 days** after an MI [1]. * **Clinical Sign:** A new-onset **holosystolic murmur** at the apex radiating to the axilla post-MI should immediately raise suspicion of MR. * **Dressler Syndrome:** An autoimmune pericarditis occurring weeks after MI (Late complication). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 556-557.

Q: A gross section of the myocardium following myocardial infarction is shown. What is the likely duration following MI?

2 weeks. ***2 weeks*** - At **2 weeks post-MI**, the gross appearance shows a characteristic **yellow-tan depressed area** with a **hyperemic rim**, representing organized granulation tissue and early scar formation. - This timeframe corresponds to the **organization phase** where necrotic tissue is being replaced by **fibrous connective tissue** and **capillary proliferation**. *Immediate MI* - **Immediate MI** shows **no gross changes** as cellular death and coagulative necrosis have not yet become visible macroscopically. - The myocardium appears **normal** or may show only subtle **congestion** without distinct color changes or depression. *2 days* - At **2 days post-MI**, the infarct appears as a **pale, gray-white area** without the yellow coloration or hyperemic rim seen later. - This represents **early coagulative necrosis** with **neutrophilic infiltration** but lacks the organized granulation tissue of later stages. *Postmortem infarct artifact* - **Postmortem changes** produce **diffuse pallor** without the **well-demarcated borders** and **hyperemic rim** characteristic of true infarction. - These artifacts lack the **inflammatory response** and **organized tissue changes** that develop in living tissue following MI.

Question 1

A patient with long-standing, moderately severe anemia dies in an automobile accident. An autopsy is performed. Which of the following cardiac changes will MOST likely be seen when the heart is examined?

Accepted Answer

Fatty change of myocytes

Answer

Endocarditis

Answer

Fibrinous pericarditis

Answer

Fibrosis of valve leaflets

Question 2

What is the most common benign heart tumor?

Accepted Answer

Myxoma

Answer

Rhabdomyoma

Answer

Hemangioma

Answer

Lipoma

Question 3

Which type of endocarditis typically presents with vegetations on both sides of the valves?

Accepted Answer

Libman-Sacks endocarditis

Answer

Infective endocarditis

Answer

Rheumatic carditis

Answer

None of the above

Question 4

What is the pathological finding that results in a tigereye appearance of the heart?

Accepted Answer

Fatty change

Answer

Hyaline change

Answer

Amyloidosis

Answer

Atrophy

Question 5

Ascoff's bodies are seen in which condition?

Accepted Answer

Rheumatic myocarditis

Answer

Rheumatic arthritis

Answer

Bacterial endocarditis

Answer

Marantic endocarditis

Question 6

Rupture of the myocardium typically occurs within what time frame after a myocardial infarction?

Accepted Answer

First week

Answer

Second week

Answer

Third week

Answer

Fourth week

Question 7

In a patient with myocardial infarction, which valvular lesion is commonly seen?

Accepted Answer

Mitral regurgitation

Answer

Aortic stenosis

Answer

Aortic regurgitation

Answer

Septal defect

Question 8

Rheumatic activity involves which valves most commonly?

Accepted Answer

Mitral and aortic

Answer

Aortic and tricuspid

Answer

Aortic and pulmonary

Answer

Mitral and tricuspid

Question 9

A gross section of the myocardium following myocardial infarction is shown. What is the likely duration following MI?

Accepted Answer

2 weeks

Answer

Immediate MI

Answer

2 days

Answer

Postmortem infarct artifact

Question 10

All are true about myxomas in the heart, EXCEPT:

Accepted Answer

Never occur on heart valves

Answer

Most common primary tumor of the heart

Answer

Associated with clonal abnormalities of chromosomes 12 and 17

Answer

90% are located in the atria

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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