Cardiac Pathology Practice Questions

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.

Q: A 73-year-old woman has had episodes of chest pain during the past week. She is afebrile. Her pulse is 80/min, respirations are 16/min, and blood pressure is 110/70 mm Hg. On auscultation of the chest, heart sounds seem distant, but the lung fields are clear. Neck veins are distended to the angle of the jaw, even while sitting. There is a darkly pigmented, irregular, 1.2-cm skin lesion on the right shoulder. A chest radiograph shows prominent borders on the left and right sides of the heart. Pericardiocentesis yields bloody fluid. Laboratory findings include a serum troponin I level of 0.3 ng/mL. Which of the following lesions is the most likely cause of these findings?

Epicardial metastases. **Explanation:** The clinical presentation describes **Beck’s Triad** (distended neck veins, distant heart sounds, and hypotension/narrow pulse pressure), which is pathognomonic for **Cardiac Tamponade** [1]. The chest radiograph showing "prominent borders" (globular heart) and the aspiration of **bloody pericardial fluid** further confirm a hemorrhagic pericardial effusion [1]. The key diagnostic clue is the **darkly pigmented, irregular skin lesion**, which is highly suggestive of **Malignant Melanoma**. Melanoma is notorious for metastasizing to the heart (epicardium/myocardium) [1]. These metastases can cause hemorrhagic effusions and subsequent tamponade [1]. While the troponin is slightly elevated (0.3 ng/mL), this reflects myocardial irritation or direct invasion by the tumor rather than a primary ischemic event. **Analysis of Incorrect Options:** * **A & D (Calcific Aortic Stenosis / Mitral Valvulitis):** These are valvular pathologies. While they cause heart failure or murmurs, they do not typically cause hemorrhagic pericardial effusions or sudden tamponade. * **B (Coronary Atherosclerosis):** While a myocardial infarction (MI) can lead to free wall rupture and hemopericardium [1], this usually occurs 3–7 days post-MI and presents with acute, catastrophic collapse. The presence of a suspicious skin lesion and a week-long history makes malignancy a more likely etiology. **NEET-PG High-Yield Pearls:** * **Most common primary tumor of the heart:** Myxoma (usually left atrium). * **Most common secondary (metastatic) tumor of the heart:** Lung cancer, Breast cancer, and Melanoma. * **Hemorrhagic Pericardial Effusion:** Think of Malignancy [1], Tuberculosis [2], or Uremia. * **Beck’s Triad:** Hypotension, JVD, and Muffled heart sounds (Cardiac Tamponade).

Question 1

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 2

Which of the following is true of Rheumatic fever?

Accepted Answer

The characteristic pathological hallmark is the presence of Aschoff bodies.

Answer

Erythema marginatum is a non-itchy rash typically seen on the trunk and proximal extremities of the patient.

Answer

Sydenham’s chorea appears late in the course of the acute Rheumatic fever episodes.

Answer

Primary prophylaxis for Rheumatic fever requires periodic use of penicillin.

Question 3

Calcification of the aortic valve is seen in which of the following conditions?

Accepted Answer

Aortic stenosis

Answer

Aortic regurgitation

Answer

Marfan's syndrome

Answer

Hurler's syndrome

Question 4

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

Question 5

A 73-year-old woman has had episodes of chest pain during the past week. She is afebrile. Her pulse is 80/min, respirations are 16/min, and blood pressure is 110/70 mm Hg. On auscultation of the chest, heart sounds seem distant, but the lung fields are clear. Neck veins are distended to the angle of the jaw, even while sitting. There is a darkly pigmented, irregular, 1.2-cm skin lesion on the right shoulder. A chest radiograph shows prominent borders on the left and right sides of the heart. Pericardiocentesis yields bloody fluid. Laboratory findings include a serum troponin I level of 0.3 ng/mL. Which of the following lesions is the most likely cause of these findings?

Accepted Answer

Epicardial metastases

Answer

Calcific aortic stenosis

Answer

Coronary atherosclerosis

Answer

Mitral valvulitis

Question 6

Which of the following findings is expected on microscopic examination of a biopsy from a heart showing ventricular hypertrophy with asymmetric septal thickening?

Accepted Answer

Disorganization of myofibrils

Answer

Aschoff bodies

Answer

Infiltration by inflammatory cells

Answer

Localized fibrous scarring

Question 7

A 62-year-old woman undergoing chemotherapy for breast cancer presents with a 3-day history of fever and chest pain. Cardiac catheterization reveals a markedly reduced ejection fraction with normal coronary blood flow. A myocardial biopsy is obtained, and a PCR test for coxsackievirus is positive. Histologic examination of this patient's myocardium will most likely reveal an abundance of which of the following inflammatory cells?

Accepted Answer

Lymphocytes

Answer

Eosinophils

Answer

Macrophages

Answer

Mast cells

Question 8

A 4-year-old boy with a history of intellectual disability and seizures presents with a one-month history of shortness of breath. Physical examination reveals numerous papules on the face. Echocardiography shows tumor-like growth in the left ventricle. What is the most likely diagnosis for this patient's condition?

Accepted Answer

Rhabdomyoma

Answer

Lipoma

Answer

Myxoma

Answer

Dilated cardiomyopathy

Question 9

Concentric hypertrophy of the heart is most commonly associated with which of the following conditions?

Accepted Answer

Systemic Hypertension

Answer

Mitral regurgitation

Answer

Hypertrophic cardiomyopathy

Answer

Mitral stenosis

Question 10

What is true about vegetations in rheumatic fever?

Accepted Answer

Soft and firm

Answer

Soft and friable

Answer

Large and firm

Answer

Large and friable

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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