Cardiac Pathology Practice Questions

Q: Vegetations on the under-surface of Aortic valve leaflets are typically found in which condition?

Libman-Sacks endocarditis. **Explanation:** **Libman-Sacks Endocarditis (LSE)**, also known as verrucous endocarditis, is the characteristic cardiac manifestation of Systemic Lupus Erythematosus (SLE). The hallmark of LSE is the presence of small, sterile, pinkish vegetations that can occur **anywhere on the valve surface** [2]. Uniquely, these vegetations are frequently found on the **under-surface of the leaflets** (ventricular surface of semilunar valves or atrial surface of AV valves), the chordae tendineae, and the endocardial surfaces [1]. **Analysis of Options:** * **Acute Rheumatic Carditis:** Vegetations (verrucae) are small, sterile, and friable, but they occur strictly along the **lines of closure** on the atrial surface of AV valves [2]. * **Non-Bacterial Thrombotic Endocarditis (NBTE):** These are sterile, bland thrombi usually found in hypercoagulable states (e.g., Trousseau syndrome). Like rheumatic fever, they are typically restricted to the **lines of valve closure** [2]. * **Chronic Rheumatic Carditis:** This stage is characterized by valve thickening, commissural fusion ("fish-mouth" deformity), and calcification rather than active vegetations. **High-Yield NEET-PG Pearls:** * **Location Trick:** If the question mentions "both sides of the valve" or "under-surface," think **Libman-Sacks (SLE)**. * **Pathology:** LSE vegetations consist of immune complexes, fibrin, and "hematoxylin bodies" (the tissue equivalent of LE cells). * **Clinical:** While usually asymptomatic, LSE can lead to valvular regurgitation or embolic events. * **Most Common Valve:** Mitral valve is most frequently involved in all forms of non-infective endocarditis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 570. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568.

Question 1

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 2

"Aschoff bodies" are seen in:

Accepted Answer

Rheumatic fever

Answer

Rheumatoid arthritis

Answer

Bacterial endocarditis

Answer

Marantic endocarditis

Question 3

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 4

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 5

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

Question 6

Carcinoid of the heart presents as?

Accepted Answer

Tricuspid regurgitation

Answer

Aortic stenosis

Answer

Mitral stenosis

Answer

Aortic regurgitation

Question 7

Which of the following is/are the characteristics of the vegetations seen in patients with Libman-Sacks endocarditis?

Accepted Answer

All the above

Answer

Medium sized

Answer

Irregular contour

Answer

Present on the surface of cusps of heart valves

Question 8

Vegetations on the under-surface of Aortic valve leaflets are typically found in which condition?

Accepted Answer

Libman-Sacks endocarditis

Answer

Acute Rheumatic carditis

Answer

Non-bacterial thrombotic endocarditis

Answer

Chronic rheumatic carditis

Question 9

Antischkow cells are characteristic findings in which of the following conditions?

Accepted Answer

Rheumatic myocarditis

Answer

Infective endocarditis

Answer

Myocardial infarction

Answer

None of the above

Question 10

Mitral valve vegetations do not typically embolize to which of the following organs?

Accepted Answer

Lungs

Answer

Brain

Answer

Liver

Answer

Spleen

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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