Cardiac Pathology Practice Questions

Q: Which of the following is the most common tumor of the heart?

Myxoma. **Explanation:** The correct answer is **A. Myxoma**. In cardiac pathology, it is crucial to distinguish between primary and secondary tumors. While metastatic (secondary) tumors are the most common tumors found in the heart overall, **Myxoma** is the most common **primary** tumor of the heart in adults [1]. * **Myxoma:** These are benign mesenchymal tumors [1]. Approximately 75-90% occur in the **left atrium**, typically attached to the interatrial septum at the fossa ovalis via a stalk (pedunculated) [1], [2]. Clinically, they can cause a "wrecking ball" effect, damaging mitral valves or causing "ball-valve" obstruction, leading to sudden syncopal episodes [2]. * **Lipoma:** While these can occur in the heart (often in the left ventricle or right atrium), they are significantly less common than myxomas [1]. * **Rhabdomyoma:** This is the most common primary cardiac tumor in **infants and children** [1]. It is highly associated with **Tuberous Sclerosis** (TSC1/TSC2 mutations) and often presents as multiple gray-white myocardial masses that frequently regress spontaneously. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common heart tumor overall:** Metastatic tumors (most commonly from lung, breast, or melanoma). 2. **Most common primary heart tumor (Adults):** Myxoma [1]. 3. **Most common primary heart tumor (Children):** Rhabdomyoma [1]. 4. **Carney Complex:** A familial syndrome (PRKAR1A mutation) characterized by multiple cardiac myxomas, spotty skin pigmentation, and endocrine overactivity. 5. **Histology of Myxoma:** Features "Lepidic" cells (stellate or globular cells) embedded in an abundant acid mucopolysaccharide (myxoid) stroma [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 304-306. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 583-584.

Q: A 30-year-old male patient presented with dyspnea. Echocardiography showed mitral stenosis with left atrial hypertrophy. The excised mitral valve is shown in the image. What is the most likely diagnosis given the findings?

Rheumatic heart disease. ***Rheumatic heart disease*** - **Mitral stenosis** with **left atrial hypertrophy** in a young adult is pathognomonic of rheumatic heart disease, especially in endemic areas like India. - The excised valve shows characteristic **fish mouth deformity**, **commissural fusion**, **leaflet thickening**, and **subvalvular apparatus changes** typical of chronic rheumatic valvulitis. *Tuberculosis* - Tuberculosis rarely causes **isolated mitral stenosis** and typically presents with **pericardial involvement** or **constrictive pericarditis**. - **Granulomatous inflammation** with **caseous necrosis** would be evident histologically, which is not characteristic of mitral stenosis pathology. *Sarcoidosis* - Cardiac sarcoidosis primarily affects the **conduction system** and **ventricular myocardium**, rarely causing valvular stenosis. - Presents with **non-caseating granulomas** and typically involves **multiple organ systems** with **bilateral hilar lymphadenopathy**. *Fungal granuloma* - Fungal endocarditis typically causes **vegetative lesions** and **valve destruction** rather than the organized **fibrotic stenosis** seen in rheumatic disease. - Usually occurs in **immunocompromised patients** or those with **prosthetic valves**, and presents acutely rather than as chronic stenosis.

Q: Which of the following statements about Nonbacterial thrombotic endocarditis (NBTE) is false?

Valvular damage is a prerequisite for NBTE to occur. Nonbacterial thrombotic endocarditis (NBTE), formerly known as marantic endocarditis, is characterized by the formation of sterile, non-infective vegetations on heart valves [1]. **Why Option C is the Correct (False) Statement:** Unlike infective endocarditis, which often requires a pre-existing valvular abnormality, **NBTE typically occurs on previously normal valves.** The primary driver is not structural damage, but rather a systemic hypercoagulable state or circulating cytokines that trigger fibrin and platelet deposition. **Analysis of Other Options:** * **Option A:** NBTE vegetations are **sterile** (composed of fibrin and platelets) and do not contain microorganisms, distinguishing them from infective endocarditis [1]. * **Option B:** The vegetations are characteristically **small (1–5 mm)**, single or multiple, and are loosely attached along the line of closure of the leaflets [1]. * **Option D:** **Hypercoagulable states** are the hallmark precursors. It is frequently associated with advanced malignancies (especially mucinous adenocarcinomas—known as **Trousseau syndrome**) and chronic wasting diseases. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** Vegetations are friable and can easily embolize, leading to systemic infarcts (e.g., stroke). * **Valve Involvement:** Most commonly affects the **Mitral valve**, followed by the Aortic valve. * **Key Association:** Often seen in patients with **DIC** (Disseminated Intravascular Coagulation) or underlying malignancy. * **Comparison:** Unlike Libman-Sacks endocarditis (SLE), NBTE vegetations occur only on the valve surfaces and do not cause significant valvular inflammation or scarring [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568.

Question 1

What is the major histological feature of myocardial infarction?

Accepted Answer

Coagulative necrosis

Answer

Liquefactive necrosis

Answer

Fibrinoid necrosis

Answer

Contraction band necrosis

Question 2

Senile cardiac amyloidosis is due to deposition of amyloid which is similar to which of the following proteins?

Accepted Answer

Transthyretin

Answer

Beta-2 microglobulin

Answer

Atrial natriuretic peptide (ANP)

Answer

Pyrin

Question 3

Which of the following is the most common tumor of the heart?

Accepted Answer

Myxoma

Answer

Lipoma

Answer

Rhabdomyoma

Answer

None of the above

Question 4

What is the characteristic pathological finding in carcinoid of the heart?

Accepted Answer

Fibrous endocardial thickening of the right ventricle and tricuspid valve

Answer

Collagen deposition in the wall of the right ventricle and tricuspid valve

Answer

Interstitial fibrous thickening of the right ventricle and pulmonary valve

Answer

Mononuclear inflammatory infiltrate in the wall of the right atrium

Question 5

A 15-year-old boy died suddenly while playing in the field. On autopsy, fibrofatty replacement of the right ventricular myocardium is seen. What is the most likely diagnosis?

Accepted Answer

Arrhythmogenic right ventricular dysplasia

Answer

Dilated cardiomyopathy

Answer

Hypertrophic cardiomyopathy

Answer

Obstructive cardiomyopathy

Question 6

Which type of cardiomyopathy is characterized by contractile dysfunction?

Accepted Answer

Dilated

Answer

Restrictive

Answer

Hypertrophic

Answer

Infiltrative

Question 7

Which is the most sensitive and specific marker for myocardial infarction?

Accepted Answer

Troponin

Answer

CK-MB

Answer

Myoglobin

Answer

LDH

Question 8

A 25-year-old basketball player suddenly collapsed during an athletic event and died. Autopsy revealed a hypertrophied septum. What is the most probable diagnosis?

Accepted Answer

Hypertrophic Obstructive Cardiomyopathy (HOCM)

Answer

Right ventricular conduction abnormality

Answer

Epilepsy

Answer

Snake bite

Question 9

A 30-year-old male patient presented with dyspnea. Echocardiography showed mitral stenosis with left atrial hypertrophy. The excised mitral valve is shown in the image. What is the most likely diagnosis given the findings?

Accepted Answer

Rheumatic heart disease

Answer

Tuberculosis

Answer

Sarcoidosis

Answer

Fungal granuloma

Question 10

Which of the following statements about Nonbacterial thrombotic endocarditis (NBTE) is false?

Accepted Answer

Valvular damage is a prerequisite for NBTE to occur

Answer

Characterized by the deposition of sterile thrombi on cardiac valves

Answer

The vegetations in NBTE are typically small (1 to 5 mm in diameter)

Answer

Hypercoagulable states are the usual precursor to NBTE

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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