Cardiac Pathology Practice Questions

Q: A 15-year-old boy presented with pancarditis. A myocardial biopsy showed a specific finding. What is the most likely diagnosis based on this finding?

Aschoff nodule. ***Aschoff nodule*** - **Aschoff nodules** are **pathognomonic** of **rheumatic carditis** and consist of **fibrinoid necrosis** surrounded by **Anitschkow cells** (enlarged macrophages with owl-eye nuclei) and **multinucleated giant cells**. - In a **15-year-old** with **pancarditis**, finding Aschoff nodules confirms **rheumatic fever**, which commonly affects children and young adults following **Group A Streptococcal** infection. *Tuberculosis* - **TB granulomas** are characterized by **caseating necrosis** with **Langhans giant cells** and **epithelioid cells**, not fibrinoid necrosis. - While TB can cause **pericarditis**, it rarely presents as **pancarditis** in young patients and has different histological features. *Foreign body giant cells* - **Foreign body giant cells** form in response to **inert foreign material** and lack **fibrinoid necrosis** or **Anitschkow cells**. - These are not associated with **pancarditis** and would require a history of **foreign body exposure** or **surgical intervention**. *None of the above* - The presence of **Aschoff nodules** is **diagnostic** of **rheumatic carditis** and is not seen in other cardiac conditions. - Given the **age**, **pancarditis presentation**, and **specific histological finding**, rheumatic fever is the most appropriate diagnosis.

Q: Which of the following is not seen in the early phase of myocardial infarction on microscopy?

Fibrosis. **Explanation:** The correct answer is **Fibrosis**. Myocardial infarction (MI) follows a predictable chronological sequence of morphological changes [1]. Fibrosis represents the final stage of the healing process, where dead myocytes are replaced by a collagenous scar. This process typically begins around **2 weeks** post-infarction and can take up to **2 months** to complete [2]. Therefore, it is never seen in the "early phase" (the first few days) of an MI. **Analysis of Incorrect Options:** * **Coagulation Necrosis:** This is the hallmark of irreversible ischemic injury in the heart [1]. It typically becomes visible under light microscopy within **4–12 hours**. Features include "wavy fibers" and loss of nuclei (karyolysis) [1]. * **Edema:** This occurs very early (within **4–12 hours**) as a result of vascular leakage and cell membrane failure following ischemic injury [1]. * **Hemorrhage:** Microvascular injury during the acute phase leads to the extravasation of red blood cells into the interstitium, often seen alongside the early neutrophilic infiltrate (**12–24 hours**) [1]. **NEET-PG High-Yield Pearls:** * **0–30 mins:** Reversible injury; no light microscopy (LM) changes [1]. * **4–12 hours:** First visible LM changes (Coagulation necrosis, edema, hemorrhage) [1]. * **1-3 days:** Peak of **Neutrophilic infiltration** (highest risk of fibrinous pericarditis) [1]. * **3–7 days:** Macrophage infiltration and beginning of **Granulation tissue** (highest risk of free wall rupture/ventricular septal defect) [1]. * **10 days–2 weeks:** Well-established granulation tissue [2]. * **>2 months:** Dense collagenous **Fibrosis/Scarring** [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 552. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 552-554.

Question 1

What is the most common site of myocardial infarction?

Accepted Answer

Anterior wall of the left ventricle

Answer

Posterior wall of the right ventricle

Answer

Posterior wall of the left ventricle

Answer

Inferior wall of the left ventricle

Question 2

What is the most likely diagnosis in a patient presenting with large, friable, irregular vegetations on the heart valves?

Accepted Answer

Infective Endocarditis

Answer

Rheumatic Heart Disease

Answer

Libman-Sacks Endocarditis

Answer

Non-bacterial thrombotic endocarditis

Question 3

Early granulation tissue in acute myocardial infarction is typically seen within which timeframe?

Accepted Answer

1 week

Answer

1 hour

Answer

24 hours

Answer

1 month

Question 4

Myxoma commonly arises from which chamber of the heart?

Accepted Answer

Left atrium

Answer

Left ventricle

Answer

Right ventricle

Answer

Right atrium

Question 5

A 15-year-old boy presented with pancarditis. A myocardial biopsy showed a specific finding. What is the most likely diagnosis based on this finding?

Accepted Answer

Aschoff nodule

Answer

Tuberculosis

Answer

Foreign body giant cells

Answer

None of the above

Question 6

Vegetations on the undersurface of Aortic and Mitral (A.V.) valves are found in which condition?

Accepted Answer

Libman-Sacks endocarditis

Answer

Acute rheumatic fever

Answer

Non-bacterial thrombotic endocarditis

Answer

Chronic rheumatic carditis

Question 7

Which of the following is not seen in the early phase of myocardial infarction on microscopy?

Accepted Answer

Fibrosis

Answer

Coagulation necrosis

Answer

Edema

Answer

Hemorrhage

Question 8

Cardiac involvement in carcinoid syndrome is characterized by which of the following?

Accepted Answer

Intimal fibrosis of the right ventricle, tricuspid valve, and pulmonary valve

Answer

Calcification of the tricuspid valve

Answer

Common involvement of the major blood vessels

Answer

Equal involvement of both sides of the heart

Question 9

Which autopsy finding is characteristic after 12 hours in a case of death due to myocardial infarction?

Accepted Answer

Coagulative necrosis

Answer

Caseous necrosis

Answer

Fat necrosis

Answer

Liquefactive necrosis

Question 10

What is the pathognomonic feature of rheumatic heart disease?

Accepted Answer

Caterpillar cell

Answer

Aschoff nodule

Answer

McCallum plaques

Answer

Fibrinous pericarditis

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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