Cardiac Pathology Practice Questions

Q: The MOST COMMON cause of concentric hypertrophy of left ventricle is?

Hypertension. ***Hypertension*** - Chronic **hypertension** is the most common cause of **pressure overload** on the left ventricle, leading to concentric hypertrophy [1]. - In response to the increased afterload, the ventricular wall thickens uniformly inward, reducing the chamber size while maintaining normal wall stress [2]. - Due to its high prevalence (30-40% of adults), hypertension is epidemiologically the most frequent cause of concentric LVH [1]. *Aortic stenosis* - While **aortic stenosis** is the classic pathological cause of **pressure overload** and concentric hypertrophy [2], **hypertension** is more prevalent in the population. - Aortic stenosis causes fixed outflow obstruction, leading to significant pressure work for the left ventricle. - This is the second most common cause but occurs in only 2-5% of elderly patients. *Mitral stenosis* - **Mitral stenosis** primarily causes pressure overload on the **left atrium** and **pulmonary circulation**, not the left ventricle. - It doesn't typically lead to **left ventricular hypertrophy** directly; instead, it causes left atrial enlargement and right ventricular hypertrophy. *Aortic regurgitation* - **Aortic regurgitation** results in **volume overload** of the left ventricle due to blood flowing back into the chamber during diastole. - This typically leads to **eccentric hypertrophy**, where the chamber dilates and the wall thickens proportionally, rather than concentric hypertrophy [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 560-562. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 536.

Q: All are true about non-bacterial thrombotic endocarditis, except?

Vegetation > 5 mm. ***Vegetation > 5 mm*** - Non-bacterial thrombotic endocarditis (NBTE) typically features **small vegetations**, often less than 5 mm, associated with conditions like **cancer** or **hypercoagulable states** [1]. - The presence of larger vegetations is more characteristic of **infective endocarditis**, making this statement false regarding NBTE. *Cause emboli* - NBTE is known to cause **embolic phenomena** due to small vegetations that dislodge, leading to **ischemia** in distant organs. - It is associated with conditions such as **adenocarcinoma**, contributing to possible embolic events. *No inflammatory reaction* - Although inflammatory cells are sparse, NBTE can produce a **minimal inflammatory response** in the tissues. - The presence of fibrin deposits and small vegetations has implications for **thrombus formation**, suggesting a mild inflammatory component. *Locally nondestructive* - NBTE vegetations are primarily **nondestructive** to the underlying valves [1], contrasting with infected vegetations that can cause significant **valvular damage**. - However, this characteristic still does not undermine that these vegetations can lead to systemic embolism despite being locally nondestructive. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568.

Q: Vegetations in Libman-Sacks endocarditis are:

Small or medium sized on either or both sides of valve. ***Small or medium sized on either or both sides of valve*** - **Libman-Sacks endocarditis** typically presents with vegetations that are **small to medium in size**, found on either aspect of the valve leaflets [1][2][3]. - These vegetations are **sterile**, non-infectious, and often associated with systemic lupus erythematosus (SLE) [2][3]. *Large and fragile* - Vegetations in Libman-Sacks endocarditis are not typically **large**; they are small or medium [1]. - The term **fragile** is misleading, as the vegetations are not characterized by fragility but by being sturdy yet non-infectious. *Small warty along the line of closure of valve* - While the vegetations are small, they are **not warty** and do not primarily form along the line of closure, which is common in infective endocarditis [1]. - Libman-Sacks vegetations can be found on either side of the valve, unlike warty vegetations [1]. *Small bland vegetations* - Vegetations in Libman-Sacks endocarditis are bland but not solely described as **small and bland**; their presence on either or both sides of the valve is critical [1]. - This option fails to capture the significance of their size and localization in the endocardial lesions associated with SLE. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 568. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 232-233. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 570.

Q: A 40-year-old woman who had several episodes of rheumatic fever as a child, is currently afebrile and feels well, and has come to a hospital for monitoring echocardiography. Which of the following findings would most likely be seen in this patient's mitral valve?

Fibrous bridging between thickened, calcified leaflets. A history of **rheumatic fever** typically leads to **chronic rheumatic heart disease**, resulting in **thickening and fibrosis of the mitral valve** [1]. The presence of **fibrous bridging** is characteristic of rheumatic valve disease, indicating scarring and adhesion of leaflets [1]. *Irregular beads of calcification in annulus* - This finding is more suggestive of **degenerative calcific changes** rather than changes due to rheumatic heart disease. - In rheumatic fever, the mitral valve typically shows **thickened leaflets** rather than calcification at the annulus [1]. *Large bulky vegetation with adjacent leaflet perforation* - This is indicative of **infective endocarditis**, not rheumatic heart disease, which would not present with bulky vegetations [2]. - Rheumatic heart disease leads to **structural valve dysfunction** without the presence of vegetations [2]. *Ballooning of valve leaflets* - Ballooning (or myxomatous degeneration) is associated with **mitral valve prolapse**, not rheumatic heart disease. - In rheumatic fever, the leaflets are usually **thickened and fused**, rather than ballooned or prolapsed [1].

Q: At what time is significant fibrous scar formation complete in myocardial infarction?

6 weeks. ***6 weeks*** - By **6 weeks**, the necrotic myocardium has been completely removed and replaced by dense fibrous scar tissue [1], which is structurally strong but non-contractile. - This phase marks the completion of the healing process, with the scar being fully formed and mature. *6 months* - While the scar tissue continues to remodel and strengthen over time, **significant fibrous scar formation** is already complete by 6 weeks [1]. - By 6 months, the scar is fully mature and stabilized, but the initial robust scar formation phase has long passed. *6 days* - At **6 days**, the myocardial infarction is primarily characterized by the initial stages of **granulation tissue formation** [2] and the ongoing removal of necrotic debris. - Significant **fibrous scar formation** has not yet occurred, as the tissue is still highly cellular and vascular. *30 days* - By **30 days (4 weeks)**, a well-developed **collagenous scar** is present, but it is still undergoing remodeling and strengthening. - While a scar is present, it is not yet as dense or as mature as the scar seen at 6 weeks, which is considered the time of significant fibrous scar formation [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 552-554. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 552.

Q: A 25-year-old man presents for a routine examination and is found to have an early diastolic murmur on examination. Clinical findings suggest hypertrophic cardiomyopathy. The family pedigree shows affected individuals in three consecutive generations with both males and females affected, and no generation is skipped. What is the most likely mode of inheritance of this genetic condition?

AD. ***AD (Autosomal Dominant)*** - The presence of affected individuals in **three consecutive generations** without skipping generations is a hallmark of autosomal dominant inheritance [1]. - Both **males and females are affected** equally, indicating it is not X-linked [1]. *AR (Autosomal Recessive)* - **Autosomal recessive** conditions typically **skip generations** and affect siblings, as carriers can pass on the gene without expressing the disease. - Such conditions often show a **25% recurrence risk** in offspring of two carrier parents, which is not suggested here. *XLD (X-linked Dominant)* - **X-linked dominant** inheritance would show **affected fathers passing the trait to all their daughters** but none of their sons, which is not specified. - Affected mothers would have a **50% chance** of passing the trait to each child, regardless of sex. *XLR (X-linked Recessive)* - **X-linked recessive** conditions predominantly affect **males**, and affected fathers cannot pass the trait to their sons. - Females are typically carriers, and affected males often have unaffected parents, which would imply skipping generations.

Q: What is the most common primary neoplasm of the heart in adults?

Myxoma. ***Myxoma*** - It is the most common **primary cardiac neoplasm** in adults [1][2], typically located in the **left atrium** [1][2]. - Myxomas can cause **obstruction** and **systemic embolization** [1][2], presenting with symptoms like dyspnea and syncope. *Papillary fibroelastoma* - This tumor is less common and usually occurs on the heart's **valves**, often causing **embolic events** but not classified as the most common. - It is generally **asymptomatic** unless it causes significant obstruction or embolism. *Lipoma* - While lipomas are common **benign tumors** [2], they make up a smaller percentage of cardiac tumors and usually do not present with **distinct symptoms** as myxomas do. - These tumors are typically **asymptomatic** and found incidentally during imaging. *Rhabdomyoma* - This is more often seen in **children** [2], particularly associated with **tuberous sclerosis**, making it uncommon in adults. - Rhabdomyomas are also **benign**, but its incidence is notably lower compared to myxomas in the adult population. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 583-584. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 304-306.

Question 1

The MOST COMMON cause of concentric hypertrophy of left ventricle is?

Accepted Answer

Hypertension

Answer

Aortic stenosis

Answer

Mitral stenosis

Answer

Aortic regurgitation

Question 2

All are true about non-bacterial thrombotic endocarditis, except?

Accepted Answer

Vegetation > 5 mm

Answer

No inflammatory reaction

Answer

Locally nondestructive

Answer

Cause emboli

Question 3

Irreversible injury in myocardium occurs at ?

Accepted Answer

30 minutes

Answer

5 hours

Answer

1 minute

Answer

1 hour

Question 4

Vegetations in Libman-Sacks endocarditis are:

Accepted Answer

Small or medium sized on either or both sides of valve

Answer

Large and fragile

Answer

Small warty along the line of closure of valve

Answer

Small bland vegetations

Question 5

All of the following are true about rheumatic fever/rheumatic heart disease except:

Accepted Answer

Mitral stenosis is evident in the early stage of the disease

Answer

Presence of Anitschkow cells is pathognomonic

Answer

MacCallum plaques are commonly seen in left atrium

Answer

Mitral valve is most commonly affected

Question 6

Fish mouth stenosis in rheumatic heart disease is due to which of the following mechanisms?

Accepted Answer

Calcification and fibrosis bridging across valvular commissures

Answer

Fibrinoid necrosis

Answer

Acute inflammation leading to valvular damage

Answer

Myxomatous degeneration of the valve, which can occur in rheumatic heart disease

Question 7

A 40-year-old woman who had several episodes of rheumatic fever as a child, is currently afebrile and feels well, and has come to a hospital for monitoring echocardiography. Which of the following findings would most likely be seen in this patient's mitral valve?

Accepted Answer

Fibrous bridging between thickened, calcified leaflets

Answer

Ballooning of valve leaflets

Answer

Irregular beads of calcification in annulus

Answer

Large bulky vegetation with adjacent leaflet perforation

Question 8

At what time is significant fibrous scar formation complete in myocardial infarction?

Accepted Answer

6 weeks

Answer

6 months

Answer

6 days

Answer

30 days

Question 9

A 25-year-old man presents for a routine examination and is found to have an early diastolic murmur on examination. Clinical findings suggest hypertrophic cardiomyopathy. The family pedigree shows affected individuals in three consecutive generations with both males and females affected, and no generation is skipped. What is the most likely mode of inheritance of this genetic condition?

Accepted Answer

AD

Answer

AR

Answer

XLD

Answer

XLR

Question 10

What is the most common primary neoplasm of the heart in adults?

Accepted Answer

Myxoma

Answer

Lipoma

Answer

Papillary fibroelastoma

Answer

Rhabdomyoma

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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