Cardiac Pathology Practice Questions

Q: Carcinoid heart disease affects which part of the heart?

Valvular endocardium. **Explanation:** **Carcinoid Heart Disease** is a manifestation of systemic carcinoid syndrome, occurring in approximately 50% of patients with the syndrome. **Why Valvular Endocardium is correct:** The primary pathology involves the deposition of **fibrous, plaque-like thickenings** on the endocardial surfaces of the heart [1]. These plaques are composed of smooth muscle cells and collagen embedded in an acid mucopolysaccharide-rich matrix [1]. The lesions characteristically involve the **valvular endocardium**, leading to thickening, shortening, and rigidity of the valve leaflets [1]. This typically results in **Tricuspid Regurgitation** and **Pulmonary Stenosis** [1]. **Why other options are incorrect:** * **Pericardium & Epicardium:** These are the outer layers of the heart. Carcinoid heart disease is a luminal (internal) pathology mediated by circulating humoral factors; it does not involve the external lining or the pericardial space. [1] * **Myocardium:** While chronic valvular dysfunction can lead to secondary right ventricular hypertrophy or failure, the primary site of the carcinoid-induced lesion is the endocardium, not the cardiac muscle fibers [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Right-sided Predominance:** It primarily affects the **Right Heart** (Tricuspid and Pulmonary valves) [1]. * **Left Heart Sparing:** The Left Heart is usually spared because the lungs contain **Monoamine Oxidase (MAO)**, which inactivates the circulating serotonin (5-HT) and bradykinin before they reach the left atrium. * **Exception:** Left-sided involvement occurs only in the presence of a **Right-to-Left shunt** (e.g., Patent Foramen Ovale) or **Primary Bronchial Carcinoid**. * **Biomarker:** Elevated urinary **5-HIAA** (5-hydroxyindoleacetic acid) is the diagnostic hallmark. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, pp. 570-572.

Q: Which coronary artery is occluded?

Left main stem. ***Left main stem*** - **Left main coronary artery (LMCA)** occlusion shows **absent filling of both LAD and LCx** on angiography, indicating complete blockage of the main trunk. - Clinically presents with **massive MI** and **cardiogenic shock** due to compromised blood supply to large areas of left ventricular myocardium. *Left anterior descending* - **LAD occlusion** would show absent filling of only the **LAD territory** while the **LCx remains patent** and fills normally. - Affects primarily the **anterior wall** and **interventricular septum**, not the entire left coronary system. *Left circumflex* - **LCx occlusion** would show absent filling of only the **LCx territory** while the **LAD remains patent** and fills normally. - Affects primarily the **lateral and posterior walls** of the left ventricle, sparing the anterior territory. *Left diagonal branch* - **Diagonal branch occlusion** would show absent filling of only a **small diagonal vessel** while both **LAD and LCx main vessels** remain patent. - Affects only a **small portion of the anterior wall**, causing a limited area of myocardial infarction.

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.

Question 1

Carcinoid heart disease affects which part of the heart?

Accepted Answer

Valvular endocardium

Answer

Pericardium

Answer

Myocardium

Answer

Epicardium

Question 2

Which coronary artery is occluded?

Accepted Answer

Left main stem

Answer

Left anterior descending

Answer

Left circumflex

Answer

Left diagonal branch

Question 3

A 60-year-old man has had angina on exertion for the past 6 years. A coronary angiogram performed 2 years ago showed 75% stenosis of the left circumflex coronary artery and 50% stenosis of the right coronary artery. For the past 3 weeks, the frequency and severity of his anginal attacks have increased, and pain sometimes occurs even when he is lying in bed. On physical examination, his blood pressure is 110/80 mm Hg, and pulse is 85/min with irregular beats. An ECG shows ST-segment elevation. Laboratory studies show serum glucose, 188 mg/dL; creatinine, 1.2 mg/dL; and troponin I, 1.5 ng/mL. Which of the following is most likely to explain these findings?

Accepted Answer

Atheromatous plaque fissure with thrombosis

Answer

Constrictive pericarditis with calcification

Answer

Endomyocardial fibrosis

Answer

Extensive myocardial fiber hypertrophy

Question 4

Rheumatic heart disease is caused by all of the following except?

Accepted Answer

Fatty infiltration of the myocardium

Answer

Amyloidosis

Answer

Ergotamine

Answer

Carcinoid syndrome

Question 5

In myocardial infarction, fibrosis is typically seen after how many days?

Accepted Answer

5 days

Answer

2 days

Answer

1 week

Answer

3 weeks

Question 6

A patient with long-standing, moderately severe anemia dies in an automobile accident. An autopsy is performed. Which of the following cardiac changes will MOST likely be seen when the heart is examined?

Accepted Answer

Fatty change of myocytes

Answer

Endocarditis

Answer

Fibrinous pericarditis

Answer

Fibrosis of valve leaflets

Question 7

What is the most common benign heart tumor?

Accepted Answer

Myxoma

Answer

Rhabdomyoma

Answer

Hemangioma

Answer

Lipoma

Question 8

Rupture of the myocardium typically occurs within what time frame after a myocardial infarction?

Accepted Answer

First week

Answer

Second week

Answer

Third week

Answer

Fourth week

Question 9

Which of the following vessels is most commonly affected by atherosclerosis?

Accepted Answer

Left Anterior Descending Artery (LAD)

Answer

Left Circumflex Artery (LCX)

Answer

Right Coronary Artery (RCA)

Answer

Diagonal branch of LAD

Question 10

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

Cardiac Pathology — MCQs

Cardiac Pathology — MCQs

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