A 47-year-old man in Hyderabad collapses at home within 30 minutes of the onset of severe chest pain and cannot be revived. Autopsy shows an occlusive thrombus in the left anterior descending artery, but the myocardium looks normal on gross and microscopic examination. What is the most likely mechanism of death?

Ventricular fibrillation from acute ischaemia

Cardiogenic shock from extensive necrosis

Rupture of the left ventricular free wall

A 59-year-old man with ST elevation in V1-V4 dies after a large myocardial infarction. At autopsy the infarct involves the anterior wall of the left ventricle near the apex and the anterior two-thirds of the interventricular septum. Which coronary artery was most likely occluded?

Left anterior descending artery

A 24-year-old man from Surat has nodules on his Achilles tendons and knuckles, a total cholesterol of 420 mg/dL with LDL of 330 mg/dL, and a father who died of MI at 42. The macrophages in his arterial plaques take up modified LDL that drives foam cell formation through which receptor?

Scavenger receptors that are not down-regulated

LDL receptors that are up-regulated in the plaque

Insulin receptors on smooth muscle cells

HDL receptors on endothelial cells

A 34-year-old woman from Bhubaneswar with longstanding exertional breathlessness, atrial fibrillation and a mid-diastolic rumble at the apex undergoes mitral valve replacement. Which appearance of the excised valve is most characteristic of her disease?

Thick leaflets with fused commissures

Floppy leaflets ballooning into the atrium

Calcified mitral annulus with normal leaflets

Large friable vegetations perforating a leaflet

Cardiovascular pathology

19 NEET-PG practice questions on Cardiovascular pathology, part of Pathology. The first 19 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 47-year-old man in Hyderabad collapses at home within 30 minutes of the onset of severe chest pain and cannot be revived. Autopsy shows an occlusive thrombus in the left anterior descending artery, but the myocardium looks normal on gross and microscopic examination. What is the most likely mechanism of death?
1. ARupture of a papillary muscle
2. BVentricular fibrillation from acute ischaemia
3. CCardiogenic shock from extensive necrosis
4. DRupture of the left ventricular free wall
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Answer: B · Ventricular fibrillation from acute ischaemia
Most deaths in the first hour of acute coronary occlusion are due to ventricular arrhythmias, usually ventricular fibrillation triggered by electrical instability of ischaemic myocardium. No morphological changes of necrosis are visible by light microscopy in the first 30 minutes, so the heart can look normal apart from the coronary thrombus. This is why rapid access to defibrillation and CPR saves lives. Mechanical complications occur days later, when the infarct has softened.
- A: Papillary muscle rupture also occurs days later, after necrosis has developed.
- C: Cardiogenic shock follows loss of a large mass of necrotic myocardium, which is not seen here.
- D: Free-wall rupture occurs mostly 3-7 days after infarction.
Question 2 · Medium
A 59-year-old man with ST elevation in V1-V4 dies after a large myocardial infarction. At autopsy the infarct involves the anterior wall of the left ventricle near the apex and the anterior two-thirds of the interventricular septum. Which coronary artery was most likely occluded?
1. ALeft anterior descending artery
2. BRight coronary artery
3. CLeft circumflex artery
4. DPosterior descending artery
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Answer: A · Left anterior descending artery
The left anterior descending artery supplies the anterior wall of the left ventricle near the apex, the anterior two-thirds of the septum and the apex itself. It is the most frequently occluded coronary artery in MI, followed by the right coronary and the left circumflex. ST elevation in V1-V4 reflects this anterior and septal territory. Large anterior infarcts carry the highest risk of heart failure, aneurysm and mural thrombus.
- B: The right coronary supplies the inferior wall and posterior third of the septum in most hearts.
- C: The circumflex supplies the lateral wall of the left ventricle.
- D: The posterior descending artery supplies the posterior third of the septum.
Question 3 · Medium
A 24-year-old man from Surat has nodules on his Achilles tendons and knuckles, a total cholesterol of 420 mg/dL with LDL of 330 mg/dL, and a father who died of MI at 42. The macrophages in his arterial plaques take up modified LDL that drives foam cell formation through which receptor?
1. ALDL receptors that are up-regulated in the plaque
2. BScavenger receptors that are not down-regulated
3. CInsulin receptors on smooth muscle cells
4. DHDL receptors on endothelial cells
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Answer: B · Scavenger receptors that are not down-regulated
The tendon xanthomas, very high LDL and early family coronary death suggest familial hypercholesterolaemia, usually from mutations in the LDL receptor gene. LDL that accumulates in the intima is oxidised and taken up by macrophages through scavenger receptors such as CD36 and SR-A. Unlike the LDL receptor, these are not down-regulated by cellular cholesterol, so macrophages keep filling with lipid and become foam cells. Statins, with ezetimibe or PCSK9 inhibitors when needed, are started early, and relatives are screened.
- A: Native LDL receptors are down-regulated by cholesterol and are defective in this patient.
- C: Insulin receptors do not mediate lipid uptake into foam cells.
- D: HDL receptors mediate cholesterol efflux to HDL, which protects against foam cells.
Question 4 · Easy
A 55-year-old diabetic man presents to casualty with three hours of central chest pressure and sweating. Which blood marker is preferred today to diagnose myocardial infarction?
1. ALactate dehydrogenase
2. BSerum myoglobin
3. CCardiac troponin I or T
4. DTotal creatine kinase
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Answer: C · Cardiac troponin I or T
Cardiac troponins I and T are part of the contractile apparatus of heart muscle, and the cardiac forms differ from those in skeletal muscle, so they are both highly sensitive and specific for myocardial injury. High-sensitivity assays detect a rise within a few hours, and levels remain raised for 7-10 days or longer. Infarction is diagnosed by a rise or fall of troponin with at least one value above the 99th percentile, together with clinical or ECG evidence of ischaemia. CK-MB and myoglobin are now of secondary use.
- A: LDH rises late and is not specific; it is no longer used for infarction.
- B: Myoglobin rises early but is found in skeletal muscle too, so it lacks specificity.
- D: Total CK also rises with skeletal muscle injury and is not specific.
Question 5 · Medium
A 34-year-old woman from Bhubaneswar with longstanding exertional breathlessness, atrial fibrillation and a mid-diastolic rumble at the apex undergoes mitral valve replacement. Which appearance of the excised valve is most characteristic of her disease?
1. AThick leaflets with fused commissures
2. BFloppy leaflets ballooning into the atrium
3. CCalcified mitral annulus with normal leaflets
4. DLarge friable vegetations perforating a leaflet
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Answer: A · Thick leaflets with fused commissures
Chronic rheumatic heart disease is the commonest cause of mitral stenosis in India. Repeated inflammation thickens the leaflets, fuses the commissures and shortens, thickens and fuses the chordae tendineae, giving a narrow fish-mouth or buttonhole orifice. Neovascularisation and calcification follow, and the left atrium dilates, favouring atrial fibrillation and mural thrombus. Anticoagulation is needed for rheumatic mitral stenosis with atrial fibrillation.
- B: Floppy, ballooning leaflets describe myxomatous mitral valve prolapse.
- C: Annular calcification occurs in the elderly and spares the leaflets themselves.
- D: Friable vegetations with perforation describe infective endocarditis.
Question 6 · Hard
A 14-year-old girl from a village in Jharkhand, a region with a high prevalence of rheumatic heart disease, has fever and joint pains three weeks after a sore throat; her ASO titre is raised. The registrar discusses the 2015 revised Jones criteria for high-risk populations: 1. A prolonged PR interval counts as a minor criterion even when carditis is already counted as major. 2. Subclinical carditis seen only on echocardiography counts as a major criterion. 3. Polyarthralgia can count as a major criterion. 4. Evidence of preceding group A streptococcal infection is needed, except in chorea or indolent carditis. Which statements are correct?
1. A2 and 3 only
2. B2, 3 and 4 only
3. C1, 3 and 4 only
4. D1 and 4 only
Answer and explanation in LearnFree account
Question 7 · Medium
A 58-year-old man undergoes primary PCI 3 hours after the onset of an inferior STEMI. He dies of an unrelated cause four days later. The reperfused infarct shows haemorrhage and myocytes with dense, irregular, eosinophilic transverse bands. What causes these bands?
1. ADeposition of amyloid between the fibres
2. BFatty change from lipid accumulation
3. CNeutrophil enzymes digesting the myofibres
4. DCalcium influx causing hypercontraction
Answer and explanation in LearnFree account
Question 8 · Easy
A 16-year-old boy dies in a road traffic accident in Nagpur. At autopsy, the aorta shows flat, yellow streaks that do not narrow the lumen. Which cells mainly form these lesions?
1. ANeutrophils with fibrin deposits
2. BLipid-laden foamy macrophages
3. CCalcified smooth muscle cells
4. DProliferating fibroblasts with collagen
Answer and explanation in LearnFree account
Question 9 · Medium
A 42-year-old woman on haemodialysis through a tunnelled jugular catheter in Kochi has had high fever with rigors for four days. Three blood culture sets grow Staphylococcus aureus, and echocardiography shows a new tricuspid valve vegetation with severe regurgitation. Which description best fits the vegetations this organism produces?
1. ASmall sterile beads along the line of closure
2. BFibrous plaques thickening the right-sided valves
3. CLarge, friable vegetations that destroy the valve
4. DSmall warty vegetations on both leaflet surfaces
Answer and explanation in LearnFree account
Question 10 · Easy
A 9-year-old girl from a tea garden in Assam dies of heart failure during her first attack of acute rheumatic fever. Sections of her myocardium show foci of fibrinoid necrosis surrounded by lymphocytes, plasma cells and plump macrophages with slender, wavy chromatin ribbons. What are these foci called?
1. AAschoff bodies
2. BCaseating granulomas
3. CBland fibrin vegetations
4. DGumma formations
Answer and explanation in LearnFree account
Question 11 · Hard
A 61-year-old man develops fever six weeks after aortic valve replacement with a mechanical prosthesis in a Bengaluru hospital. Echocardiography shows a vegetation on the sewing ring. Blood cultures grow Gram-positive cocci in clusters that are catalase-positive and coagulase-negative. Which property of the organism best explains its ability to cause this infection?
1. ABiofilm formation on foreign material
2. BProduction of coagulase that clots plasma
3. CToxic shock syndrome toxin-1 production
4. DProtein A binding the Fc portion of IgG
Answer and explanation in LearnFree account
Question 12 · Medium
In a pathology tutorial on a 54-year-old smoker who died of acute coronary thrombosis, the resident lists features of coronary plaques: 1. A thin fibrous cap. 2. A large necrotic lipid core. 3. Many macrophages and T cells in the cap. 4. A thick fibrous cap with heavy calcification. Which features make a plaque vulnerable to rupture?
1. A1, 2 and 3 only
2. B3 and 4 only
3. C1 and 4 only
4. D2 and 3 only
Answer and explanation in LearnFree account
Question 13 · Medium
An 11-year-old boy from Odisha has migratory pain and swelling of the knees and ankles, a new apical pansystolic murmur and a raised ASO titre, three weeks after a sore throat that was not treated. What is the mechanism of his heart damage?
1. ADirect invasion of the heart by streptococci
2. BImmune complexes after streptococcal skin infection
3. CImmune cross-reaction with M protein
4. DCirculating streptococcal toxin damaging the valve
Answer and explanation in LearnFree account
Question 14 · Medium
A 62-year-old man with an anterior wall MI was admitted 48 hours ago and was not reperfused. He dies suddenly in the ward. Sections of the infarcted myocardium would most likely show which change?
1. AGranulation tissue with new vessels
2. BWavy fibres at the margin only
3. CNecrotic fibres with many neutrophils
4. DDense collagenous scar
Answer and explanation in LearnFree account
Question 15 · Medium
A 63-year-old man with weight loss and a mass in the body of the pancreas, later shown to be mucinous adenocarcinoma, develops a sudden right hemiparesis. He is afebrile, and repeated blood cultures are sterile. Echocardiography shows small vegetations along the closure line of the mitral leaflets. What is the most likely diagnosis?
1. ACarcinoid heart disease
2. BNonbacterial thrombotic endocarditis
3. CSubacute infective endocarditis
4. DLibman-Sacks endocarditis
Answer and explanation in LearnFree account
Question 16 · Hard
A 50-year-old man reaches casualty 50 minutes after the onset of central chest pain. His ECG shows no ST elevation. A high-sensitivity troponin I drawn on arrival is just below the 99th percentile upper reference limit. What is the next best step in evaluating him for myocardial infarction?
1. AMeasure LDH to rule it out
2. BMeasure CK-MB to rule it out
3. CRepeat hs-troponin after 1-3 hours
4. DDischarge as MI is excluded
Answer and explanation in LearnFree account
Question 17 · Hard
A 66-year-old hypertensive woman was admitted with an anterior STEMI that was not reperfused. On day 5 she suddenly becomes breathless and collapses. BP is 70/50 mmHg with pulsus paradoxus, the neck veins are distended, heart sounds are muffled, and the monitor shows sinus rhythm with no palpable pulse. Which finding would most likely be seen in the infarct at autopsy?
1. AMacrophages clearing soft necrotic muscle
2. BDense collagenous scar with thinning
3. CGranulation tissue with abundant collagen
4. DWavy fibres at the margins only
Answer and explanation in LearnFree account
Question 18 · Medium
A 44-year-old man with known rheumatic mitral regurgitation has had fever for six weeks. Blood cultures grow viridans streptococci. Urine shows red cells and red cell casts, creatinine is 1.9 mg/dL and serum C3 is low. What is the most likely cause of his renal involvement?
1. ARenal infarction from septic emboli
2. BImmune complex glomerulonephritis
3. CRenal amyloidosis from chronic infection
4. DDrug-induced acute interstitial nephritis
Answer and explanation in LearnFree account
Question 19 · Easy
A 32-year-old woman with systemic lupus erythematosus and lupus nephritis dies of a stroke. At autopsy, the mitral valve shows small, warty, sterile vegetations on both the atrial and ventricular surfaces of the leaflets. What is this lesion called?
1. AInfective endocarditis
2. BRheumatic verrucous endocarditis
3. CCarcinoid heart disease
4. DLibman-Sacks endocarditis
Answer and explanation in LearnFree account

Cardiovascular pathology

A 59-year-old man with ST elevation in V1-V4 dies after a large myocardial infarction. At autopsy the infarct involves the anterior wall of the left ventricle near the apex and the anterior two-thirds of the interventricular septum. Which coronary artery was most likely occluded?

A 24-year-old man from Surat has nodules on his Achilles tendons and knuckles, a total cholesterol of 420 mg/dL with LDL of 330 mg/dL, and a father who died of MI at 42. The macrophages in his arterial plaques take up modified LDL that drives foam cell formation through which receptor?

A 55-year-old diabetic man presents to casualty with three hours of central chest pressure and sweating. Which blood marker is preferred today to diagnose myocardial infarction?

A 34-year-old woman from Bhubaneswar with longstanding exertional breathlessness, atrial fibrillation and a mid-diastolic rumble at the apex undergoes mitral valve replacement. Which appearance of the excised valve is most characteristic of her disease?

A 58-year-old man undergoes primary PCI 3 hours after the onset of an inferior STEMI. He dies of an unrelated cause four days later. The reperfused infarct shows haemorrhage and myocytes with dense, irregular, eosinophilic transverse bands. What causes these bands?

A 16-year-old boy dies in a road traffic accident in Nagpur. At autopsy, the aorta shows flat, yellow streaks that do not narrow the lumen. Which cells mainly form these lesions?

An 11-year-old boy from Odisha has migratory pain and swelling of the knees and ankles, a new apical pansystolic murmur and a raised ASO titre, three weeks after a sore throat that was not treated. What is the mechanism of his heart damage?

A 62-year-old man with an anterior wall MI was admitted 48 hours ago and was not reperfused. He dies suddenly in the ward. Sections of the infarcted myocardium would most likely show which change?

A 50-year-old man reaches casualty 50 minutes after the onset of central chest pain. His ECG shows no ST elevation. A high-sensitivity troponin I drawn on arrival is just below the 99th percentile upper reference limit. What is the next best step in evaluating him for myocardial infarction?

A 44-year-old man with known rheumatic mitral regurgitation has had fever for six weeks. Blood cultures grow viridans streptococci. Urine shows red cells and red cell casts, creatinine is 1.9 mg/dL and serum C3 is low. What is the most likely cause of his renal involvement?

A 32-year-old woman with systemic lupus erythematosus and lupus nephritis dies of a stroke. At autopsy, the mitral valve shows small, warty, sterile vegetations on both the atrial and ventricular surfaces of the leaflets. What is this lesion called?