ABPath Cardiovascular System Pathology 2 — Questions and Answers
Question 1: Which finding is most characteristic of a 12-hour-old myocardial infarct on microscopy?
- Coagulative necrosis with early neutrophil infiltration (Correct answer)
- Granulation tissue with fibroblasts
- Dense collagenous scar
- Wavy fibers and contraction band necrosis only
Correct answer: Coagulative necrosis with early neutrophil infiltration
By 12–24 hours, coagulative necrosis with early neutrophilic infiltration begins to appear.
Question 2: A ruptured ventricular free wall after MI most commonly occurs at what time point?
- Within 1 hour
- 3 to 7 days (Correct answer)
- 6 to 8 weeks
- 6 months or later
Correct answer: 3 to 7 days
Free wall rupture peaks at 3–7 days when the wall is maximally softened by macrophage-mediated debris removal.
Question 3: Aschoff bodies are pathognomonic of which condition?
- Infective endocarditis
- Acute rheumatic fever (Correct answer)
- Dilated cardiomyopathy
- Cardiac amyloidosis
Correct answer: Acute rheumatic fever
Aschoff bodies with Anitschkow cells are diagnostic of rheumatic myocarditis.
Question 4: Which valve is most frequently involved in chronic rheumatic heart disease?
- Pulmonic
- Tricuspid
- Mitral (Correct answer)
- Aortic and tricuspid equally
Correct answer: Mitral
The mitral valve is most commonly affected, often producing stenosis with a fish-mouth appearance.
Question 5: Large, friable vegetations that can embolize and destroy the valve suggest which type of endocarditis?
- Nonbacterial thrombotic (marantic)
- Libman-Sacks
- Acute infective endocarditis (Correct answer)
- Rheumatic verrucae
Correct answer: Acute infective endocarditis
Acute infective endocarditis, often from S. aureus, produces large destructive vegetations.
Question 6: Contraction band necrosis is most characteristically associated with which mechanism?
- Chronic ischemia
- Reperfusion injury and catecholamine excess (Correct answer)
- Viral infection
- Amyloid deposition
Correct answer: Reperfusion injury and catecholamine excess
Reperfusion and high catecholamine states cause hypercontracted myofibers with eosinophilic transverse bands.
Question 7: Which cardiac enzyme/protein remains elevated longest after myocardial infarction?
- CK-MB
- Myoglobin
- Troponin I/T (Correct answer)
- AST
Correct answer: Troponin I/T
Troponins remain elevated for 7–10 days, longer than CK-MB or myoglobin.
ABPath Cardiovascular System Pathology 2
Which finding is most characteristic of a 12-hour-old myocardial infarct on microscopy?