A patient has left ventricular hypertrophy from chronic outflow obstruction across a stenotic aortic valve. Which hemodynamic load best explains this hypertrophy pattern?
A) Volume overload
B) Pressure overload
C) Low-output unloading
D) Diastolic underfilling
B. Pressure overload
Which valve lesion most classically produces pressure-overload hypertrophy?
A) Stenotic valve
B) Regurgitant valve
C) Insufficient valve
D) Prolapsed valve
A. Stenotic valve
A patient has ventricular dilation and hypertrophy because blood repeatedly refluxes back through an incompetent valve. Which hemodynamic load is most likely?
A) Pressure overload
B) Afterload reduction
C) Volume overload
D) Coronary underfilling
C. Volume overload
Which valve lesion most classically produces volume-load hypertrophy?
A) Stenotic valve
B) Regurgitant valve
C) Calcified valve
D) Fused valve
B. Regurgitant valve
An elderly patient has the most common valvular abnormality seen in adults. Which diagnosis is most likely?
A) Rheumatic mitral stenosis
B) Libman-Sacks endocarditis
C) Calcified aortic stenosis
D) Myxomatous tricuspid prolapse
C. Calcified aortic stenosis
A middle-aged patient develops calcific aortic stenosis earlier than expected, and family history suggests inherited risk. Which condition most likely explains this?
A) Congenitally bicuspid aortic valve
B) Rheumatic mitral valve disease
C) Libman-Sacks endocarditis
D) Nonbacterial thrombotic endocarditis
A. Congenitally bicuspid aortic valve
A bicuspid aortic valve has only 2 leaflets instead of 3. Because the valve is structurally abnormal, blood flow across it is more turbulent over many years. That extra mechanical stress causes earlier fibrosis and calcification.
A pathology specimen shows calcific deposits involving the fibrous ring supporting the mitral valve. Where are these deposits located?
A) Papillary muscle tips
B) Chordae tendineae
C) Annular fibrous tissue
D) Aortic valve commissures
C. Annular fibrous tissue
The calcific deposits described are characteristic of Mitral Annular Calcification (MAC), a common degenerative process that occurs in the fibrous ring that supports the mitral valve leaflets
Mitral annular calcification most directly involves which valve-associated structure?
A) Leaflet free edge
B) Annular fibrous ring
C) Spongiosa layer
D) Papillary muscle belly
B. Annular fibrous ring
A patient with mitral valve prolapse has abnormal extracellular matrix signaling implicated in disease pathogenesis. Which cytokine is associated?
A) IL-2
B) TNF-α
C) IL-8
D) TGF-β
D. TGF-β
TGF-β Signaling: Myxomatous mitral valve prolapse is recognized as a disease driven by aberrant TGF-β-dependent signaling, leading to valve interstitial cell activation and altered extracellular matrix (ECM) remodeling.
A valvular disease shows myxomatous degeneration in the spongiosa layer of the valve. Which diagnosis is most likely
A) Mitral valve prolapse
B) Calcified aortic stenosis
C) Rheumatic aortic regurgitation
D) Infectious endocarditis
A. Mitral valve prolapse
A young woman has atypical chest pain and a high-pitched sound before S2 heard best at the PMI. Which valvular disorder is suggested?
A) Aortic stenosis
B) Mitral valve prolapse
C) Rheumatic mitral stenosis
D) Infectious endocarditis
B. Mitral valve prolapse
Which heart sound most classically identifies mitral valve prolapse?
A) Opening snap
B) Holosystolic murmur
C) Mid-systolic click
D) Early diastolic rumble
C. Mid-systolic click
A child develops fever, migratory joint pain, and carditis several weeks after untreated streptococcal pharyngitis. Which immune-mediated disorder is most likely?
A) Infectious endocarditis
B) Rheumatic fever
C) Libman-Sacks endocarditis
D) Nonbacterial thrombotic endocarditis
B. Rheumatic fever
Rheumatic fever is one of the few major causes of stenosis involving which valve?
A) Aortic valve
B) Mitral valve
C) Pulmonic valve
D) Tricuspid valve
B. Mitral valve
Cardiac histology after rheumatic fever shows inflammatory foci containing T lymphocytes and activated macrophages. What are these lesions called?
A) Aschoff bodies
B) Osler nodes
C) Janeway lesions
D) Mural thrombi
A. Aschoff bodies
A heart biopsy from rheumatic carditis shows activated macrophages with characteristic caterpillar-like chromatin. What are these cells called?
A) Reed-Sternberg cells
B) Touton giant cells
C) Anitschkow cells
D) Langhans giant cells
C. Anitschkow cells
Anitschkow cells are characteristic macrophages associated with which condition?
A) Rheumatic heart disease
B) Nonbacterial thrombotic endocarditis
C) Calcified aortic stenosis
D) Prinzmetal angina
A. Rheumatic heart disease
During rheumatic fever, immune-mediated damage produces necrosis in affected valves. Which necrosis pattern is expected
A) Liquefactive necrosis
B) Caseous necrosis
C) Fat necrosis
D) Fibrinoid necrosis
D. Fibrinoid necrosis
During rheumatic fever, the immune-mediated damage (specifically type II hypersensitivity, where antibodies cross-react with host tissue) causes inflammatory destruction of collagen and other connective tissues within the heart valves. This specific pattern of damage is characterized by a bright pink, amorphous, proteinaceous deposit, known as fibrinoid necrosis.
A patient has chronic rheumatic mitral stenosis. Which gross valve finding is most likely?
A) Fish-mouth valve orifice
B) Large friable vegetations
C) Annular calcium nodules
D) Floppy myxomatous leaflets
A. Fish-mouth valve orifice
A stenotic mitral valve from chronic rheumatic disease has a narrowed slit-like orifice. Which gross appearance is classic
A) Buttonhole appearance
B) Fish-mouth appearance
C) Bread-and-butter appearance
D) Tree-bark appearance
B. Fish-mouth appearance
Which clinical feature belongs to the classic rheumatic fever pentad?
A) Hemoptysis
B) Migratory polyarthritis
C) Splinter hemorrhages
D) Pulsus paradoxus
B. Migratory polyarthritis
A patient has migratory polyarthritis, pancarditis, subcutaneous nodules, erythema marginatum, and Sydenham chorea after pharyngitis. Which diagnosis fits best?
A) Infectious endocarditis
B) Rheumatic fever
C) Libman-Sacks endocarditis
D) Calcific valve disease
B. Rheumatic fever
A patient presents with stormy onset of fever, chills, fatigue, destructive valve lesions, and bulky vegetations. Which diagnosis is most likely?
A) Infectious endocarditis
B) Stable angina
C) Mitral valve prolapse
D) Chronic cor pulmonale
A. Infectious endocarditis
"bulky vegetations"—masses of platelets, fibrin, and microorganisms—that often lead to destructive valve lesions and impaired heart function
Which presentation best suggests infectious endocarditis rather than nonbacterial thrombotic endocarditis?
A) Small sterile embolizing vegetations
B) Hypercoagulable sterile vegetations
C) Stormy fever with destructive lesions
D) Myxomatous valve degeneration
C. Stormy fever with destructive lesions
An IV drug user develops acute infective endocarditis with destructive valvular vegetations. Which organism is the major cause?
A) S. viridans
B) S. epidermidis
C) Enterococcus faecalis
D) S. aureus
D. S. aureus
A patient with a previously damaged valve develops subacute infectious endocarditis caused by a less virulent organism. Which organism is most likely?
A) S. aureus
B) S. viridans
C) Neisseria gonorrhoeae
D) Coxsackievirus B
B. S. viridans
A cancer patient with a hypercoagulable state develops small sterile valve vegetations that embolize. Which diagnosis best fits?
A) Infectious endocarditis
B) Rheumatic fever
C) Nonbacterial thrombotic endocarditis
D) Mitral valve prolapse
C. Nonbacterial thrombotic endocarditis
A patient with systemic lupus erythematosus develops sterile vegetations on both sides of valve leaflets. What is this endocarditis called?
A) Rheumatic endocarditis
B) Libman-Sacks endocarditis
C) Infectious endocarditis
D) Calcific endocarditis
B. Libman-Sacks endocarditis
Libman-Sacks endocarditis
→ sterile vegetations
→ associated with
SLE/antiphospholipid syndrome
→ can be on both sides of valve leaflets
Infective endocarditis
→ infected vegetations
→ usually on the line of
closure of the valve
Rheumatic endocarditis
→ small vegetations along the line of closure
→ not typically both sides
Which pairing correctly matches valvular load type with typical valve lesion?
A) Pressure-regurgitant; volume-stenotic
B) Pressure-stenotic; volume-regurgitant
C) Pressure-prolapsed; volume-calcified
D) Pressure-insufficient; volume-stenotic
B. Pressure-stenotic; volume-regurgitant
A patient has valvular plaques with episodic flushing, diarrhea, and dermatitis. Urine testing shows elevated 5-HIAA. Which malignancy is most likely?
A) Carcinoid tumor
B) Cardiac myxoma
C) Renal cell carcinoma
D) Adrenal pheochromocytoma
A. Carcinoid tumor
A patient receives a mechanical prosthetic valve. What is the major long-term concern requiring careful prevention?
A) Ventricular septal rupture
B) Thromboembolism
C) Restrictive cardiomyopathy
D) Myxomatous degeneration
B. Thromboembolism
A patient with a porcine biological prosthetic valve develops progressive obstruction years later. Which complication is most characteristic of biological valves?
A) Thromboembolism
B) Stenosis
C) Ventricular arrhythmia
D) Carcinoid plaques
B. Stenosis
A patient has a cardiomyopathy dominated by impaired ventricular contractility and reduced systolic pumping. Which cardiomyopathy best fits?
A) Hypertrophic cardiomyopathy
B) Restrictive cardiomyopathy
C) Dilated cardiomyopathy
D) Arrhythmogenic cardiomyopathy
C. Dilated cardiomyopathy
Which cardiomyopathy is most associated with systolic contractile dysfunction?
A) Dilated cardiomyopathy
B) Hypertrophic cardiomyopathy
C) Restrictive cardiomyopathy
D) Amyloid cardiomyopathy
A. Dilated cardiomyopathy
Which cardiomyopathy pair causes diastolic dysfunction?
A) Dilated and Takotsubo
B) Hypertrophic and restrictive
C) Arrhythmogenic and dilated
D) Myocarditis and rhabdomyoma
B. Hypertrophic and restrictive
Which pairing correctly matches cardiomyopathy type with the primary functional defect?
A) Dilated-diastolic; restrictive-systolic
B) Hypertrophic-systolic; dilated-diastolic
C) Dilated-systolic; hypertrophic-diastolic
D) Restrictive-systolic; Takotsubo-diastolic
C. Dilated-systolic; hypertrophic-diastolic
A cardiology review asks which cardiomyopathy is most common overall. Which answer is correct?
A) Restrictive cardiomyopathy
B) Dilated cardiomyopathy
C) Hypertrophic cardiomyopathy
D) Arrhythmogenic cardiomyopathy
B. Dilated cardiomyopathy
Which cardiomyopathy is least common among the major cardiomyopathy categories?
A) Dilated cardiomyopathy
B) Hypertrophic cardiomyopathy
C) Restrictive cardiomyopathy
D) Takotsubo cardiomyopathy
C. Restrictive cardiomyopathy
A patient with familial dilated cardiomyopathy has truncating mutations in a giant sarcomeric structural protein. Which protein is implicated?
A) Dystrophin
B) Titin
C) Desmin
D) Lamin
B. Titin
Titin is a huge sarcomeric structural protein that helps maintain elasticity and alignment in cardiac muscle.
Truncating mutations in TTN, the gene for titin, are a major genetic cause of familial dilated cardiomyopathy.
Which exposure is a classic toxic cause of dilated cardiomyopathy?
A) Ethanol ingestion
B) Silica inhalation
C) Mercury vapor
D) Arsenic ointment
A. Ethanol ingestion
A patient with hemochromatosis develops cardiomyopathy, and myocardial biopsy shows intracellular hemosiderin in a spindle-shaped pattern. Which cardiomyopathy types are associated?
A) Dilated and restrictive
B) Hypertrophic and arrhythmogenic
C) Takotsubo and hypertrophic
D) Restrictive and Brugada
A. Dilated and restrictive
Iron deposits in the heart → toxic injury + stiffness → dilated or restrictive cardiomyopathy.
A woman develops acute LV contractile dysfunction after severe emotional stress. Imaging shows apical ballooning. Which cardiomyopathy is most likely?
A) Takotsubo cardiomyopathy
B) Restrictive cardiomyopathy
C) Arrhythmogenic cardiomyopathy
D) Hypertrophic cardiomyopathy
A. Takotsubo cardiomyopathy
A patient develops “broken heart syndrome” after intense psychological stress. Which term best describes this condition?
A) Dilated cardiomyopathy
B) Takotsubo cardiomyopathy
C) Infectious myocarditis
D) Fibrinous pericarditis
B. Takotsubo cardiomyopathy
A cardiomyopathy patient has severe systolic dysfunction with an ejection fraction below 25%. Which diagnosis is most likely?
A) Dilated cardiomyopathy
B) Hypertrophic cardiomyopathy
C) Restrictive cardiomyopathy
D) Pericardial effusion
A. Dilated cardiomyopathy
Which cardiomyopathy commonly causes passing out in young men due to rhythm disturbances?
A) Restrictive cardiomyopathy
B) Takotsubo cardiomyopathy
C) Arrhythmogenic cardiomyopathy
D) Infectious myocarditis
C. Arrhythmogenic cardiomyopathy
A patient presents with right-sided heart failure and ventricular rhythm disturbances rather than isolated LV systolic failure. Which diagnosis best fits?
A) Arrhythmogenic cardiomyopathy
B) Hypertrophic cardiomyopathy
C) Dilated cardiomyopathy
D) Fibrinous pericarditis
A. Arrhythmogenic cardiomyopathy
Arrhythmogenic cardiomyopathy classically affects the right ventricle.
It causes: fibrofatty replacement of myocardium → weak RV contraction + electrical instability
A patient with familial hypertrophic cardiomyopathy has mutations affecting contractile apparatus proteins. Which protein class is most often involved?
A) Sarcomeric proteins
B) Basement membrane proteins
C) Lysosomal enzymes
D) Collagen crosslinking proteins
A. Sarcomeric proteins
A patient has myocardial hypertrophy without ventricular dilation and marked asymmetric septal thickening. Which cardiomyopathy is most likely?
A) Dilated cardiomyopathy
B) Restrictive cardiomyopathy
C) Hypertrophic cardiomyopathy
D) Takotsubo cardiomyopathy
C. Hypertrophic cardiomyopathy
Which structural pattern best supports hypertrophic cardiomyopathy?
A) Ventricular dilation with thin walls
B) Asymmetric septal hypertrophy
C) Amyloid-stiffened normal ventricles
D) Globular pericardial enlargement
B. Asymmetric septal hypertrophy
A patient has diastolic dysfunction from asymmetric septal hypertrophy without ventricular dilation. Which diagnosis best integrates these findings?
A) Hypertrophic cardiomyopathy
B) Dilated cardiomyopathy
C) Chronic myocarditis
D) Carcinoid heart disease
A. Hypertrophic cardiomyopathy
A patient has restrictive ventricular filling due to amyloid deposition in the myocardium. Which cardiomyopathy is most characteristic?
A) Dilated cardiomyopathy
B) Hypertrophic cardiomyopathy
C) Restrictive cardiomyopathy
D) Arrhythmogenic cardiomyopathy
C. Restrictive cardiomyopathy
Amyloidosis is most strongly associated with which cardiomyopathy pattern?
A) Restrictive cardiomyopathy
B) Dilated cardiomyopathy
C) Takotsubo cardiomyopathy
D) Arrhythmogenic cardiomyopathy
A. Restrictive cardiomyopathy
A patient has angina-like chest pain, and biopsy shows lymphocytic and eosinophilic inflammatory infiltrates in myocardium. Which diagnosis is most likely?
A) Infectious myocarditis
B) Calcified aortic stenosis
C) Cardiac myxoma
D) Carcinoid valvulopathy
A. Infectious myocarditis
Which inflammatory pattern is correctly matched with infectious myocarditis causes?
A) Lymphocytes-viral; eosinophils-parasitic
B) Neutrophils-amyloid; lymphocytes-carcinoid
C) Eosinophils-ischemia; macrophages-myxoma
D) Plasma cells-ethanol; neutrophils-titin
A. Lymphocytes-viral; eosinophils-parasitic
A chest x-ray shows a characteristically globular enlargement of the cardiac silhouette. Which condition is suggested?
A) Pericardial effusion
B) Aortic stenosis
C) Ventricular aneurysm
D) Mitral prolapse
A. Pericardial effusion
Which pericarditis subtype is most common?
A) Fibrinous pericarditis
B) Tuberculous pericarditis
C) Suppurative pericarditis
D) Cholesterol pericarditis
A. Fibrinous pericarditis
The most common primary tumor of the adult heart is which lesion?
A) Myxoma
B) Rhabdomyoma
C) Lipoma
D) Mesothelioma
A. Myxoma
Where do cardiac myxomas most commonly arise?
A) Right ventricle
B) Left atrium
C) Aortic valve
D) Pericardium
B. Left atrium
Myxoma = benign “jelly-like” heart tumor, usually in the left atrium, that can obstruct flow or embolize.
A patient has a left atrial primary cardiac tumor producing constitutional symptoms through cytokine release. Which cytokine is elevated?
A) IL-1
B) IL-6
C) IL-12
D) IL-17
B. IL-6
Atrial myxoma → ↑ IL-6 → systemic inflammatory symptoms
A fetus is found to have the most common primary tumor of the fetal heart. Which tumor is most likely?
A) Myxoma
B) Rhabdomyoma
C) Angiosarcoma
D) Papillary fibroelastoma
B. Rhabdomyoma
A fetus with a cardiac rhabdomyoma is evaluated for an associated genetic disease. Which condition is classically linked?
A) Tuberous sclerosis
B) Marfan syndrome
C) Down syndrome
D) Wilson disease
A. Tuberous sclerosis
Which condition is best matched with severe psychological stress and transient LV contractile dysfunction?
A) Takotsubo cardiomyopathy
B) Restrictive cardiomyopathy
C) Infectious myocarditis
D) Cardiac rhabdomyoma
A. Takotsubo cardiomyopathy
A patient has pericarditis with an exudate containing blood mixed with fibrinous inflammatory material. Which pericarditis subtype best fits?
A) Serous pericarditis
B) Hemorrhagic pericarditis
C) Purulent pericarditis
D) Constrictive pericarditis
B. Hemorrhagic pericarditis
A patient with systemic lupus erythematosus develops pericarditis with a thin, nonpurulent effusion. Which pericarditis subtype is most consistent?
A) Purulent pericarditis
B) Hemorrhagic pericarditis
C) Serous pericarditis
D) Caseous pericarditis
C. Serous pericarditis
Which group of conditions is most associated with serous pericarditis?
A) SLE, scleroderma, uremia
B) Staph aureus, sepsis, abscess
C) Trauma, rupture, anticoagulation
D) Tuberculosis, fungi, sarcoidosis
A. SLE, scleroderma, uremia
Which underlying process most directly produces serous pericarditis?
A) Microbial invasion of pericardium
B) Noninfectious inflammatory disease
C) Blood leaking into exudate
D) Ventricular free-wall rupture
B. Noninfectious inflammatory disease
Serous means thin, watery, clear fluid.
A patient has fever and pericardial fluid filled with neutrophil-rich pus after bacteria invade the pericardial space. Which subtype is present?
A) Purulent pericarditis
B) Serous pericarditis
C) Hemorrhagic pericarditis
D) Rheumatic pericarditis
A. Purulent pericarditis
Purulent simply means pus filled.
A pericardial effusion is caused by active infection within the pericardial space. Which term best describes this pericarditis
A) Serous pericarditis
B) Hemorrhagic pericarditis
C) Suppurative pericarditis
D) Uremic pericarditis
C. Suppurative pericarditis
Suppurative inflammation usually means there is an active infection, especially a bacterial infection.