ABPath - American Board of Pathology Cardiovascular System Pathology Questions and Answers

Question 1

A 17-year-old athlete suddenly collapses and dies during a basketball game.
Autopsy reveals a heart weight of 550 grams (normal <350g) with marked, asymmetric thickening of the interventricular septum.
Microscopic examination of the septum shows extensive, haphazardly arranged cardiomyocytes with interstitial fibrosis.
Which of the following is the most likely diagnosis?

Accepted Answer

Hypertrophic cardiomyopathy

Answer

Arrhythmogenic right ventricular cardiomyopathy

Answer

Dilated cardiomyopathy

Answer

Restrictive cardiomyopathy due to amyloidosis

Question 2

A 65-year-old male with a history of untreated hypertension presents with a sudden, severe, tearing chest pain radiating to his back. He rapidly develops hypotension and dies. Autopsy reveals a hemopericardium. Which of the following underlying histopathologic findings in the aorta is most strongly associated with this catastrophic event?

Accepted Answer

Cystic medial degeneration

Answer

Atheromatous plaque with intraplaque hemorrhage

Answer

Libman-Sacks endocarditis

Answer

Syphilitic aortitis with vasa vasorum obliteration

Question 3

A 70-year-old man dies suddenly at home five days after being diagnosed with a large transmural anterior wall myocardial infarction. Autopsy is performed. Which of the following is the most likely cause of death?

Accepted Answer

Rupture of the ventricular free wall

Answer

Ventricular aneurysm formation

Answer

Dressler syndrome

Answer

Ventricular arrhythmia

Question 4

A biopsy of a mitral valve from a patient with a history of recurrent pharyngitis in childhood and subsequent development of mitral stenosis shows a focal collection of plump macrophages, some of which are multinucleated, admixed with lymphocytes and plasma cells surrounding a central area of fibrinoid necrosis. Some of the macrophages have abundant cytoplasm and central nuclei with wavy, ribbon-like chromatin. What is the pathognomonic term for this inflammatory lesion?

Accepted Answer

Aschoff body

Answer

Granuloma with caseous necrosis

Answer

Infective endocarditis vegetation

Answer

Libman-Sacks endocarditis

Question 5

Which of the following cell types is the primary constituent of the fatty streak, the earliest grossly visible lesion of atherosclerosis?

Accepted Answer

Lipid-laden macrophages (foam cells)

Answer

Proliferating smooth muscle cells

Answer

Adherent platelets

Answer

Neutrophils

Question 6

An explanted heart from a 50-year-old patient with progressive dyspnea and signs of right-sided heart failure shows normal-sized, non-dilated ventricles with marked atrial enlargement. The myocardium is firm and rubbery on sectioning. Endomyocardial biopsy with Congo red staining reveals salmon-pink deposits within the interstitium that exhibit apple-green birefringence under polarized light. These findings are most consistent with which type of cardiomyopathy?

Accepted Answer

Restrictive cardiomyopathy

Answer

Dilated cardiomyopathy

Answer

Hypertrophic cardiomyopathy

Answer

Arrhythmogenic right ventricular cardiomyopathy