Cardiovascular: nonbacterial thrombotic endocarditis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Cardiovascular: nonbacterial thrombotic endocarditis

Sample item

A 66-year-old woman with metastatic mucin-secreting pancreatic adenocarcinoma and migratory thrombophlebitis develops a cerebral embolic stroke. Echocardiography shows small sterile vegetations along the closure lines of the mitral valve, and blood cultures are negative. What is the likely pathogenesis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Fibrin and platelet deposition on normal valves in a hypercoagulable state

Nonbacterial thrombotic (marantic) endocarditis shows small, sterile, friable fibrin-platelet vegetations on the closure lines of normal valves, linked to cancer (especially mucinous adenocarcinomas), Trousseau syndrome and DIC. Emboli commonly cause stroke or infarcts; treatment is heparin and treating the cancer.

Option by option

  • A. Fibrin and platelet deposition on normal valves in a hypercoagulable state (correct)

    A hypercoagulable cancer state deposits sterile fibrin-platelet thrombi on normal valves.

  • B. Bacterial colonisation of damaged valve leaflets

    Bacterial colonisation defines infective endocarditis, which would have positive cultures.

  • C. Fibrinoid necrosis with Aschoff bodies

    Aschoff bodies are found in rheumatic heart disease with small verrucae along closure lines.

  • D. Immune complex deposition producing verrucous lesions on both surfaces of the valve

    Verrucous vegetations on both valve surfaces describe Libman-Sacks endocarditis in lupus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Fibrin and platelet deposition on normal valves in a hypercoagulable state. Nonbacterial thrombotic (marantic) endocarditis shows small, sterile, friable fibrin-platelet vegetations on the closure lines of normal valves, linked to cancer (especially mucinous adenocarcinomas), Trousseau syndrome and DIC.

Why is "Bacterial colonisation of damaged valve leaflets" not the answer?

Bacterial colonisation defines infective endocarditis, which would have positive cultures.

Why is "Fibrinoid necrosis with Aschoff bodies" not the answer?

Aschoff bodies are found in rheumatic heart disease with small verrucae along closure lines.

Why is "Immune complex deposition producing verrucous lesions on both surface…" not the answer?

Verrucous vegetations on both valve surfaces describe Libman-Sacks endocarditis in lupus.

What concept does this question test?

It tests Cardiovascular: nonbacterial thrombotic endocarditis in Pathology. Emboli commonly cause stroke or infarcts; treatment is heparin and treating the cancer.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiovascular: nonbacterial thrombotic endocarditis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.