Cardiovascular: Libman-Sacks 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: Libman-Sacks endocarditis

Sample item

A 26-year-old woman with a malar rash, arthritis and proteinuria has a new murmur. Echocardiography shows small sterile verrucous vegetations on both surfaces of the mitral valve leaflets. What is the most likely diagnosis?

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

The answer and the reasoning

C. Libman-Sacks endocarditis of systemic lupus erythematosus

Libman-Sacks endocarditis produces small, flat, sterile, warty vegetations on either surface of the valve, including the undersurface, and sometimes on the chordae and endocardium. It is associated with SLE and antiphospholipid antibodies. The valve is rarely badly deformed, although fibrosis can eventually cause regurgitation.

Option by option

  • A. Non-bacterial thrombotic endocarditis of malignancy

    Marantic (non-bacterial thrombotic) vegetations are small, bland and friable and lie along the closure lines, typically in patients with mucinous cancers.

  • B. Acute rheumatic valvulitis

    Rheumatic valvulitis causes small vegetations along the closure lines only, with Aschoff bodies, after a streptococcal infection.

  • C. Libman-Sacks endocarditis of systemic lupus erythematosus (correct)

    Correct. Sterile vegetations on both valve surfaces in lupus define Libman-Sacks endocarditis.

  • D. Subacute bacterial endocarditis

    Infective endocarditis has fever and bulky destructive vegetations along closure lines with positive blood cultures.

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.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Libman-Sacks endocarditis of systemic lupus erythematosus. Libman-Sacks endocarditis produces small, flat, sterile, warty vegetations on either surface of the valve, including the undersurface, and sometimes on the chordae and endocardium.

Why is "Non-bacterial thrombotic endocarditis of malignancy" not the answer?

Marantic (non-bacterial thrombotic) vegetations are small, bland and friable and lie along the closure lines, typically in patients with mucinous cancers.

Why is "Acute rheumatic valvulitis" not the answer?

Rheumatic valvulitis causes small vegetations along the closure lines only, with Aschoff bodies, after a streptococcal infection.

Why is "Subacute bacterial endocarditis" not the answer?

Infective endocarditis has fever and bulky destructive vegetations along closure lines with positive blood cultures.

What concept does this question test?

It tests Cardiovascular: Libman-Sacks endocarditis in Pathology. It is associated with SLE and antiphospholipid antibodies. The valve is rarely badly deformed, although fibrosis can eventually cause regurgitation.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: Libman-Sacks 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.