Cardiovascular: cardiac amyloidosis: 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: cardiac amyloidosis

Sample item

A 68-year-old man has exertional dyspnoea, ankle oedema and a raised jugular venous pressure with a prominent y descent. His ECG shows low voltage, but echocardiography shows thick ventricular walls with a speckled texture and no pericardial effusion. Fat pad biopsy is Congo red positive. Why is the ECG voltage low despite thick walls?

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

The answer and the reasoning

D. Extracellular amyloid is electrically inert and infiltrates the myocardium rather than adding conducting muscle mass

Cardiac amyloidosis causes restrictive cardiomyopathy: amyloid deposits stiffen the ventricles, causing diastolic failure and a restrictive filling pattern. The amyloid replaces myocytes without adding electrical mass, so voltage is low despite wall thickening, unlike hypertrophy, where voltage is high. The mismatch is a useful diagnostic clue.

Option by option

  • A. A large pericardial effusion is dampening the surface voltage

    Echocardiography shows no pericardial effusion, and an effusion would not explain the thickened, speckled walls.

  • B. Myocyte hypertrophy from pressure overload has reduced the conducting mass

    True myocyte hypertrophy raises ECG voltage and is the pattern in hypertension or aortic stenosis.

  • C. Myofibre disarray has shorted the conduction pathways

    Myofibre disarray is hypertrophic cardiomyopathy, which also gives high voltages.

  • D. Extracellular amyloid is electrically inert and infiltrates the myocardium rather than adding conducting muscle mass (correct)

    Correct. Infiltration with inert amyloid thickens the wall without adding conducting tissue.

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 D, Extracellular amyloid is electrically inert and infiltrates the myocardium rather than adding conducting muscle mass. Cardiac amyloidosis causes restrictive cardiomyopathy: amyloid deposits stiffen the ventricles, causing diastolic failure and a restrictive filling pattern.

Why is "A large pericardial effusion is dampening the surface voltage" not the answer?

Echocardiography shows no pericardial effusion, and an effusion would not explain the thickened, speckled walls.

Why is "Myocyte hypertrophy from pressure overload has reduced the conducting…" not the answer?

True myocyte hypertrophy raises ECG voltage and is the pattern in hypertension or aortic stenosis.

Why is "Myofibre disarray has shorted the conduction pathways" not the answer?

Myofibre disarray is hypertrophic cardiomyopathy, which also gives high voltages.

What concept does this question test?

It tests Cardiovascular: cardiac amyloidosis in Pathology. The amyloid replaces myocytes without adding electrical mass, so voltage is low despite wall thickening, unlike hypertrophy, where voltage is high. The mismatch is a useful diagnostic clue.

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: cardiac amyloidosis?

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.