Pathology Exam - Know More About Inflammation
(238).jpg "Pathology Exam - Know More About Inflammation - Quiz")
Pathology is the study of the causes and effects of disease or injury. The word pathology also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices.
The signs of inflammation include loss of function, heat, pain, redness, and swelling. Inflammation is part of the body's complex biological response to harmful stimuli, such as irritants, pathogens, and damaged cells.
Questions and Answers
- 1.
Which of the following is responsible for the necrosis seen in this microphotograph?
- A.
Macrophages
- B.
Plasma cells
- C.
Basophils
- D.
Neutrophils
- E.
Lymphocytes
Correct Answer
D. NeutropHilsExplanation
Neutrophils release degradative enzymes that completely digest tissue and cause liquefactive necrosis as seen in the center of this abscess.Rate this question:
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- 2.
In myocardial infarction, the necrosis of cardiac myocytes is usually followed immediately by:
- A.
Atrophy
- B.
Inflammation
- C.
Regeneration
- D.
Repair
- E.
Resolution
Correct Answer
B. InflammationExplanation
Necrotic or dead myocardiocytes attract PMNs (acute inflammatory cells). Hence inflammation is immediately followed by inflamation.
Atrophy of heart muscle cells is seen only in the very elderly and associated with lipofuscin (brown atrophy).
Cardiac muscle cells are permanent non-dividing cells that are NOT capable of regeneration. Hence resolution is NOT possible.
Repair of irreversibly injured myocardiocyte occurs via scarring and follows chronic inflammation.Rate this question:
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- 3.
Research shows that within the first 24 hours of a myocardial infarction, neutrophils migrate towards the infarct. Which of the following is responsible for this migration?
- A.
Diapedesis
- B.
Exudation
- C.
Emigration
- D.
Anaphylaxis
- E.
Chemotaxis
Correct Answer
E. ChemotaxisExplanation
Chemotaxis or movement of PMNs towards the necrotic myocardial cells.
Diapedesis or emigration is the movement of WBCs from the vascular space to the interstitium.
Exudation involves the escape of proteins from the microvascular space.
Anaphylaxis is an allergic type I hypersensitivity reaction that does not play a role in MI. Eosinophils are associated with type I hypersensitivity reactions.Rate this question:
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- 4.
Enzymes responsible for inflammation seen in this image are derived chiefly from:
- A.
Tissue
- B.
Serum
- C.
Neutrophils
- D.
Lymphocytes
- E.
Plasma cells
Correct Answer
C. NeutropHilsExplanation
Enzymes derived from neutrophils are responsible for the liquefactive necrosis seen in the center of this abscess.
The other answer choices listed do not play a role in abscess or suppurative inflammation. Lymphocytes and macrophages are seen in granulomatous inflammation.Rate this question:
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- 5.
The suppurative response of inflammation is the result of:
- A.
Activation of eosinophils
- B.
Degranulation of mast cells
- C.
Extrusion of enzymes from macrophages
- D.
Release of bacterial toxins
- E.
Release of hydrolases from neutrophils
Correct Answer
E. Release of hydrolases from neutropHilsExplanation
The release of hydrolases from PMNs is responsible for the suppurative response of inflammation.
Activation of eosinophils occurs in type I hypersensitivity reactions or in parasitic infections.
Degranulation of mast cells results in the release of several mediators, but most importantly histamine which caused increase vascular permeability.
Release of bacterial toxins will cause liquefactive necrosis.Rate this question:
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- 6.
Leukocytic emigration during an inflammatory response occurs primarily from:
- A.
Arteries
- B.
Arterioles
- C.
Capillaries
- D.
Venules
- E.
Veins
Correct Answer
D. VenulesExplanation
Venules, followed by capillaries and rarely arterioles are the most likely sites where WBC emigration or diapedesis occurs.Rate this question:
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- 7.
A patient dies after being stung by a bee. Autopsy reveals severe laryngeal edema. Which of the following is most likely responsible for this finding?
- A.
Venous congestion
- B.
Lymphatic obstruction
- C.
Increased arterial flow
- D.
Increased arterial pressure
- E.
Increased vascular permeability
Correct Answer
E. Increased vascular permeabilityExplanation
Edema is caused by increased vascular permeability.
Venous congestion, lymphatic obstruction, increased arterial flow and pressure can cause edema but do not occur in this case.Rate this question:
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- 8.
Which one of the following is the most important in chemotaxis?
- A.
Histamine
- B.
Complement
- C.
Kinins
- D.
Serotonin
- E.
Hageman factor
Correct Answer
B. ComplementExplanation
Complement (C5a) is an important chemotactic agent, particularly for PMNs.
Hageman factor (XII), kinins, serotonin and histamine are all chemical mediators of inflammation but do not cause chemotaxis.
Histamine causes arteriolar dilation and results in venular endothelial contraction & interendothelial gaps and ultimately increased vascular permeability
Hageman factor (XII) activation initiates 4 systems involved in plasma derived mediators that regulate many of the effects inflammation. These 4 systems inlcude:
1) Kinin system (activation leads to formation of Bradykinin which causes pain & increased vascular permeability
2) Clotting system (activation results in thrombin which is responsible for the conversion of soluble circulating fibrinogen
to become an insoluble fibrin clot (cement between the PLTs (bricks or blocks)
3) Fibrinolytic system (activation results in formation of plasmin which cleaves fibrin to solubilize the clot (secondary
hemostatic clot)
4) Complement system (activation leads to opsonization (C3b), chemotaxis of WBCs, and cell lysis (C5-9)
Serotonin (5-hydroxytryptamine) is a preformed vasoactive mediator with similar effects to histamine. It is found primarily within platelet dense body granules and released during platelet aggregation.
Hageman factor is a protein synthesized by liver which circulates in an inactive form and activates when it encounters collagen, basement membrane, or activated platelets (at site of endothelial injury)Rate this question:
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- 9.
The presence of neutrophils in the tonsils in an acute bacterial pharyngitis is most likely a result of:
- A.
C1
- B.
C3a
- C.
C4
- D.
C5a
- E.
C5b67
Correct Answer
D. C5aExplanation
C5a is responsible of chemotaxis of PMNs.
C3a & C5a are anaphylatoxins and are major mediators of increased vascular permeability and edema seen in inflammation and anaphylaxis. Please see slide 51 (Fig 2-13) for further details.Rate this question:
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- 10.
Which of the following plasma components is central to the activation of the complement, coagulation, and kinin systems?
- A.
Plasmin
- B.
Hageman factor (XIIa)
- C.
C1 esterase
- D.
Thrombin
- E.
Kininogen
Correct Answer
B. Hageman factor (XIIa)Explanation
Hagman factor activation initiates the complement, coagulation, kinin, and fibrinolytic system.
Plasmin is produced and degrades thrombin and the fibrin in an insoluble clot.
Thrombin cleaves fibrinogen and produces fibrin which causes an insoluble clot to form. Thrombin also enhances WBC adhesion to endothelium by generating fibrinopeptides (during fibrinogen cleavage). Thrombin causes increased vascular permeability and chemotaxis of WBCs.
High molecular weight kininogen cofactor is important in the activation of Hageman factor (XII). When the kinin system is activated the formation of bradykinin occurs. Bradykinin is responsible for pain and increased vascular permeability which causes edema.Rate this question:
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- 11.
The chronic inflammation of a delayed hypersensitivity reaction is mediated by
- A.
Lymphokines
- B.
Histamine
- C.
Bradykinin
- D.
Complement
Correct Answer
A. LympHokinesExplanation
Lymphokines are released from lymphocytes and are important for the activation of macrophages in delayed hypersensitivity type IV reactions, particularly granulomatous inflammation.
Histamine causes arteriolar dilation and results in venular endothelial contraction & interendothelial gaps and ultimately increased vascular permeability
Bradykinin is responsible for pain and increased vascular permeability which causes edema.Rate this question:
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- 12.
A mediator of acute inflammation that causes increased vascular permeability and pain is:
- A.
Bradykinin
- B.
Complement
- C.
Endotoxin
- D.
Histamine
- E.
Tumor necrosis factor
Correct Answer
A. BradykininExplanation
Bradykinin is responsible for pain and increased vascular permeability which causes edema.
Complement system (activation leads to opsonization (C3b), chemotaxis of WBCs, and cell lysis (C5-9).
Endotoxin from bacteria is responsible for vasodilation, particularly in gram negative sepsis and shock.
Histamine causes arteriolar dilation and results in venular endothelial contraction & interendothelial gaps and ultimately increased vascular permeability
Tumor Necrosis Factor (TNF) is an important mediator of acute phase reactions and play a role in the production of Il-1 and fever. TNF is secreted by activated macrophages and other cells.Rate this question:
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- 13.
A 27-year-old woman develops an acute bacterial pyelonephritis accompanied by fever, myalgia, and malaise. The fever is the result of chemical mediators released primarily from which of the following inflammatory cells?
- A.
Basophil
- B.
Eosinophil
- C.
Lymphocyte
- D.
Macrophage
- E.
Neutrophils
Correct Answer
D. MacropHageExplanation
Macrophages release TNF& IL-1 which both act on the thermoregulatory centers of the hypothalamus via prostaglandin E (PGE) to induce fever.
Basophils release mediators of inflammation, mainly histamine
Lymphocytes release lymphokines that activate macrophages
Eosinophils release major basic protein to kill parasites
Neutrophils release degradative enzymes to kill bacteriaRate this question:
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- 14.
A complete blood count (CBC) has a comment indicating that there has been a "left shift" in the neutrophil series. Which of the following is most likely seen on peripheral blood smear?
- A.
Immature lymphocytes
- B.
Immatute band forms of PMNs
- C.
Increase in mature PMNs
- D.
A decrease in PLTs
- E.
An anemia
Correct Answer
B. Immatute band forms of PMNsExplanation
A shift to the left means that immature band forms are seen in the peripheral blood.
Thrombocytopenia is a decrease in PLT numbers.
Anemia is a decrease in hemoglobin and hematocrit.
Increase in mature PMNs is a neutrophilic leukocytosis.
Immature lymphocytes or lymphoblasts may be seen in cases of severe chronic inflammation in which there is a lymphocytic hyperplasia in the bone marrow and an increase loss of lymphocytes from the blood supply.Rate this question:
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- 15.
The cell seen in this microphotograph most likely originated from multinucleated giant cells of the foreign body type originate from
- A.
Nuclear division of granulocytes
- B.
Atypical regeneration of epithelium
- C.
Megakaryocytes
- D.
Fusion or nuclear division of macrophage
- E.
Multiplication of nuclei in surrounding fibrocytes
Correct Answer
D. Fusion or nuclear division of macropHageExplanation
The multinucleated giant cells seen in this granuloma are a result of fusion or nuclear division of macrophages (IL-4 & Inteferon gamma).Rate this question:
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- 16.
Which of the following cells is most abundant in an abscess?
- A.
Eosinophil
- B.
Lymphocyte
- C.
Macrophage
- D.
Neutrophil
- E.
Plasma cell
Correct Answer
D. NeutropHilExplanation
An abscess or a collection of pus primarily consists of neutrophils.
Eosinophils are usually increased in parasitic or allergic reactions.
Lymphocytes are usually increased in viral infections unless the infection is so severe that there is a net loss of lymphocytes from the circulating pool.
Macrophages are found in granulomas.
Plasma cells are mature and differentiated B lymphoctyes that secrete immunoglobulins or antbodies.Rate this question:
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- 17.
The most important cell in the destruction of pyogenic cocci is the
- A.
Neutrophil
- B.
Lymphocyte
- C.
Basophil
- D.
Eosinophil
- E.
Monocyte
Correct Answer
A. NeutropHilExplanation
Neutrophils are responsible for killing pyogenic cocci.
Lymphocytes respond to virus (karate kid)
Eosinophils respond to parasitic infections and allergic reactions.
Basophils release mediators that help orchestrate inflammation.
Monocytes are macrophages in the blood which are responsible for phagocytosis.Rate this question:
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- 18.
Which of the following cells can liberate histamine?
- A.
Plasma cells
- B.
Eosinophils
- C.
Vascular endothelial cells
- D.
Tissue mast cells
Correct Answer
D. Tissue mast cellsExplanation
Mast cells can liberate histamine. See Slide 43 (Fig 2-11)Rate this question:
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- 19.
After a mini-exam, you and a couple of friends spend the weekend on the beach in St. Martin. At the end of the day, one of your friends complains of sunburn. His back is very red, warm and painful to touch. What is the most likely cause of this erythema?
- A.
Ischemia
- B.
Edema of the dermis
- C.
Vasodilation of blood vessels in dermis
- D.
Infiltration of neutrophils
- E.
Bradykinin
Correct Answer
C. Vasodilation of blood vessels in dermisExplanation
The most likely cause of the erythema (redness) on your friend's back is vasodilation of blood vessels in the dermis. Vasodilation refers to the widening of blood vessels, which allows more blood to flow through them. In this case, the blood vessels in the dermis have widened, leading to increased blood flow and causing the redness. This can happen as a result of sun exposure, as the body tries to cool down the skin and regulate body temperature.Rate this question:
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- 20.
Approximately 30-60 minutes after being bitten by a "bug", a 26-year-old man noticed a localized swelling and erythema in the affected area. The edema is most likely the result of:
- A.
Altered plasma oncotic pressure
- B.
Increased arterial hydrostatic pressure
- C.
Increased vascular permeability
- D.
Lymphatic obstruction
- E.
Venous obstruction
Correct Answer
C. Increased vascular permeabilityExplanation
The localized swelling and erythema observed after being bitten by a "bug" suggest an inflammatory response. Increased vascular permeability is a characteristic of inflammation, where the blood vessels become more permeable, allowing fluids and immune cells to move from the bloodstream into the affected tissue. This increased permeability leads to the accumulation of fluid in the tissue, causing edema. Therefore, increased vascular permeability is the most likely cause of the observed edema in this case.Rate this question:
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- 21.
A pathology report notes that a granuloma was seen in the lung of your patient. The patient asks for a copy and explanation of this report. What should you say to best explain?
- A.
A small area of pre-scar tissue containing new capillaries and fibroblasts
- B.
A small area containing pus made up of apoptotic PMNs with liquefactive necrosis
- C.
An accumulation of granulocytes including neutrophils, eosinophils, and basophils
- D.
An accumulation of WBCs that fight persistent bacterial infections
Correct Answer
D. An accumulation of WBCs that fight persistent bacterial infectionsExplanation
The presence of a granuloma in the lung indicates an accumulation of white blood cells (WBCs) that are actively fighting persistent bacterial infections. This is the best explanation to provide to the patient regarding the pathology report.Rate this question:
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- 22.
A patient is scheduled to have a chronic abscess incised and drained. What would you expect microscopic examination of the contents of the abscess to most likely show?
- A.
Lymphocytes and macrophages
- B.
An area of caseous necrosis
- C.
Any area of coagulative necrosis
- D.
Neutrophils, lymphocytes,& plasma cells
- E.
An acute inflammatory infiltrate of PMNs
Correct Answer
E. An acute inflammatory infiltrate of PMNsExplanation
Microscopic examination of the contents of a chronic abscess would most likely show an acute inflammatory infiltrate of polymorphonuclear leukocytes (PMNs). This is because PMNs, also known as neutrophils, are the first immune cells to arrive at the site of infection or inflammation. They play a crucial role in the body's defense mechanism by engulfing and destroying bacteria and other foreign substances. In the case of a chronic abscess, the presence of PMNs indicates an ongoing inflammatory response to the persistent infection.Rate this question:
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- 23.
An 8-year-old boy cuts his hand on a piece of glass. Two days later there is an open sore surrounded by swelling. His forearm is tender with red streaks extending towards the axilla. What is the most likely diagnosis?
- A.
Inflammatory lymphadenopathy
- B.
Reactive lymphadenopathy
- C.
Lymphangitis
- D.
Abscess
- E.
Lymphadenitis
Correct Answer
C. LympHangitisExplanation
Lymphangitis-- is an inflammation of the lymphatic channels that occurs as a result of infection at a site distal to the channel. The most common cause of lymphangitis in humans is Streptococcus pyogenes (Group A strep). Lymphangitis is also sometimes called "blood poisoning".
Signs and symptoms include a deep reddening of the skin, warmth, lymphadenitis, and a raised border around the affected area. The person may also have chills and a high fever along with moderate pain and swelling. A person with lymphangitis should be hospitalized and closely monitored by medical professionals.
Thin red lines may be observed running along the course of the lymphatic vessels in the affected area, accompanied by painful enlargement of the nearby lymph nodesRate this question:
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- 24.
Which of the following would you expect to find in the alveoli in a patient with pneumococcal pneumonia of 24 hours duration?
- A.
Serous inflammation
- B.
Fibrinous inflammation
- C.
Fibrino-purulent inflammation
- D.
Suppurative inflammation
Correct Answer
D. Suppurative inflammationExplanation
suppurative refers to "pus" which is caused by Neutrophils.
Neutrophils are the first responders in infection.Rate this question:
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- 25.
You order an erythrocyte sedimentation rate (ESR) in a chronically ill patient. The ESR is significantly elevated and is most likely associated with:
- A.
Increased numbers of leukocytes
- B.
Hageman factor activation
- C.
Increased serum acute phase reactants
- D.
The action of complement
- E.
Accumulation of blood-borne pyrogens
Correct Answer
C. Increased serum acute pHase reactantsExplanation
The ESR is governed by the balance between pro-sedimentation factors, mainly fibrinogen, and those factors resisting sedimentation, namely the negative charge of the erythrocytes (zeta potential). When an inflammatory process is present, the high proportion of fibrinogen in the blood causes red blood cells to stick to each other. The red cells form stacks called 'rouleaux,' which settle faster. Rouleaux formation can also occur in association with some lymphoproliferative disorders in which one or more immunoglobulin are secreted in high amounts
The ESR is increased by any cause or focus of inflammation. The ESR is increased in pregnancy or rheumatoid arthritis, and decreased in polycythemia, sickle cell anemia, hereditary spherocytosis, and congestive heart failure. The basal ESR is slightly higher in femalesRate this question:
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- 26.
A 72-y/o man develops gram-negative bacterial peritonitis resulting from colonic diverticulitis. The ensuing fever, macrophage activation, and B-cell mitogenicity are mediated by induction of host cytokines including tumor necrosis factor (TNF) and IL-1. What bacterial product activates these events?
- A.
Adenosine diphosphate
- B.
Polypeptide
- C.
RNA
- D.
Lipopolysaccharide
- E.
Cytochrome oxidase
Correct Answer
D. LipopolysaccharideExplanation
Lipopolysaccharide (LPS) is a component of the outer membrane of gram-negative bacteria. It is a potent activator of the immune system and can induce the production of pro-inflammatory cytokines such as tumor necrosis factor (TNF) and interleukin-1 (IL-1). In this case, the 72-year-old man developed gram-negative bacterial peritonitis, and the fever, macrophage activation, and B-cell mitogenicity are all mediated by the induction of host cytokines, including TNF and IL-1, which are activated by the presence of LPS.Rate this question:
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- 27.
A patient is being treated for tuberculosis. Caseating pulmonary granulomas were seen on microscopic examination of a lung biopsy. What is the usual outcome of a pulmonary granuloma after treatment?
- A.
Complete resolution
- B.
Metastasis of the lesion
- C.
Replacement by macrophages
- D.
Scarring and calcification
- E.
Progression to chronic inflammation
Correct Answer
D. Scarring and calcificationExplanation
After treatment for tuberculosis, the usual outcome of a pulmonary granuloma is scarring and calcification. This occurs as a result of the body's immune response to the infection, leading to the formation of fibrous tissue and deposition of calcium in the affected area. Scarring and calcification help to contain the infection and prevent its spread, but they can also cause long-term damage to the lungs.Rate this question:
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- 28.
A well-demarcated area of myocardium appears paler than surrounding tissue and microscopically consists of eosinophilic muscle fibers with only a few karyorrheetic and pyknotic nuclei remaining. Many polys are seen, especially at the margin of this area. What is the most likely age of this myocardial infarct?
- A.
2 minutes
- B.
2 hours
- C.
2 days
- D.
2 weeks
- E.
2 months
Correct Answer
C. 2 daysExplanation
The presence of eosinophilic muscle fibers with only a few karyorrhectic and pyknotic nuclei remaining suggests that the myocardial infarct is in the subacute phase. This phase typically occurs around 2 days after the initial injury, as indicated by the presence of many polys at the margin of the area. Therefore, the most likely age of this myocardial infarct is 2 days.Rate this question:
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- 29.
A 45-year-old woman has a lung biopsy because of a 1.0 cm lesion seen on a chest x-ray. Histologic examination reveals epithelioid macrophages and lymphocytes around a focus of caseous necrosis. What is the best explanation for this form of necrosis?
- A.
Cell-mediated hypersensitivity
- B.
Complement fixation
- C.
Local histamine release
- D.
PMNs releasing degradative enzymes
- E.
Suppurative inflammation
Correct Answer
A. Cell-mediated hypersensitivityExplanation
Caseous necrosis is a form of cell death in which the tissue maintains a cheese-like appearance. The dead tissue appears as a soft and white proteinaceous dead cell mass.
Frequently, caseous necrosis is encountered in the foci of tuberculous infections. It can also be caused by syphilis and certain fungi.
A similar appearance can be associated with histoplasmosis, cryptococcosis, and coccidioidomycosisRate this question:
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- 30.
The chronic inflammation of a delayed hypersensitivity reaction is mediated by
- A.
Lymphokines
- B.
Histamine
- C.
Bradykinin
- D.
Complement
Correct Answer
A. LympHokinesExplanation
Lymphokines are molecules released by immune cells, specifically lymphocytes, in response to an immune reaction. In the case of chronic inflammation in a delayed hypersensitivity reaction, lymphokines play a crucial role in mediating the inflammatory response. They attract immune cells to the site of inflammation, promote the activation and migration of immune cells, and regulate the immune response. This leads to the sustained inflammation observed in delayed hypersensitivity reactions. Histamine, bradykinin, and complement are also involved in inflammation but are not specifically responsible for the chronic inflammation seen in delayed hypersensitivity reactions.Rate this question:
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- 31.
Which of the following events in acute inflammation occurs first?
- A.
Chemotaxis
- B.
Emigration
- C.
Hemostasis
- D.
Margination
- E.
Phagocytosis
Correct Answer
C. HemostasisExplanation
Vasodilation and its resulting increased blood flow causes the redness (RUBOR)
and increased heat (CALOR).
Increased permeability of the blood vessels results in an EXUDATION (leakage) of plasma proteins and fluid into the tissue (EDEMA),
which manifests itself as swelling (TUMOR).
Some of the released mediators such as bradykinin increase the sensitivity to pain (DOLOR).
The mediator molecules also alter the blood vessels to permit the migration of leukocytes, mainly neutrophils, outside of the blood vessels (EXTRAVASATION)
into the tissue. The neutrophils migrate along a chemotactic gradient created by the local cells to reach the site of injury. The loss of function (FUNCTIO LAESA)
is probably the result of a neurological reflex in response to pain.Rate this question:
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- 32.
The suppurative response of inflammation is the result of:
- A.
Activation of easinophils
- B.
Degranulation of mast cells
- C.
Extrusion of enzymes from macrophages
- D.
Release of bacterial toxins
- E.
Release of hydrolases from neutrophils
Correct Answer
E. Release of hydrolases from neutropHilsExplanation
The suppurative response of inflammation is the result of the release of hydrolases from neutrophils. Hydrolases are enzymes that break down proteins, and their release from neutrophils helps to break down dead tissue and bacteria at the site of inflammation. This process leads to the formation of pus, which is characteristic of the suppurative response.Rate this question:
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.JPG "Which of the following is responsible for the necrosis seen in this microphotograph?")
.JPG "Enzymes responsible for inflammation seen in this image are derived chiefly from:")
.JPG "The cell seen in this microphotograph most likely originated from multinucleated giant cells of the foreign body type originate from")
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