Anatomy, Physiology, Pathology 2018-2020

Question 1

1. Which of the following is inappropriately paired with the effect on airway smooth muscle
   by inflammatory cell mediators?
   A. Contraction: histamine, cys-LT, kinin, prostanoid, endothelin
   B. Proliferation: PDGF, EGF, endothelin-1
   C. Secretion: cytokines, chemokines, prostanoids
   D. Neurogenic inflammation: neurotrophin, SP, CGRP

Answer 1

1. D, Neurogenic inflammation: neurotrophin, SP, CGRP, p. 333-4.
   Sensory nerves release S P and CGRP to act on inflammatory cells. Inflammatory cells release neurotrophins to act on sensory nerves.

Chapter 21: Pathophysiology of Allergic Inflammation
Middleton’s Allergy Principles and Practice, 8th ed.

Question 2

1. When does the embryonic stage of lung development begin and end?
   A. Begins at the 3rd or 4th week and ends at the 7Th week of gestation
   B. Begins at the 15th week and ends at the 17th week of gestation
   C. Begins at the 16th week and ends at the 26th week of gestation
   D. Begins at the 24th week and ends at the 38th week of gestation

Answer 2

Chapter 44(1) Answers:
1. A, Begins at the 3rd or 4th week and ends at the 7th week of gestation, p. 700.

During the embryonic stage, the lung sacs develop from the ventral wall of the esophagus.
This is the reason behind the common features of the lung and the gastrointestinal tract. The pseudoglandular stage occurs from the 15th to the 17th week of gestation. The canalicular stage occurs from the 16th week to the 26th week of gestation. The saccular period occurs from the 24thweek to the 38th week of gestation.

Chapter 44(1): Development, Structure, and Physiology in Normal Lung and Asthma Middleton’s Allergy Principles and Practice, 8th ed

Question 3

1. Which important cytokine is involved in the proliferation and function of natural killer
cells and T-regulatory lymphocytes?
A. Interleukin 2
B. Interleukin 4
C. Interleukin 10
D. Interleukin 12

Answer 3

Chapter 93 Answers:
1. A, Interleukin 2, p. 1492.
IL-2 is a potent activator of the proliferation and function of T lymphocytes and natural killer cells. IL-2 functions as a T cell growth factor, can augment natural killer (NK) cell cytolytic activity, contributes to the development of regulatory T (Treg) cells and promotes immunoglobulin production by B cells, as well as regulating the expansion and apoptosis of activated T cells.
Chapter 93: Cytokine-Specific Therapy in Asthma
Middleton’s Allergy Principles and Practice, 8th Edition

Question 4

2. Which cytokines are considered the “Th2 defining” cytokines and regarded as being
   the most important cytokines in Th2 high-asthma pathogenesis?
   A. IL-2 and IL-13
   B. IL-4 and IL-2
   C. IL-4 and IL-6
   D. IL-4 and IL-13

Answer 4

Chapter 93 Answers:
2. D, IL-4 and IL-13, p. 1495.
IL-4 and IL-13 are the “Th2 defining” cytokines and arguably are the most important cytokines in asthma pathogenesis in Th2 asthma. Owing to structural homogeneity, their actions are broadly similar, and they are therefore considered together

Question 5

3. Which cytokine modulates eosinophilic production, maturation, activation, and survival in
blood?
A. IL-4
B. IL-5
C. IL-9
D. IL-13

Answer 5

3. B, IL-5, p. 1496.
   IL-5 modulates eosinophil progenitor production, maturation, activation, and survival in blood and can induce airway eosinophilia.

Question 6

4. Which cytokine uniquely promotes airway mastocytosis and mast cell progenitor
   development andlocalization to the airway?
   A. IL-1
   B. IL-2
   C. IL-9
   D. IL-13

Answer 6

4. C, IL-9, p. 1498.
   IL-9 is derived from CD4+ (Th9) cells, eosinophils, and mast cells. It causes T cell proliferation,
   increases IgE production by B cells, and increases expression of the α-subunit of IgE
   receptors. It uniquely promotes airway mastocytosis and mast cell progenitor development
   and localization to the airway.

Question 7

5. Which pleiotropic cytokine is considered the principle Th1 effector cytokine and plays an
important role in Th1 differentiation?
A. IFN-γ
B. IL-2
C. IL-12
D. TNF-α

Answer 7

5. A, IFN-γ. p. 1500.
   IFN-γ is a pleiotropic cytokine that induces and modulates an array of immune responses.
   Most importantly, it is the principal Th1 effector cytokine with a crucial role in Th1
   differentiation. IFN-γ mainly inhibits eosinophils, a crucial cell type in the allergic Th2 model
   of asthma, as evidenced when targeted disruption of the IFNγR receptor gene resulted in a
   prolonged airway eosinophilia in response to allergen.

Question 8

6. Which family of cytokines are linked to autoimmune diseases (rheumatoid arthritis, inflammatory bowel diseases, multiple sclerosis), in addition to increased expression in Th2 low-asthmatic patients?
A. IFN-γ
B. IL-16 family cytokines
C. IL-17 family cytokines
D. TNF-α

Answer 8

6. C, IL-17 family cytokines, p. 1500.
   The IL-17 family cytokines, IL-17A to IL-17F, are linked with several autoimmune diseases
   such as rheumatoid arthritis, inflammatory bowel disease, and multiple sclerosis. IL-17E and
   IL-17F are of interest in asthma because their expression is increased in the airways of
   asthmatic patients; levels have been correlated with disease severity.

Question 9

7. Which anti-IL5 allows for successful oral corticosteroid withdrawal in prednisonedependent patients with asthma?
A. Dupilumab
B. Mepolizumab
C. Omalizumab
D. Tralokinumab

Answer 9

7. B, Mepolizumab, p. 1497-1498.
   Mepolizumab therapy allowed for successful oral corticosteroid withdrawal in prednisonedependent patients with asthma compared with placebo. The median time to exacerbation
   was 20 weeks in the mepolizumab group and 12 weeks in the placebo group (P = .003).