Chapter 2: Inflammation

Question 1

A 22-year-old woman nursing her newborn develops a tender
erythematous area around the nipple of her left breast. A
thick, yellow fl uid is observed to drain from an open fi ssure.
Examination of this breast fl uid under the light microscope
will most likely reveal an abundance of which of the following
infl ammatory cells?

Answer 1

1.Neutrophils.

Question 2

Which of the following mediators of infl ammation facilitates
chemotaxis, cytolysis, and opsonization at the site of infl ammation
in the patient described in Question 1?

Answer 2

2. Complement proteins.

Question 3

A 63-year-old man becomes febrile and begins expectorating
large amounts of mucopurulent sputum. Sputum cultures are
positive for Gram-positive diplococci. Which of the following
mediators of infl ammation provides potent chemotactic factors
for the directed migration of infl ammatory cells into the
alveolar air spaces of this patient?

Answer 3

3. N-formylated peptides.

Question 4

A 59-year-old man suffers a massive heart attack and expires
24 hours later due to ventricular arrhythmia. Histologic examination
of the affected heart muscle at autopsy would show an
abundance of which of the following infl ammatory cells?

Answer 4

4. Neutrophils.

Question 5

A 5-year-old boy punctures his thumb with a rusty nail. Four
hours later, the thumb appears red and swollen. Initial swelling
of the boy’s thumb is primarily due to which of the following
mechanisms?

Answer 5

5. Increased capillary permeability.

Question 6

Which serum protein activates the complement,

coagulation, and fi brinolytic systems?

Answer 6

6. Hageman factor.

Question 7

An 80-year-old woman presents with a 4-hour history of fever,
shaking chills, and disorientation. Her blood pressure is 80/40
mm Hg. Physical examination shows diffuse purpura on her
upper arms and chest. Blood cultures are positive for Gramnegative
organisms. Which of the following cytokines is primarily
involved in the pathogenesis of direct vascular injury in
this patient with septic shock?

Answer 7

7. Tumor necrosis factor-a (TNF-a).

Question 8

A 24-year-old intravenous drug abuser develops a 2-day history
of severe headache and fever. His temperature is 38.7°C
(103°F). Blood cultures are positive for The patient is given intravenous antibiotics, but he deteriorates
rapidly and dies. A cross section of the brain at autopsy (shown
in the image) reveals two encapsulated cavities. Which of the
following terms best characterizes this pathologic fi nding?Gram-positive cocci.

Answer 8

8. Suppurative infl ammation.

Question 9

A 36-year-old woman with pneumococcal pneumonia develops
a right pleural effusion. The pleural fl uid displays a high specifi c
gravity and contains large numbers of polymorphonuclear
(PMN) leukocytes. Which of the following best characterizes
this pleural effusion?

Answer 9

9. Purulent exudate.

Question 10

A 33-year-old man presents with a 5-week history of calf
pain and swelling and low-grade fever. Serum levels of creatine
kinase are elevated. A muscle biopsy reveals numerous
eosinophils. What is the most likely etiology of this patient’s
myalgia?

Answer 10

10. Parasitic infection.

Question 11

A 10-year-old boy with a history of recurrent bacterial infections
presents with fever and a productive cough. Biochemical
analysis of his neutrophils demonstrates that he has an
impaired ability to generate reactive oxygen species. This
patient most likely has inherited mutations in the gene that
encodes which of the following proteins?

Answer 11

11. NAPDH oxidase.

Question 12

A 25-year-old woman presents with a history of recurrent
shortness of breath and severe wheezing. Laboratory studies
demonstrate that she has a defi ciency of C1 inhibitor, an
esterase inhibitor that regulates the activation of the classical
complement pathway. What is the diagnosis?

Answer 12

12. Hereditary angioedema.

Question 13

A 40-year-old man complains of a 2-week history of increasing
abdominal pain and yellow discoloration of his sclera. Physical
examination reveals right upper quadrant pain. Laboratory
studies show elevated serum levels of alkaline phosphatase
(520 U/dL) and bilirubin (3.0 mg/dL). A liver biopsy shows
portal fi brosis, with scattered foreign bodies consistent with
schistosome eggs. Which of the following infl ammatory cells
is most likely to predominate in the portal tracts in the liver of
this patient?

Answer 13

13. Eosinophils.

Question 14

A 41-year-old woman complains of excessive menstrual
bleeding and pelvic pain of 4 months. She uses an intrauterine
device for contraception. Endometrial biopsy (shown in the
image) reveals an excess of plasma cells (arrows) and macrophages
within the stroma. The presence of these cells and
scattered lymphoid follicles within the endometrial stroma is
evidence of which of the following conditions?

Answer 14

14. Chronic infl ammation.

Question 15

A 62-year-old woman undergoing chemotherapy for breast
cancer presents with a 3-day history of fever and chest pain.
Cardiac catheterization reveals a markedly reduced ejection
fraction with normal coronary blood fl ow. A myocardial
biopsy is obtained, and a PCR test for coxsackievirus is
positive. Histologic examination of this patient’s myocardium
will most likely reveal an abundance of which of the following
infl ammatory cells?

Answer 15

15. Lymphocytes.

Question 16

A 58-year-old woman with long-standing diabetes and
hypertension develops end-stage renal disease and dies in
uremia. A shaggy fi brin-rich exudate is noted on the visceral
pericardium at autopsy (shown in the image). Which of the
following best explains the pathogenesis of this fi brinous
exudate?

Answer 16

16. Injury and increased vascular permeability.

Question 17

A 68-year-old man presents with fever, shaking chills, and
shortness of breath. Physical examination shows rales and
decreased breath sounds over both lung fi elds. The patient
exhibits grunting respirations, 30 to 35 breaths per minute,
with fl aring of the nares. The sputum is rusty yellow and
displays numerous polymorphonuclear leukocytes. Which of
the following mediators of infl ammation is chiefl y responsible
for the development of fever in this patient?

Answer 17

17. Interleukin-1.

Question 18

Sputum cultures obtained from the patient described in
Question 17 are positive for Streptococcus pneumoniae. Removal
of bacteria from the alveolar air spaces in this patient involves
opsonization by complement, an important step in mediating
which of the following leukocyte functions?

Answer 18

18. Phagocytosis.

Question 19

Which of the following mediators of infl ammation is primarily
responsible for secondary injury to alveolar basement
membranes and lung parenchyma in the patient described in
Questions 17 and 18?

Answer 19

19. Lysosomal enzymes.

Question 20

Which of the following proteins inhibits fi brinolysis, activation
of the complement system, and protease-mediated damage in
the lungs of the patient described in the previous questions?

Answer 20

20. a2-Macroglobulin

Question 21

A 35-year-old woman presents with a 5-day history of a
painful sore on her back. Physical examination reveals a 1-cm
abscess over her left shoulder. Biopsy of the lesion shows
vasodilation and leukocyte margination (shown in the image).
What glycoprotein mediates initial tethering of segmented
neutrophils to endothelial cells in this skin lesion?

Answer 21

21. Selectin.

Question 22

A 14-year-old boy receives a laceration on his forehead during
an ice hockey game. When he is fi rst attended to by the medic,
there is blanching of the skin around the wound. Which of the
following mechanisms accounts for this transient reaction to
neurogenic and chemical stimuli at the site of injury?

Answer 22

22. Constriction of precapillary arterioles.

Question 23

An 8-year-old girl with asthma presents with respiratory
distress. She has a history of allergies and upper respiratory
tract infections. She also has history of wheezes associated with
exercise. Which of the following mediators of infl ammation
is the most powerful stimulator of bronchoconstriction and
vasoconstriction in this patient?

Answer 23

23. Leukotrienes.

Question 24

Which of the following preformed substances is released
from mast cells and platelets, resulting in increased vascular
permeability in the lungs of the patient described in
Question 23?

Answer 24

24. Histamine.

Question 25

A 75-year-old woman complains of recent onset of chest pain,
fever, and productive cough with rust-colored sputum. A chest
X-ray reveals an infiltrate in the right middle lobe. Sputum
cultures are positive for Streptococcus pneumoniae. Phagocytic
cells in this patient’s affected lung tissue generate bacteriocidal
hypochlorous acid using which of the following enzymes?

Answer 25

25. Myeloperoxidase.

Question 26

A 28-year-old woman cuts her hand while dicing vegetables
in the kitchen. The wound is cleaned and sutured. Five days
later, the site of injury contains an abundance of chronic
infl ammatory cells that actively secrete interleukin-1, tumor
necrosis factor-α, interferon-α, numerous arachidonic acid
derivatives, and various enzymes. Name these cells.

Answer 26

26. Macrophages.

Question 27

A 68-year-old man with prostate cancer and bone metastases
presents with shaking chills and fever. The peripheral WBC
count is 1,000/μL (normal = 4,000 to 11,000/μL). Which of
the following terms best describes this hematologic fi nding?

Answer 27

27. Leukopenia.

Question 28

A 25-year-old machinist is injured by a metal sliver in his left
hand. Over the next few days, the wounded area becomes
reddened, tender, swollen, and feels warm to the touch.
Redness at the site of injury in this patient is caused primarily
by which of the following mechanisms?

Answer 28

28. Vasodilation.

Question 29

The patient described in Question 28 goes to the emergency
room to have the sliver removed. Which of the following
mediators of infl ammation plays the most important role in
stimulating platelet aggregation at the site of injury following
this minor surgical procedure?

Answer 29

29. Thromboxane A2

Question 30

Twenty-four hours later, endothelial cells at the site of injury
in the patient described in Questions 28 and 29 release a
chemical mediator that inhibits further platelet aggregation.
Name this mediator of infl ammation.

Answer 30

30. Prostaglandin (PGI2).

Question 31

A 37-year-old man with AIDS is admitted to the hospital
with a 3-week history of chest pain and shortness of breath.
An X-ray fi lm of the chest shows bilateral nodularities of the
lungs. A CT-guided lung biopsy is shown in the image. The
multinucleated cell in the center of this fi eld is most likely
derived from which of the following infl ammatory cells?

Answer 31

31. Macrophages

Question 32

A 45-year-old woman with autoimmune hemolytic anemia
presents with increasing fatigue. Which of the following
mediators of infl ammation is primarily responsible for
antibody-mediated hemolysis in this patient?

Answer 32

32. Complement proteins.

Question 33

A 59-year-old alcoholic man is brought to the emergency room
with a fever (38.7°C/103°F) and foul-smelling breath. A chest
X-ray reveals a pulmonary abscess in the right lower lobe.
The patient subsequently develops acute bronchopneumonia
and dies. Microscopic examination of the lungs at autopsy is
shown in the image. Activation of phospholipase A2 in these
intra-alveolar cells resulted in the formation of which of the
following mediators of infl ammation?

Answer 33

33. Arachidonic acid.

Question 34

A 10-year-old girl presents with a 2-week history of puffi ness
around her eyes and swelling of the legs and ankles. Laboratory
studies show hypoalbuminemia and proteinuria. The urinary
sediment contains no infl ammatory cells or red blood cells.
Which of the following terms describes this patient’s peripheral
edema?

Answer 34

34. Transudate.

Question 35

A 25-year-old woman develops a sore, red, hot, swollen left
knee. She has no history of trauma and no familial history
of joint disease. Fluid aspirated from the joint space shows
an abundance of segmented neutrophils. Transendothelial
migration of acute infl ammatory cells into this patient’s joint
space was mediated primarily by which of the following
families of proteins?

Answer 35

35. Integrins.

Question 36

Aspirin is effective in relieving symptoms of acute infl ammation
in the patient described in Question 35 because it inhibits
which of the following enzymes?

Answer 36

36. Cyclooxygenase.

Question 37

A 50-year-old woman is discovered to have metastatic breast
cancer. One week after receiving her fi rst dose of chemotherapy,
she develops bacterial pneumonia. Which of the following
best explains this patient’s susceptibility to bacterial
infection?

Answer 37

37. Neutropenia.

Question 38

A 53-year-old man develops weakness, malaise, cough with
bloody sputum, and night sweats. A chest X-ray reveals numerous
apical densities bilaterally. Exposure to Mycobacterium
tuberculosis was documented 20 years ago, and M. tuberculosis
is identifi ed in the sputum. The patient subsequently dies
of respiratory insuffi ciency. The lungs are examined at autopsy
(shown in the image). Which of the following best characterizes
the histopathologic features of this pulmonary lesion?

Answer 38

38. Granulomatous infl ammation.

Question 39

A 59-year-old man experiences acute chest pain and is rushed
to the emergency room. Laboratory studies and ECG demonstrate
an acute myocardial infarction; however, coronary artery
angiography performed 2 hours later does not show evidence
of thrombosis. Intravascular thrombolysis that occurred in
this patient was mediated by plasminogen activators that were
released by which of the following cells

Answer 39

39: Endothelial cells.

Question 40

Which of the following mediators of infl ammation causes
relaxation of vascular smooth muscle cells and vasodilation
of arterioles at the site of myocardial infarction in the patient
described in Question 39?

Answer 40

40. Nitric oxide.

Question 41

A 68-year-old coal miner with a history of smoking and
emphysema develops severe air-fl ow obstruction and expires.
Autopsy reveals a “black lung,” with coal-dust nodules
scattered throughout the parenchyma and a central area of
dense fi brosis. The coal dust entrapped within this miner’s lung
was sequestered primarily by which of the following cells?

Answer 41

41. Macrophages.

Question 42

A 40-year-old man presents with 5 days of productive cough
and fever. Pseudomonas aeruginosa is isolated from a pulmonary
abscess. The CBC shows an acute effect characterized by
marked leukocytosis (50,000 WBC/μL), and the differential
count reveals numerous immature cells (band forms). Which
of the following terms best describes these hematologic
fi ndings?

Answer 42

42. Leukemoid reaction.

Question 43

A 19-year-old woman presents with 5 days of fever
(38°C/101°F) and sore throat. She reports that she has felt
fatigued for the past week and has diffi culty swallowing. A
physical examination reveals generalized lymphadenopathy. If
this patient has a viral infection, a CBC will most likely show
which of the following hematologic fi ndings?

Answer 43

43. Lymphocytosis

Question 44

A 40-year-old woman presents with an 8-month history of
progressive generalized itching, weight loss, fatigue, and
yellow sclerae. Physical examination reveals mild jaundice.
The antimitochondrial antibody test is positive. A liver biopsy
discloses periductal infl ammation and bile duct injury (shown
in the image). Which of the following infl ammatory cells is the
principal mediator of destructive cholangitis in this patient?

Answer 44

44. T lymphocytes.

Question 45

A 25-year-old woman presents with a 2-week history of febrile
illness and chest pain. She has an erythematous, macular
facial rash and tender joints, particularly in her left wrist and
elbow. A CBC shows mild anemia and thrombocytopenia.
Corticosteroids are prescribed for the patient. This medication
induces the synthesis of an inhibitor of which of the following
enzymes in infl ammatory cells?

Answer 45

45. Phospholipase A2

Question 46

ceruloplasmin, fi brinogen, α2-macroglobulin,
serum amyloid A protein, and C-reactive protein are markers that belong to which of the following families of
proteins?

Answer 46

46. Acute phase proteins.