Chapter 2 Q&A

Question 1

1. 23 yo woman nurses newborn and has tender erythematous area around nipple of left breast. Thick, yellow fluid drains fron open fissure. What inflammatory cells are there under light microscope?

Answer 1

Neutrophils; purulent exudate (pyogenic bacterial infections with predominant cell type as segmented neutrophil)

Question 2

2. Which mediator of inflammation facilitates chemotaxis, cytolysis, and opsonization at the site of inflammation in the patient described with that 23 yo woman with the purulent exudate?

Answer 2

Complement proteins: act in a cascade, making biologically active fragments or complexes (e.g. C5a, or C567)

Question 3

3. 63 yo man becomes febrile and expectorates large amounts of mucopurulent sputum; cultures pos for gram-pos diplococci. What mediates directed migration of imflammatory cells into the alveolar air spaces of this patient?

Answer 3

N-formylated peptides (potent chemotactic factors are complement proteins, bacterial and mito products, like the peptides, products of arachidonic metabolism, and chemokines)

Question 4

4. 59-yo man with massive heart attack expires due to ventricular arrhythmia; what inflammatory cells are abundant at autopsy of affected heart muscle?

Answer 4

Neutrophils (acute inflammation; they adhere to the vascular endothelium; they infiltrate necrotic tissue at the periphery of the infarct)

Question 5

5. 5 yo boy punctures thumb with rusty nail; later, thumb is red and swollen; why?

Answer 5

Increased capillary permeability

Question 6

6. What serum proteins will activate the complement, coagulation, and fibrinolytic systems at site of injury for 5 yo boy?

Answer 6

Hageman factor (Factor XII)

Question 7

7. 80 yo woman with 4 hr history of fever, shaking chills, disorientation; bp is 80/40, PE with diffuse purpura on upper arms and chest; blood pos for Gram neg organisms; which cytokine involved in pathogenesis of direct vascular injury in this woman with septic shock?

Answer 7

TNF-alpha

Question 8

8. 24 yo IV drug abuser with 2-day history of severe headache and fever; blood pos for Gram-pos cocci; given IV antibiotics, but deteriorates and dies; brain shows two encapsulated cavities; what characterizes this finding?

Answer 8

Suppurative inflammation (purulent exudate accompanied by significant liquefactive necrosis, aka pus)

Question 9

9. 36 yo woman with pneumococcal pneumonia develops right pleural effusion; pleural fluid with high specific gravity and large numbers of PMN leukocytes; what is this pleural effusion?

Answer 9

Purulent exudate

Question 10

10. 33 yo man with 5-wk history of calf pain and swelling and low-grade fever; CK levels elevated; muscle biopsy with eosinophils; what causes myalgia?

Answer 10

Parasitic infection (eosinophils)

Question 11

11. 10 yo boy with recurrent bacterial infections presents with fever and productive cough; neutrophils demonstrate impaired ability to generate ROS; what inherited mutations does this kid have?

Answer 11

NADPH oxidase: can’t make superoxide anion and hydrogen peroxide during phagocytosis, and so these people are susceptible to recurrent bacterial infections

Question 12

12. 25 yo woman with history of recurrent SOB and wheezing; labs show deficiency of C1 inhibitor, an esterase inhibitor that regs the activation of the classical complement pathway; diagnosis?

Answer 12

Hereditary angioedema (deficiency of C1 inhibitor, with excessive cleavage of C4 and C2 by C1s; episodic painless nonpitting edema of soft tissues)

Question 13

13. 40 yo man with 2-wk history of increasing abdo pain and yellow discoloration of sclera; PE shows RUQ pain; lab shows high serum levels of alkaline phosphatase and bilirubin; liver biopsy shows portal fibrosis and scattered foreign bodies consistent with schistosome eggs; what cells predominate?

Answer 13

Eosinophils (schistosome eggs!!)

Question 14

14. 41 yo woman complains of excessive menstrual bleeding and pelvic pain of 4 mos; endometrial biopsy with excess of plasma cells and macrophages within stroma; these cells and lymphoid follicles are consistent with which condition?

Answer 14

Chronic inflammation (if acute, would have neutrophils predominate; if chronic, we see lymphocytes, antibody-producing plasma cells, and macrophages)

Question 15

15. 62 yo woman with chemotherapy for breast cancer has 3 day history of fever and chest pain; she has a reduced ejection fraction but normal coronary blood flow; myocardial biopsy obtained, and PCR test for coxsackievirus positive; patient myocardium will most likely show what cells?

Answer 15

Lymphocytes (viral myocarditis will have these in the affected heart muscle)

Question 16

16. 58 yo woman with long-standing diabetes and hypertension develops end-stage renal disease and dies in uremia; shaggy fibrin-rich exudate seen on visceral pericardium; how to explain exudate?

Answer 16

Injury and increased vascular permeability (binding of vasoactive mediators to specific receptors on endothelial cells results in contraction and gap formation; break in endothelial barrier leads to leakage of intravascular fluid to extravascular space)

Question 17

17. 68 yo man with fever, shaking chills, and shortness of breath; PE with rales and decreased breath sounds over lung fields; grunting respirations, 30-35 RR, flraing of nares; sputum rusty yellow and many PMN leukocytes; what is leading to the fever?

Answer 17

IL-1 (endogenous pyrogen that will stimulate prostaglandin synthesis in the hypothalamic thermoreg centers, altering thermostat)

Question 18

18. Sputum cultures obtained from that 68 yo man are pos for Strep pneumoniae; need opsonization by complement, which does what for leukocytes?

Answer 18

Phagocytosis

Question 19

19. What mediators of inflammation is responsible for secondary injury to alveolar basement membranes and lung parenchyma?

Answer 19

Lysosomal enzymes (these would be from the neutrophils when they go a little overboard and have their enzymes released to EC environment)

Question 20

20. Which protein can inhibit fibrinolysis, activation of complement system, and protease-mediated damage in lungs of the 68 yo man?

Answer 20

Alpha2-macroglobulin (along with alpha1-antitrypsin)

Question 21

21. 35 yo woman with 5 day history of painful sore on back; PE shows 1-cm abscess over left shoulder; biopsy of lesion shows vasodilation and leukocyte margination; what glycoprotein mediates initial tethering of segmented neutrophils to endothelial cells?

Answer 21

Selectins (mediate initial adhesion of leukocytes to endothelial cells at sites of inflammation; they activate, and redistributed along luminal surface of endothelial cells and mediate initial adhesion and rolling of leukocytes)

Question 22

22. 14 yo boy with laceration on forehead in hockey game; wound will blanch; what accounts for this transient reaction?

Answer 22

Constriction of precapillary arterioles (transient vasoconstriction in the initial response)

Question 23

23. 8 yo girl with asthma has respiratory distress; history of allergies and upper respiratory tract infections; most powerful stimulator of bronchoconstriction and vasoconstriction in patient?

Answer 23

Leukotrienes

Question 24

24. Which of the preformed substances is released from mast cells and platelets, leading to increased vascular permeability in patient lungs of this 8 yo girl?

Answer 24

Histamine

Question 25

25. 75 yo woman with recent onset of chest pain, fever, productive cough with rust-colored sputum; CXR shows infiltrate in right middle lobe; sputum pos for Strep pneumoniae; phagocytic cells in affected lung tissue makes bacteriocidal hypochlorous acid with which enzyme?

Answer 25

Myeloperoxidase (catalyzes conversion of H2O2 in the presence of a halide to form hypochlorous acid)

Question 26

26. 28 yo woman cuts hand while dicing veggies in kitchen; wound cleaned and sutured; five days later, sit of injury with inflammatory cells secreting interleukin-1, TNF-alpha, INF-alpha, numerous arachidonic acid derivatives; name these cells

Answer 26

Macrophages

Question 27

27. 68 yo man with prostate cancer and bone metastases has shaking chills and fever; WBC count is 1000; what is this finding?

Answer 27

Leukopenia

Question 28

28. 25 yo machinist injured by metal sliver in left hand; next few days, wounded area becomes reddened, tender, swollen, warm to the touch; redness at site of injury caused how?

Answer 28

Vasodilation

Question 29

29. Patient tries to have sliver removed. What plays most important role in stimulating platelet aggregation at site of injury?

Answer 29

Thromboxane A2 (platelet adherence, aggregation, degranulation occur when platelets come in contact with fibrillar collagen or thrombin)

Question 30

30. 24 hrs later for this machinist, endothelial cells at site of injury release chem mediator that inhibits further platelet aggregation; mediator name?

Answer 30

Prostaglandin (PGI2): derivative of arachidonic acid that is formed in cyclooxygenase enzyme pathway (promotes vasodilation and bronchodilation and inhibits platelet aggregation)

Question 31

31. 37 yo man with AIDS admitted to hospital with 3 wk history of chest pain and SOB; CXR shows bilateral nodularities of lungs; what is in the figure that is multinucleated?

Answer 31

Macrophages

Question 32

32. 45 yo woman with autoimmune hemolytic anemia presents with increasing fatigue; which of the following mediators of inflammation is primarily responsible for Ab-mediated hemolysis in patient?

Answer 32

Complement proteins

Question 33

33. 59 yo alcoholic brought to ER with fever and foul breath; CXR shows pulmonary abscess in right lower lobe; patient develops acute bronchopneumonia and dies; what happens in intra-alveolar cells after phospholipase A2 activation?

Answer 33

Arachidonic acid:

Question 34

34. 30 yo girl with 2wk history of puffiness around eyes and swelling of legs and ankles; labs show hypoalbuminemia and proteinuria; urinary sediment with no inflammatory cells or RBC’s; how to describe peripheral edema?

Answer 34

Transudate (noninflammatory edema, such as in the case when you lose albumin or stop synthesizing plasma proteins)

Question 35

35. 25 yo woman develops sore, red, hot, swollen left knee; no history of trauma and no familial history of joint disease; fluid aspirated from joint space has segmented neutrophils; transendothelila migration of acute inflammatory cells into patient’s joint space mediated by which proteins?

Answer 35

Integrins (participate in cell-cell and cell-substrate adhesions and cell signaling; involved in leukocyte recruitment to sites of injury in acute inflammation)

Question 36

36. Aspirin effective in reflieving symptoms of acute inflammation by inhibiting what?

Answer 36

Cyclooxygenase

Question 37

37. 50 yo woman has metastatic breast cancer; one week after getting chemotherapy, she has bacterial pneumonia; what describes patient susceptibility?

Answer 37

Neutropenia

Question 38

38. 53 yo man with weakness, malaise, cough with bloody sputum, night sweats; CXR shows apical densities bilaterally; was exposed to Mycobacterium TB and it is ID’d in sputum; dies of respiratory insufficiency; what describes this lesion?

Answer 38

Granulomatous inflammation

Question 39

39. 59 yo man has acute chest pain and is rushed to the ER; labs and ECG show acute MI; coronary artery angiography does not show evidence of thrombosis; intravascular thrombolysis mediated by plasminogen activators released by which cells?

Answer 39

Endothelial cells (ability to promote or inhibit tissue perfusion and inflammatory cell influx through multiple mechs)

Question 40

40. What can cause relaxation of vascular SM cells and vasodilation of arterioles at site of MI?

Answer 40

NO

Question 41

41. 68 yo coal miner with smoking and emphysema history develops severe air-flow obstruction and dies; coal-dust nodules scattered throughout parenchyma was trapped by which cells?

Answer 41

Macrophages

Question 42

42. 40 yo man has 5 days of productive cough and fever; pseudomonas aeruginosa isolated from pulmonary abscess; CBC with marked leukocytosis, and differential shows numerous immature cells (band forms); what describes findings?

Answer 42

Leukemoid reaction

Question 43

43. 19 yo woman with five days of fever and sore throat; felt fatigued for past week and difficulty swallowing; PE shows generalized lymphadenopathy; if patient has viral infection, CBC shows which findings?

Answer 43

Lymphocytosis (causes of peripheral blood lymphocytosis are acute viral infections, chronic bacterial infections, lymphoproliferative diseases)

Question 44

44. 40 yo woman presents with 8-mo history of progressive generalized itching, weight loss, fatigue, and yellow sclerae; mild jaundice; antimito Ab test is positive; periductal inflammation and bile duct injury; which cells mediate destructive cholangitis?

Answer 44

T lymphocytes (primary biliary cirrhosis is a chronic progressive cholestatic liver disease characterized by intrahepatic bile duct destruction)

Question 45

45. 25 yo woman with 2 wk history of febrile illness and chest pain; erythematous, macular facial rash and tender joints (left wrist and elbow); CBC with mild anemia and thrombocytopenia; corticosteroids prescribed, which will help with synthesis of inhibitor of which enzymes in inflammatory cells?

Answer 45

Phospholipase A2 (you’re blocking release of arachidonic acid from plasma membranes of inflammatory cells)

Question 46

46. Patient described as being 25 has increased ceruloplasmin, fibrinogen, alpha2-macroglobulin, serum amyloid A protein, and C-reactive protein; what family of proteins is this?

Answer 46

Acute phase proteins (made by the liver and are released into circulation in response to acute inflammatory challenge)