Systemic Response To Injury

Question 1

C-reactive protein (CRP)

A. Is secreted in a circadian rhythm with higher levels in the morning
B. Increases after eating a large meal
C. Does not increase in response to stress in patients with liver failure
D. Is less sensitive than erythrocyte sedimentation rate as a marker of inflammation

Answer 1

C. Does not increase in response to stress in patients with liver failure

Question 2

Which of the following is true regarding the inflammatory response following traumatic injury?

A. There is an acute proinflammatory response caused by stimulation of the adaptive immune system.
B. There is an anti-inflammatory response that leads to a return to homeostasis accompanied suppression of the innate immune system.
C. The degree of inflammation is proportional to injury severity.
D. Systemic inflammation following trauma is related to the immune response to microbes.

Answer 2

C. The degree of inflammation is proportional to injury severity.

Question 3

High-mobility group protein B1 (HMGB1)

A. Is associated with the best-characterized damage-associated molecular pattern (DAMP), detectable in the circulation within 30 minutes of trauma
B. Is a protein secreted by immune-competent cells stimulated by pathogen-associated molecular patterns (PAMPs) or inflammatory cytokines
C. Is also secreted by endothelial cells, platelets, and also as a part of cell death
D. All of the above

Answer 3

D. All of the above

Question 4

The most abundant amino acid in the human body is

A. Carnitine
B. Arginine
C. Glutamine
D. Methionine

Answer 4

C. Glutamine

Question 5

What is the role of mitochondrial DAMPs in the injury-mediated inflammatory response?

A. Mitochondrial DNA induces production of HMGB1.
B. Mitochondrial DNA and peptides from damaged mitochondria activate the macrophage inflammasome.
C. Mitochondrial DNA and peptides modulate the anti-inflammatory response that suppresses the adaptive immune system.
D. Mitochondrial DNA is directly toxic to the liver and lung in high amounts.

Answer 5

B. Mitochondrial DNA and peptides from damaged mitochondria activate the macrophage inflammasome.

Question 6

Which is FALSE regarding the hypothalamic-pituitary-adrenal (HPA) axis and injury-associated stress?

A. The HPA is initiated by the hypothalamus producing corticotropin-releasing hormone (CRH) in response to inflammatory cytokines.
B. CRH acts on the anterior pituitary to stimulate adrenocorticotropin hormone (ACTH) secretion.
C. CRH simulates the zona fasciculata of the adrenal gland to synthesize and secrete glucocorticoids.
D. Insufficient cortisol in response to critical illness can lead to tachycardia, hypotension, weakness, hypoglycemia, hyponatremia, and hyperkalemia.

Answer 6

C. CRH simulates the zona fasciculata of the adrenal gland to synthesize and secrete glucocorticoids.

Question 7

Nutritional formulas used  to  treat  pulmonary failure typically increase the fat  intake of a patient’s total caloric intake  to
A. 50% 
B. 20% 
C. 80% 
D. 10%

Answer 7

A. 50%