同济大学：《病理学》课程教学资源（试卷习题，含答案）Inflammation

Week 2 Quiz 1 Inflammation 1.The bright red cell in thep cteristically abundant in C.Viral infections D.Mycobacterial infections E.Bacterial infections Ans:B The histologic section demonstrates cells with bi-lobed nuclei and strongly eosinophilic cvtoplasm.tvpical of eosinophils present in cases of allergic reaction or parasitic infection.in acute lung injury,there is congestion,interstitial and intra-alveolar edema,inflammation,and diffuse alveolar damage.Alveolar septae are not seen in this high power photomicrograph.Viral mation vith giant cells at the al infe phase will show a predominance of tior edema not eosinophils. A rose farme lains which developed after he spent the day the ground ed tha eukocyt re an migrate e culatio vemen 689ou5060m0g013g09Pap29013I1sou6316ona3sa330一 A.Bradykinin B.Chemokines Complement C3a D.Histamine E.Prostaglandins -1

- 1 - Week 2 Quiz 1 Inflammation 1. The bright red cells in the photomicrograph above are characteristically abundant in A. Acute lung injury B. Allergic reactions C. Viral infections D. Mycobacterial infections E. Bacterial infections Ans: B The histologic section demonstrates cells with bi-lobed nuclei and strongly eosinophilic cytoplasm, typical of eosinophils present in cases of allergic reaction or parasitic infection. In acute lung injury, there is congestion, interstitial and intra-alveolar edema, inflammation, and diffuse alveolar damage. Alveolar septae are not seen in this high power photomicrograph. Viral infections are usually accompanied by numerous lymphocytes. Granulomatous inflammation with giant cells, at the periphery of a necrotic nodule is characteristic of mycobacterial infections. Regular bacterial infections in the acute phase will show a predominance of inflammation, edema, and neutrophilic infiltrate, not eosinophils. 2. A rose farmer complains of a swollen, red, painful thumb, which developed after he spent the day clearing dead rose branches from the ground. You have learned that in this setting, leukocytes leave the vasculature and migrate to the site of bacterial inoculation. The movement of these leukocytes is most likely to be mediated by which of the following substances? A. Bradykinin B. Chemokines C. Complement C3a D. Histamine E. Prostaglandins

Ans:B Chemokines are small cytokines that mediate chemotaxis of immune cells.Bradykinin and histamine are both comnounds that increase vascular nermeability to allow for leukocyte extravasation from the blood vessels into the interstitial tissues.C3a is a complement protein that activates mast cell degranulation.Prostaglandins are potent local lipid molecules that play a role in vascular dilation calcium movement inflammation modulation cell growth and platelet aggregation (to name a few) 3 A 53-vear-old wor man has had a high fever and cough productive of yellowish sputum for the past 2 days.On auscultation of the chest,crackles are audible in both lung bases.A chest shows bilat ral n infiltrates.An intern recently graduated from Duke .What is the major inflammatory cell type? Langhans cells ymphocytes Macrophages D.Mast cells E.Neutrophils Ans:E Many of the cells seen above have multi-lobed nclei.Also.presence ofyellowish sputum implies pus formation,which is a product of acute inflammation characterized by ongoing neutrophilic invasion.Langerhans cells are specialized dendritic cells of the skin and mucosa that are most often seen in the stratum spinosum of the epidermis.Lymphocytes are small cells (about the sixe -2

- 2 - Ans: B Chemokines are small cytokines that mediate chemotaxis of immune cells. Bradykinin and histamine are both compounds that increase vascular permeability to allow for leukocyte extravasation from the blood vessels into the interstitial tissues. C3a is a complement protein that activates mast cell degranulation. Prostaglandins are potent local lipid molecules that play a role in vascular dilation, calcium movement, inflammation modulation, cell growth, and platelet aggregation (to name a few). 3. A 53-year-old woman has had a high fever and cough productive of yellowish sputum for the past 2 days. On auscultation of the chest, crackles are audible in both lung bases. A chest radiograph shows bilateral patchy pulmonary infiltrates. An intern recently graduated from Duke obtains a lung biopsy, which is shown above. What is the major inflammatory cell type? A. Langhans cells B. Lymphocytes C. Macrophages D. Mast cells E. Neutrophils Ans: E Many of the cells seen above have multi-lobed nuclei. Also, presence of yellowish sputum implies pus formation, which is a product of acute inflammation characterized by ongoing neutrophilic invasion. Langerhans cells are specialized dendritic cells of the skin and mucosa that are most often seen in the stratum spinosum of the epidermis. Lymphocytes are small cells (about the sixe

of an RBC)with dense.dark nuclei with little to no visible eosinophilic cytoplasm.Macrophages are amoeboid cells with cytoplasmic granules (lysosomes)surrounding the large nucleus.Mast cells have basophilic nuclei surrounded by stippled cytoplasm of pre-formed granules. 4.A 63-year-old man develops worsening congestive heart failure 1 month after an acute myocardial infarction.An echocardiogram shows a markedly decreased ejection fraction.He dies six weeks after his acute myocardial infarct.At autopsy,a section of the infarct shows that the necrotic myocardium has largely been replaced by capillaries,fibroblasts,and collagen. Which of the following inflammatory cell types plays the most important role in the healing process by removing debris? A.Eosinophils C.Macrophages Plasmacytes Ans:C Macrophages arrive at damaged tissue afer neutrophils to conti ue to phagocytose cellular debris and initiate the repai process by re asing cytokines an ctants.Eosinoph lymphocytes,and plasma cells do not contribute to the removal of cellular debris.Neutrophils are most prevalent during the acute phase of inflammation,namely the first 24-hours. Macrophages subsequently arrive for phagocytosis and debris removal.However,neutrophils continue to participate in the inflammatory response until after the pathogenic organisms are completely removed.Thus,in a longstanding (chronic)active infection,both macrophages and neutrophils are present. 5.a 22-vear-old man develops marked right lower quadrant abdominal pain over the past dav On physical examination there is rebound tenderness on palpation over the right lower quadrant. Laparoscopie surgeryis performed,and the appendix is s and partly covered by a vellow ish e xudate it is removed and a microse ction sho ows infiltration with ophils.The pain experienced by this patien t is predominantly the result of the formation of which of the follow ing two cher edia Complement C3b and IgG Interlekn-and necrosis factor E.Prostaglandin and bradykinin Ans:E Prostaglandin E2 and bradykinin sensitize neurons to pain.Complement C3b and IgG are powerful opsonins of bacteria.Histamine and serotonin have both been implicated as causing pain from insect bites,however these are unlikely to be causing pain of appendicitis.IL-I and -3

- 3 - of an RBC) with dense, dark nuclei with little to no visible eosinophilic cytoplasm. Macrophages are amoeboid cells with cytoplasmic granules (lysosomes) surrounding the large nucleus. Mast cells have basophilic nuclei surrounded by stippled cytoplasm of pre-formed granules. 4. A 63-year-old man develops worsening congestive heart failure 1 month after an acute myocardial infarction. An echocardiogram shows a markedly decreased ejection fraction. He dies six weeks after his acute myocardial infarct. At autopsy, a section of the infarct shows that the necrotic myocardium has largely been replaced by capillaries, fibroblasts, and collagen. Which of the following inflammatory cell types plays the most important role in the healing process by removing debris? A. Eosinophils B. Lymphocytes C. Macrophages D. Neutrophils E. Plasmacytes Ans: C Macrophages arrive at damaged tissue after neutrophils to continue to phagocytose cellular debris and initiate the repair process by releasing cytokines and chemoattractants. Eosinophils, lymphocytes, and plasma cells do not contribute to the removal of cellular debris. Neutrophils are most prevalent during the acute phase of inflammation, namely the first 24-hours. Macrophages subsequently arrive for phagocytosis and debris removal. However, neutrophils continue to participate in the inflammatory response until after the pathogenic organisms are completely removed. Thus, in a longstanding (chronic) active infection, both macrophages and neutrophils are present. 5. A 22-year-old man develops marked right lower quadrant abdominal pain over the past day. On physical examination there is rebound tenderness on palpation over the right lower quadrant. Laparoscopic surgery is performed, and the appendix is swollen, erythematous, and partly covered by a yellowish exudate. It is removed, and a microscopic section shows infiltration with numerous neutrophils. The pain experienced by this patient is predominantly the result of the formation of which of the following two chemical mediators? A. Complement C3b and IgG B. Histamine and serotonin C. Interleukin-1 and tumor necrosis factor D. Leukotriene and HPETE E. Prostaglandin and bradykinin Ans: E Prostaglandin E2 and bradykinin sensitize neurons to pain. Complement C3b and IgG are powerful opsonins of bacteria. Histamine and serotonin have both been implicated as causing pain from insect bites, however these are unlikely to be causing pain of appendicitis. IL-1 and

TNF are cytokines of inflammation and immune cell regulation.HPETE is an intermediate in the production of leukotrienes from arachidonic acid via lipooxygenase.Leukotrienes are very important molecules of inflammation. 6.A woman who is allergic to cats visits a neighbor who has several cats.During the visit,she inhales cat dander and within minutes.she develops nasal congestion with abundant nasal secretions.Which of the following substance is most likely to produce these symptoms? A.Bradykinin D ompler ment C5a E.Phospholipase C Ans:C Histamine induces endothelial contraction,gap formation,and edema leading to the abundant nasal secretions seen here.Bradykinin and related peptides have many functions,including inflammatory mediated pain responses.Complement C5a is a chemotactic agent,inducing leukocvte activation and mast cell degranulation.it is not the best choice here since it is more likely to mediate anaphylaxis,a life threatening reaction,instead of the minor symptoms described here.IL-I mediates fever.Phospholipase C is an enzyme use in the conversion of membrane lipids to arachidonic acid as part of an inflammatory response. 7.One month after an appendectomy,a 25-year-old woman palpates a small nodule beneath the skin at the site of the healed right lower quadrant incision The nodule is excised and microscopic examination sho macrop ages,collagen,a few small lymphocytes,and eated giant cells.Polarizable ractile material is s een in the r odule.Which of the following complications of the surgery best accounts for these finding? ron uture granuloma E.Ulceration Ans:D A nodule of macrophages surrounding necrotic material is a description of a granuloma and the presence at the skin just below the incision makes "surgical granuloma"the best choice. Abscess formation,chronic inflammation,or ulceration are processes that would have been accompanied by erythema,edema,and pain.Edema is not found in discrete nodules,rather it is merely a collection of fluid. -4

- 4 - TNF are cytokines of inflammation and immune cell regulation. HPETE is an intermediate in the production of leukotrienes from arachidonic acid via lipooxygenase. Leukotrienes are very important molecules of inflammation. 6. A woman who is allergic to cats visits a neighbor who has several cats. During the visit, she inhales cat dander and within minutes, she develops nasal congestion with abundant nasal secretions. Which of the following substance is most likely to produce these symptoms? A. Bradykinin B. Complement C5a C. Histamine D. Interleukin-1 E. Phospholipase C Ans: C Histamine induces endothelial contraction, gap formation, and edema leading to the abundant nasal secretions seen here. Bradykinin and related peptides have many functions, including inflammatory mediated pain responses. Complement C5a is a chemotactic agent, inducing leukocyte activation and mast cell degranulation. It is not the best choice here since it is more likely to mediate anaphylaxis, a life threatening reaction, instead of the minor symptoms described here. IL-1 mediates fever. Phospholipase C is an enzyme use in the conversion of membrane lipids to arachidonic acid as part of an inflammatory response. 7. One month after an appendectomy, a 25-year-old woman palpates a small nodule beneath the skin at the site of the healed right lower quadrant incision. The nodule is excised, and microscopic examination shows macrophages, collagen, a few small lymphocytes, and multinucleated giant cells. Polarizable, refractile material is seen in the nodule. Which of the following complications of the surgery best accounts for these finding? A. Abscess formation B. Chronic inflammation C. Edema D. Suture granuloma E. Ulceration Ans: D A nodule of macrophages surrounding necrotic material is a description of a granuloma and the presence at the skin just below the incision makes “surgical granuloma” the best choice. Abscess formation, chronic inflammation, or ulceration are processes that would have been accompanied by erythema, edema, and pain. Edema is not found in discrete nodules, rather it is merely a collection of fluid

©Elsevier2005 8.A43-year- A transbronchial lung biopsy is performed,yielding a specimen with the microscopic appearance shown.What type of inflammation is this? A.Acute B.Chronic C.Fibrotic D.Granulomatous E.Necrotic Ans:D The specimen shows a central area of (pink)necrosis and lack ofcell nuclei.surrounded by nt cells with oplasm.In the ntext of the c is a caused by infection with bacteriu rculosis.Acute na and ma cells an answer granulomalous injlammation is a more specific answer 9.A 30-year-old woman with a history of a congenital ventricular septal defect has had a persistent temperature of 38.6C and headache for the past 3 weeks.A head CT scan shows an enhancing 3-cm ring like lesion in the right parietal lobe,which the radiologist feels is most .5

- 5 - 8. A 43-year-old man has had a cough and fever for the past 2 months. A chest radiograph shows bilateral nodular densities, some with calcification, located mainly in the upper lobes of the lungs. A transbronchial lung biopsy is performed, yielding a specimen with the microscopic appearance shown. What type of inflammation is this? A. Acute B. Chronic C. Fibrotic D. Granulomatous E. Necrotic Ans: D The specimen shows a central area of (pink) necrosis and lack of cell nuclei, surrounded by several multinucleated giant cells with abundant pink cytoplasm. In the context of the case, this is likely a caseating granuloma caused by infection with Mycobacterium tuberculosis. Acute inflammation would show edema and numerous neutrophils, not granuloma formation. Chronic inflammation is characterized by proliferation of macrophages, lymphocytes, plasma cells, and fibroblasts. There is necrosis in the center of this granuloma (cellular debris without nuclei), but answer granulomatous inflammation is a more specific answer. 9. A 30-year-old woman with a history of a congenital ventricular septal defect has had a persistent temperature of 38.6 o C and headache for the past 3 weeks. A head CT scan shows an enhancing 3-cm ring like lesion in the right parietal lobe, which the radiologist feels is most

consistent with an abscess.Which of the following actions by inflammatory cells is most likely to produce this CT finding? A.Formation of nitric oxide by macrophages B.Formation of transforming growth factor-B by macrophages C.Generation of prostaglandin by endothelium D.Production of interferon-y by lymphocytes E.Release of lysosomal enzymes from neutrophils Ans:E Nongenital heart defectsh-o-ef shumting predispo se ly S ausing gener granulation tissue here because we see extensive necrotic debris more likely due to powerful lysosomal enzymes. TGF-beta secretion by macrophages actually turns off the inflammatory response in preparation for healing.Prostaglandins have many functions but are not related to the direct actions of the microbial-killing inflammatory cells.Interferon-gamma is a cytokine released by lymphocytes in response to viral or intracellular bacterial infections.It is less likely to cause the extensive necrosis evident in this patient. -6

- 6 - consistent with an abscess. Which of the following actions by inflammatory cells is most likely to produce this CT finding? A. Formation of nitric oxide by macrophages B. Formation of transforming growth factor-B by macrophages C. Generation of prostaglandin by endothelium D. Production of interferon-γ by lymphocytes E. Release of lysosomal enzymes from neutrophils Ans: E Congenital heart defects with right-to-left shunting predispose patients to brain abscesses. Neutrophils release lysosomal enzymes (“respiratory burst”) to kill invading microorganisms, causing general liquefactive necrosis. Over time, granulation tissue and neovascularization surround the infection, hence the ring-enhancing lesion evident on CT. Nitric oxide can be secreted as a free radical that causes microbial death via DNA damage. It is not the best choice here because we see extensive necrotic debris more likely due to powerful lysosomal enzymes. TGF-beta secretion by macrophages actually turns off the inflammatory response in preparation for healing. Prostaglandins have many functions but are not related to the direct actions of the microbial-killing inflammatory cells. Interferon-gamma is a cytokine released by lymphocytes in response to viral or intracellular bacterial infections. It is less likely to cause the extensive necrosis evident in this patient