Inflammation and Repair Practice Questions

Q: Which of the following statements regarding wound healing is correct?

Angiogenesis occurs during the proliferative phase. ***Angiogenesis occurs during the proliferative phase*** - The **proliferative phase**, occurring roughly between days 3 and 21, is defined by the formation of **granulation tissue** fueled by **angiogenesis** to supply oxygen and nutrients to the healing wound. - Key cells such as **fibroblasts** proliferate and deposit new extracellular matrix to bridge the wound gap. *The inflammatory phase is directly followed by the exudative phase* - The standard phases of wound healing are **hemostasis, inflammation, proliferation, and remodeling**; the exudative phase is not a distinct, sequential stage in this timeline. - **Inflammation** (which involves exudate) is followed directly by the **proliferative phase**, not an independent exudative phase. *Type I collagen is deposited in early wound healing in a random haphazard manner* - **Type III collagen** (immature collagen) is the initial type deposited during the early proliferative phase, not Type I. - Type III collagen is eventually replaced by the stronger, more organized **Type I collagen** during the **remodeling** phase. *Type III collagen replaces Type I collagen in a 3:1 ratio* - It is the other way around; during the **remodeling phase**, the initial scaffold of **Type III collagen** is enzymatically degraded and replaced by **Type I collagen**. - The final mature scar is composed mostly of **Type I collagen**.

Q: A patient with long-standing chronic inflammatory disease develops systemic amyloidosis. Which amyloid protein subtype is characteristically deposited?

AA. ***AA amyloidosis*** - Occurs secondary to **chronic inflammatory conditions** (e.g., rheumatoid arthritis, osteomyelitis, inflammatory bowel disease) due to elevated levels of **serum amyloid A (SAA)** protein, an acute-phase reactant. - The SAA protein is synthesized by the liver and undergoes misfolding and deposition in tissues, typically affecting the **kidneys, spleen, and liver**. *ATTR amyloidosis* - This subtype is associated with **transthyretin (TTR)**, a protein produced in the liver that transports thyroxine and retinol binding protein. - It is predominantly linked to **familial amyloid polyneuropathy** or age-related systemic senile amyloidosis, rather than chronic inflammation. *Abeta2m amyloidosis* - Involves the deposition of **beta-2 microglobulin**, a component of the MHC class I molecule. - This subtype is characteristically seen in patients with **end-stage renal disease** who have undergone long-term **hemodialysis**, as the protein is not effectively filtered out. *AL amyloidosis* - Involves the deposition of **amyloid light chain** proteins derived from immunoglobulin light chains. - This is associated with **plasma cell dyscrasias**, such as **multiple myeloma**, rather than chronic inflammation.

Q: A 62-year-old male shipyard worker presents with progressive dyspnoea and dull chest pain for 6 months. Chest X-ray shows massive unilateral pleural effusion with pleural thickening. He has a 30-year history of occupational dust exposure. The gross pathology specimen is shown in Image 2. Which histological subtype of this tumour carries the best prognosis and is most likely to show strong immunoreactivity for calretinin and WT-1?

A. Epithelioid subtype with tubulo-papillary architecture. ***A. Epithelioid subtype with tubulo-papillary architecture*** - The **epithelioid subtype** is the most common histological variant of **malignant mesothelioma** and is associated with the **best prognosis** compared to other subtypes. - It consistently shows strong **nuclear immunoreactivity for calretinin and WT-1**, which are essential markers for differentiating mesothelial cells from adenocarcinoma or other malignancies. *B. Sarcomatoid subtype with desmoplastic stromal pattern* - This subtype is characterized by spindle cells and carries a **poor prognosis** due to its highly aggressive nature and resistance to therapy. - It frequently **loses the expression** of characteristic mesothelial markers like **calretinin**, making it difficult to distinguish from other sarcomas. *C. Biphasic subtype with equal epithelioid and sarcomatoid components* - Biphasic mesothelioma contains a mixture of both epithelial and mesenchymal-like cells, resulting in an **intermediate prognosis**. - While the epithelioid areas may show expression for **WT-1**, the overall survival is significantly lower than the pure epithelioid subtype. *D. Desmoplastic subtype with storiform collagenous stroma* - The desmoplastic variant is an extremely aggressive form of **sarcomatoid mesothelioma** that is notoriously difficult to diagnose due to dense fibrous tissue. - It bears the **worst clinical prognosis** and rarely expresses standard mesothelial markers in more than small, focal areas.

Q: Chediak-Higashi syndrome is due to a defect in which of the following processes?

Chemotaxis. **Explanation:** **Chediak-Higashi Syndrome (CHS)** is a rare autosomal recessive disorder caused by a mutation in the **LYST (Lysosomal Trafficking Regulator) gene**. This defect leads to impaired microtubule polymerization, which is the fundamental mechanism behind the clinical manifestations. 1. **Why Chemotaxis is Correct:** Microtubules are essential for the structural integrity and movement of leukocytes. In CHS, the inability to properly organize microtubules prevents leukocytes from migrating effectively toward a site of inflammation or infection. This failure of directed movement is known as **defective chemotaxis**. Additionally, the defect causes the formation of **giant lysosomal granules** because lysosomes cannot be properly transported and distributed, leading to impaired phagosome-lysosome fusion. 2. **Why Other Options are Incorrect:** * **Opsonization:** This is the process of coating a pathogen with antibodies or complement (C3b) to enhance phagocytosis. It is an extracellular process unaffected by microtubule defects. * **Leukocyte Adhesion Deficiency (LAD):** This is due to a defect in **integrins (CD18)**, preventing leukocytes from adhering to the vascular endothelium (rolling and adhesion), not a microtubule defect. * **Extracellular microbacterial killing:** CHS primarily affects intracellular killing (phagolysosome formation). Extracellular killing (like NETs or complement-mediated lysis) is not the primary defect. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Triad:** Partial albinism (melanocyte transport defect), recurrent pyogenic infections (Staph/Strep), and peripheral neuropathy. * **Peripheral Smear:** Pathognomonic **giant azurophilic granules** in neutrophils and platelets. * **Associated Feature:** Mild coagulation defects due to lack of dense granules in platelets.

Question 1

Which of the following statements regarding wound healing is correct?

Accepted Answer

Angiogenesis occurs during the proliferative phase

Answer

The inflammatory phase is directly followed by the exudative phase

Answer

Type I collagen is deposited in early wound healing in a random haphazard manner

Answer

Type III collagen replaces Type I collagen in a 3:1 ratio

Question 2

A patient with long-standing chronic inflammatory disease develops systemic amyloidosis.
Which amyloid protein subtype is characteristically deposited?

Accepted Answer

AA

Answer

ATTR

Answer

Abeta2m

Answer

AL

Question 3

A 22-year-old male presents with painless cervical lymphadenopathy, drenching night sweats, and a 6 kg weight loss over 3 months. CT scan shows mediastinal widening. Excisional lymph node biopsy is sent for histopathology. The biopsy image is shown (Image 2). Immunohistochemistry on the neoplastic cells would most likely demonstrate which of the following marker profiles?

Accepted Answer

A. CD15+, CD30+, CD45−, PAX5 dim positive, EBV-LMP1 positive in a subset

Answer

B. CD20+, CD10+, BCL2+, CD45+, TdT negative with t(14;18) translocation

Answer

C. CD3+, CD30+, ALK+, CD45+, EMA positive with t(2;5) translocation

Answer

D. CD20+, CD15−, CD30−, CD45+, BCL6+ with a germinal centre B-cell phenotype

Question 4

A 62-year-old male shipyard worker presents with progressive dyspnoea and dull chest pain for 6 months. Chest X-ray shows massive unilateral pleural effusion with pleural thickening. He has a 30-year history of occupational dust exposure. The gross pathology specimen is shown in Image 2. Which histological subtype of this tumour carries the best prognosis and is most likely to show strong immunoreactivity for calretinin and WT-1?

Accepted Answer

A. Epithelioid subtype with tubulo-papillary architecture

Answer

B. Sarcomatoid subtype with desmoplastic stromal pattern

Answer

C. Biphasic subtype with equal epithelioid and sarcomatoid components

Answer

D. Desmoplastic subtype with storiform collagenous stroma

Question 5

Foci of granulomatous inflammation show all of the following except?

Accepted Answer

Eosinophils

Answer

Epithelioid cells

Answer

Fibrosis

Answer

Lymphocytes

Question 6

Chediak-Higashi syndrome is due to a defect in which of the following processes?

Accepted Answer

Chemotaxis

Answer

Opsonization

Answer

Leukocyte Adhesion Deficiency (LAD)

Answer

Extracellular microbacterial killing

Question 7

Maximum tensile strength is recovered in a wound area during what period after an injury?

Accepted Answer

3 to 4 weeks

Answer

1 to 2 weeks

Answer

6 months

Answer

1 year

Question 8

Epithelial granuloma is caused by which of the following immune cells?

Accepted Answer

Helper T cells

Answer

Neutrophil

Answer

Cytotoxic T cells

Answer

NK cells

Question 9

Which of the following is considered a major pyrogenic cytokine?

Accepted Answer

Interleukin-1

Answer

Interferon alpha

Answer

Tumor necrosis factor beta

Answer

Interleukin-3

Question 10

In cellular events of acute inflammation, all of the following are observed EXCEPT:

Accepted Answer

PECAM involved in activation of leukocytes

Answer

Complement involved in chemotaxis

Answer

ICAM involved in adhesion of leukocytes

Answer

Selectins involved in margination and rolling

Inflammation and Repair — MCQs

Inflammation and Repair — MCQs

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