Chronic Inflammation — MCQs
The characteristic cell of a granulomatous reaction is:
A researcher is studying the interactions between foreign antigens and human immune cells. She has isolated a line of lymphocytes that is known to bind antigen-presenting cells. From this cell line, she has isolated a cell surface protein that binds to class I major histocompatibility complex molecules. The continued activation, proliferation and survival of this specific cell line requires which of the following signaling molecules?
Which feature is most consistent with chronic inflammation?
Identify the cell marked in the image below
All of the following are features of granulomatous thyroiditis except?
A 42 year-old female patient presents with cough, low-grade fever, and hemoptysis. Investigations reveal a cavitary lesion on her right lung apex, which on biopsy reveals caseous necrosis. The underlying pathophysiology is:
Which of the following statements is true regarding anemia of chronic disease?
Who described the four classical features of inflammation?
Which interleukin is specifically secreted by Th17 cells?
Which statement about macrophages is incorrect?
Chronic Inflammation Indian Medical PG Practice Questions and MCQs
Question 1: The characteristic cell of a granulomatous reaction is:
- A. Plasma cell
- B. Epithelioid cell (Correct Answer)
- C. Lymphocyte
- D. Eosinophil
Explanation: ***Epithelioid cell*** - Epithelioid cells are activated **macrophages** that are a hallmark of granulomatous inflammation, forming the core of the granuloma [1]. - These cells are characterized by their large size, abundant cytoplasm, and **epithelial-like appearance**, crucial for tuberculous and other granulomatous diseases [1,2]. *Eosinophil* - Eosinophils are primarily involved in **allergic reactions** and **parasitic infections**, not granulomatous reactions. - While present in some conditions (like asthma), they do not contribute to the **formation of granulomas**. *Lymphocyte* - Lymphocytes are involved in **adaptive immunity** but are not the main cell type in granulomatous reactions. - They contribute to inflammation but do not form the characteristic structures seen in **granulomas** [1]. *Plasma cell* - Plasma cells are differentiated **B cells** responsible for producing antibodies, not associated with granulomatous inflammation. - Their roles are more aligned with humoral immunity rather than the **granulomatous response**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 109. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, p. 360.
Question 2: A researcher is studying the interactions between foreign antigens and human immune cells. She has isolated a line of lymphocytes that is known to bind antigen-presenting cells. From this cell line, she has isolated a cell surface protein that binds to class I major histocompatibility complex molecules. The continued activation, proliferation and survival of this specific cell line requires which of the following signaling molecules?
- A. Interleukin 1
- B. Interleukin 4
- C. Interleukin 2 (Correct Answer)
- D. Interleukin 8
- E. Interleukin 6
Explanation: ***Interleukin 2*** - The description of the lymphocyte binding the **constant portion of MHC class I** and requiring a signaling molecule for activation, proliferation, and survival points to a **T cell**. - **Interleukin-2 (IL-2)** is a crucial cytokine for the proliferation, differentiation, and survival of T lymphocytes, acting in an autocrine or paracrine fashion after T cell activation. *Interleukin 1* - **Interleukin-1 (IL-1)** is primarily involved in inflammation and fever, produced by macrophages and other innate immune cells. - While it can act as a costimulator for T cells, it is not the primary cytokine required for their sustained proliferation and survival after initial activation. *Interleukin 4* - **Interleukin-4 (IL-4)** is a key cytokine in humoral immunity, promoting B cell proliferation and differentiation, and inducing IgE class switching. - It also plays a role in the differentiation of naive T cells into **Th2 cells**, but it is not the main cytokine for general T cell proliferation and survival. *Interleukin 8* - **Interleukin-8 (IL-8)**, also known as CXCL8, is a chemokine primarily responsible for attracting and activating neutrophils to sites of infection or inflammation. - It does not have a direct role in the sustained proliferation and survival of activated lymphocytes. *Interleukin 6* - **Interleukin-6 (IL-6)** is a pleiotropic cytokine involved in acute phase reactions, hematopoiesis, and the immune response, particularly B cell differentiation and antibody production. - Although it can influence T cell responses, it is not the primary growth factor for activated T lymphocytes as IL-2 is.
Question 3: Which feature is most consistent with chronic inflammation?
- A. Hyperemia
- B. Vasodilation
- C. Fibrosis (Correct Answer)
- D. Edema
Explanation: ***Fibrosis*** - **Fibrosis** is the excessive accumulation of connective tissue, often seen as a **scarring process**, which is a hallmark of chronic inflammation as the body attempts to repair damaged tissue. [1] - Unlike acute inflammation, which is characterized by immediate vascular changes and exudation, chronic inflammation involves persistent tissue injury and attempts at repair, leading to **fibroblast proliferation** and collagen deposition. [2] *Hyperemia* - **Hyperemia** is an active process involving increased blood flow to a tissue, which causes it to redden. - It is a prominent feature of **acute inflammation**, contributing to rubor (redness) and calor (heat). *Vasodilation* - **Vasodilation**, the widening of blood vessels, is a key component of the **acute inflammatory response**. - It increases blood flow to the inflamed area, contributing to the cardinal signs of **redness and warmth**. *Edema* - **Edema** refers to the accumulation of excess fluid in the interstitial spaces, often due to increased vascular permeability. - While it can occur in both acute and chronic inflammation, it is a particularly prominent and early feature of **acute inflammation** as fluid rushes to the site of injury. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 103-104. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 194-195.
Question 4: Identify the cell marked in the image below
- A. Macrophage
- B. Plasma cell
- C. Fibroblast
- D. Mast cell (Correct Answer)
Explanation: ***Mast cell*** - The cell indicated by the arrow displays characteristic features of a **mast cell**, including its large size, prominent central nucleus, and cytoplasm densely packed with numerous large, basophilic (darkly stained) granules. - These granules contain powerful inflammatory mediators like **histamine** and **heparin**, which are key in allergic reactions and inflammation. *Macrophage* - Macrophages are typically larger than mast cells with an **irregular shape**, a kidney-shaped nucleus, and often contain phagocytosed material in their cytoplasm, which is not clearly visible here. - While they are also immune cells, they lack the characteristic dense, uniform basophilic granulation seen in the indicated cell. *Plasma cell* - Plasma cells are characterized by an **eccentric nucleus** with **chromatin clumping** (cartwheel or clock-face appearance) and a prominent Golgi apparatus (perinuclear halo), none of which are evident in the marked cell. - Their cytoplasm is typically basophilic but lacks the distinct large granules. *Fibroblast* - Fibroblasts are typically **spindle-shaped** or stellate cells with elongated nuclei and a sparse cytoplasm, responsible for producing extracellular matrix. - They do not possess the abundant, dense cytoplasmic granules that are a hallmark of the cell shown.
Question 5: All of the following are features of granulomatous thyroiditis except?
- A. Hyperthyroidism
- B. Giant cells on histology
- C. Painless (Correct Answer)
- D. Hypothyroidism
Explanation: ***Painless*** - Granulomatous thyroiditis is characterized by **painful** thyroid gland inflammation, which is a distinguishing feature. - Thus, describing it as **painless** contradicts the typical clinical presentation. *Hyperthyroidism* - Granulomatous thyroiditis may lead to **hyperthyroidism** initially due to the release of thyroid hormones from damaged follicles [1]. - However, this condition can also lead to transient thyroid function changes or even permanent hypothyroidism later on [1]. *Hypothyroidism* - While **hypothyroidism** can occur post-thyroiditis, it is not a feature of granulomatous thyroiditis at the outset like the **painless** descriptor. - This condition often starts with hyperthyroid symptoms and may evolve later, differing from primary hypothyroid disorders. *Giant cells on histology* - Histological examination typically reveals **multinucleated giant cells**, a hallmark of granulomatous inflammation, as seen in this thyroid condition. - This significant finding helps in differentiating it from other thyroid disorders. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1091-1092.
Question 6: A 42 year-old female patient presents with cough, low-grade fever, and hemoptysis. Investigations reveal a cavitary lesion on her right lung apex, which on biopsy reveals caseous necrosis. The underlying pathophysiology is:
- A. Type 4 hypersensitivity reaction (Correct Answer)
- B. Sudden cut off of blood supply
- C. Enzyme degradation
- D. Fibrinoid deposition
Explanation: ***Type 4 hypersensitivity reaction*** - **Caseous necrosis**, characteristic of **tuberculosis**, is mediated by a **Type 4 hypersensitivity reaction** to the mycobacterial antigens [1], [3]. - This delayed-type hypersensitivity involves activated **macrophages** and **T-lymphocytes** forming **granulomas** with central caseous necrosis [2], [4]. *Sudden cut off of blood supply* - This mechanism typically leads to **coagulative necrosis** (e.g., in myocardial infarction), where the tissue architecture is preserved for some time. - **Infarction** due to loss of blood supply generally does not result in the distinct cheesy, crumbly appearance of caseous necrosis. *Enzyme degradation* - This mechanism describes **liquefactive necrosis**, where dead cells are digested by hydrolytic enzymes, resulting in a viscous fluid. - Liquefactive necrosis is common in bacterial infections and central nervous system infarcts, which is not consistent with the morphology of caseous necrosis. *Fibrinoid deposition* - **Fibrinoid necrosis** involves immune complex deposition in arterial walls, leading to leakage of plasma proteins and fibrin. - This type of necrosis is characteristic of **vasculitis** and immunologic reactions in vessels, not the widespread tissue destruction seen in caseous necrosis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 173-174. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 109. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, p. 380. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 383-384.
Question 7: Which of the following statements is true regarding anemia of chronic disease?
- A. Decreased TIBC (Correct Answer)
- B. Decreased macrophage iron in marrow
- C. Increased serum iron levels
- D. Decreased serum ferritin level
Explanation: Decreased TIBC - In **anemia of chronic disease (ACD)**, there is functional **iron deficiency** due to inflammation, leading to a decreased capacity for transferrin to bind iron, hence **decreased TIBC**. [1] - **Inflammation** increases hepcidin which blocks iron absorption and release from macrophages, thus reducing the amount of iron available to bind transferrin. [1] *Decreased macrophage iron in marrow* - ACD is characterized by **increased macrophage iron stores** in the marrow, as iron is sequestered within macrophages due to elevated hepcidin levels. [1] - This sequestration prevents iron from being effectively utilized for erythropoiesis despite adequate body iron stores. [1] *Increased serum iron levels* - Serum iron levels are typically **decreased** in ACD due to the inflammatory response and **hepcidin-mediated blockage** of iron release from macrophages and duodenal cells. [1] - This reduction in circulating iron contributes to the hypoproliferative anemia. *Decreased serum ferritin level* - **Serum ferritin** levels are usually **normal or increased** in ACD because ferritin is an acute-phase reactant and reflects increased iron stores within macrophages. - Decreased serum ferritin is characteristic of **iron deficiency anemia**, not anemia of chronic disease. [2]
Question 8: Who described the four classical features of inflammation?
- A. Aulus Cornelius Celsus (Correct Answer)
- B. Hippocrates
- C. Aristotle
- D. Galen
Explanation: ***Aulus Cornelius Celsus*** - Credited with describing the **four classical features of inflammation**: redness, heat, swelling, and pain [1]. - His work **De Medicina** laid the groundwork for understanding inflammation in clinical settings. *Aristotle* - Although a significant figure in early medicine and philosophy, he did not specifically describe the features of inflammation. - His contributions focused more on **natural philosophy** rather than detailed clinical observations of inflammation. *Galen* - A prominent physician whose works expanded upon earlier knowledge, but he did not delineate the four classical features of inflammation. - His emphasis was on **anatomy and physiology**, which laid a foundation for later medical understanding, but not specifically on inflammation. *Hippocrates (contributed to medical knowledge but not specific to inflammation)* - Known as the "Father of Medicine," Hippocrates made pivotal contributions to medicine but did not explicitly describe the classical features of inflammation. - His teachings laid the foundations for **clinical observation** but lacked detail about inflammation's characteristics as outlined by Celsus. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 185-186.
Question 9: Which interleukin is specifically secreted by Th17 cells?
- A. IFN Gamma
- B. IL6
- C. IL-17 (Correct Answer)
- D. IL-22
Explanation: ***IL22*** - Th17 cells predominantly secrete **IL-17** and also produce **IL-22**, which is significant in mucosal immunity and inflammation [1]. - **IL-22** plays a crucial role in the response to infections and in the pathogenesis of inflammatory diseases. *IL16* - IL-16 is primarily associated with **chemoattractant and regulatory functions** for lymphocytes and not directly secreted by Th17 cells. - It is involved in **eosinophil and T cell activation**, which is not characteristic of the Th17 response. *IFN Gamma* - IFN-gamma is mainly produced by **Th1 cells** and is critical for **cell-mediated immunity**, which is distinct from the function of Th17 cells. - It plays a role in activating **macrophages**, unlike Th17 cells which focus on **neutrophil recruitment** and inflammation. *IL6* - While IL-6 is a pro-inflammatory cytokine that can be involved in various immune responses, it is not primarily secreted by Th17 cells. - It is produced by a variety of cell types including fibroblasts and macrophages, acting as a mediator in the **acute phase response**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 158-160.
Question 10: Which statement about macrophages is incorrect?
- A. Phagocytic cells
- B. M2 type involved in inflammation (Correct Answer)
- C. Activation by IFN-γ
- D. Major cells in chronic inflammation
Explanation: ***M2 type involved in inflammation*** - The M2 macrophages are primarily associated with **anti-inflammatory responses** and tissue repair, not inflammation [1][2]. - They play a role in **wound healing** and **resolution of inflammation**, contrasting with the inflammatory role attributed in the statement [2][3]. *Phagocytic cells* - **Macrophages are indeed phagocytic**, meaning they ingest and eliminate pathogens and debris [1]. - This is a fundamental characteristic of macrophages, playing a crucial role in the **immune response**. *Activation by IFN-y* - **Interferon-gamma (IFN-y)** is known to activate macrophages, particularly enhancing their ability to kill intracellular pathogens [1][2]. - This activation is vital for macrophage's role in **cell-mediated immunity** [1]. *Major cells in chronic inflammation* - Macrophages are significant players in **chronic inflammation**, contributing to tissue remodeling and the persistent inflammatory state [1]. - They secrete various cytokines that maintain the pathological state seen in chronic inflammatory diseases. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 105-106. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 106-107. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 115.
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