Inflammation and Repair Practice Questions

Q: Caspase-1 mediated cell death with inflammation is known as

Pyroptosis. ***Pyroptosis*** - This form of programmed cell death is characterized by the formation of an **inflammasome** complex [2], activating **Caspase-1** [1]. - Caspase-1 activation leads to the cleavage of pro-IL-1$\beta$ and pro-IL-18 into their active forms, resulting in a highly **inflammatory** process and cell lysis [1]. *Necroptosis* - This programmed, but non-apoptotic, cell death is mediated by the **RIPK1/RIPK3/MLKL** signaling pathway, involving receptor-interacting protein kinases [1]. - It is morphologically similar to necrosis but can be pharmacologically inhibited; it is **Caspase-independent** [3]. *Ferroptosis* - Ferroptosis is a form of regulated necrosis driven by **iron-dependent lipid peroxidation**. - It is characterized by the accumulation of reactive oxygen species and is typically **Caspase-independent**. *Necrosis* - Necrosis is an uncontrolled, **non-programmed** form of cell death resulting from acute cellular injury or pathology (e.g., ischemia). - It involves cell swelling, rupture of the plasma membrane, and leakage of cellular contents, leading to massive local inflammation, but is **not directly mediated by Caspase-1**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 71. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 196. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, pp. 69-71.

Q: The image shows presence of which cells?

Langhans cells. ***Langhan cells*** - **Langhan cells** are a type of **giant cell** characterized by multiple nuclei arranged in a **horseshoe or peripheral pattern** [1]. - They are typically found in **granulomas**, especially those associated with **tuberculosis** and other chronic inflammatory conditions [1]. *Epithelioid cells* - **Epithelioid cells** are activated macrophages that resemble epithelial cells and are a key component of **granulomas** [1][2]. - While present in granulomas, they are **mononuclear** and do not have the characteristic multinucleated appearance with peripheral nuclei seen in the image [1]. *Anitschkow cells* - **Anitschkow cells** are plump macrophages with a characteristic **caterpillar nucleus** or **owl-eye appearance**. - They are pathognomonic for **rheumatic fever** and are found in **Aschoff bodies** within the myocardium, not typically in granulomas. *Mott cells* - **Mott cells** are plasma cells containing multiple large, eosinophilic cytoplasmic inclusions called **Russell bodies**. - These inclusions are accumulations of **immunoglobulins** and are seen in conditions with chronic antigenic stimulation, such as **multiple myeloma** or chronic inflammation, but are not giant cells. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 109. [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. 198-200.

Q: The image shows a histological section of intestinal tissue with a granuloma. What is the most likely diagnosis?

Crohn's. ***Crohn's*** - Crohn's disease is characterized by **non-caseating granulomas** in the intestinal wall, which are a key diagnostic feature [1][3]. - These granulomas are typically **non-necrotizing** and can be found in any part of the gastrointestinal tract from mouth to anus [1][2]. *TB* - Tuberculosis (TB) typically forms **caseating granulomas** with central necrosis, which is distinct from the non-caseating granulomas of Crohn's. - TB granulomas often contain **Langhans giant cells** [4] and are associated with a specific infectious etiology. *Cat scratch disease* - Cat scratch disease, caused by *Bartonella henselae*, presents with **stellate or suppurative granulomas** in lymph nodes. - These granulomas are characterized by a central area of **necrosis and neutrophils**, surrounded by epithelioid cells, differing from Crohn's. *Syphilis* - Syphilis, particularly in its tertiary stage, can form **gummas**, which are granulomatous lesions. - Gummas are characterized by **coagulative necrosis** and a chronic inflammatory infiltrate, but they are not typically found in the intestinal wall as a primary feature like in Crohn's. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 806-807. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 365-366. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 366-367. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 109.

Q: A patient presents with a solitary bone lesion. Histopathological examination shows the following microscopic features. What is the most likely diagnosis?

Unifocal Langerhans cell histiocytosis. ***Unifocal Langerhans cell histiocytosis*** - This condition is characterized by a single lesion of **Langerhans cells**, often presenting as a **lytic bone lesion** in children or young adults [1]. - It is the most benign form of Langerhans cell histiocytosis and typically has an excellent prognosis after local treatment. *Monoclonal Gammopathy of unknown significance* - MGUS is an asymptomatic condition characterized by the presence of a **monoclonal protein** in the blood without evidence of multiple myeloma or related disorders. - It does not typically present with **lytic bone lesions** or symptoms of bone pain. *Multiple myeloma* - Multiple myeloma is a malignant proliferation of **plasma cells** in the bone marrow [3], leading to widespread **lytic bone lesions** [2,4], hypercalcemia, renal failure, and anemia. - While it causes lytic lesions, the presentation is usually more systemic and aggressive than a single bone lesion [4]. *Paget's disease* - Paget's disease is a chronic bone disorder characterized by abnormal bone remodeling, leading to enlarged and weakened bones. - It typically presents with **bone pain**, deformities, and increased bone turnover markers, but the lesions are often **sclerotic** or mixed, not purely lytic, and it's more common in older adults. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 630. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 608. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 606-607. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-617.

Q: The maximum tensile strength that a wound can reach after healing is complete, in comparison to normal skin, is

60%–80%. ***60%–80%*** - A fully healed wound, after complete maturation (typically **3 months**), achieves approximately **70–80%** of the **tensile strength** of normal unwounded skin [1]. - This is the **maximum tensile strength** that can be attained despite ongoing **collagen remodeling** and cross-linking [1]. - The strength never reaches 100% because scar tissue has a different collagen architecture compared to normal tissue, with **Type I collagen** replacing the original dermis but in a less organized pattern. *50%–60%* - This range underestimates the final tensile strength achieved by completely healed wounds. - At approximately **6 weeks**, wounds may be at this strength level, but further maturation increases strength to 70–80% [1]. *20%–30%* - This represents the tensile strength at an **early stage** of wound healing (around 3 weeks). - By the time healing is **complete**, the tensile strength is substantially higher than this range. *30%–50%* - This range also underestimates the maximum tensile strength of fully healed wounds. - While this may represent intermediate stages of healing, the final mature scar achieves greater strength approaching 70–80%. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 119-121.

Q: Langhans' giant cells are characteristically seen in

peritoneal tuberculosis. ***Peritoneal tuberculosis*** - **Langhans' giant cells** are a characteristic histological feature of **granulomatous inflammation**, particularly seen in **tuberculosis** [1], [2]. - They are formed by the fusion of epithelioid histiocytes and are a hallmark of **mycobacterial infections**, including peritoneal tuberculosis [2]. - While not pathognomonic, their presence in the appropriate clinical context strongly suggests tuberculosis [1]. *Typhoid Peyer's patch* - **Typhoid fever** causes **macrophage infiltration** with **necrosis** and **ulceration** in Peyer's patches. - The inflammatory response is mononuclear but does **not** form **epithelioid granulomas** or Langhans' giant cells. - Histology shows mononuclear cell infiltration and typhoid nodules, not granulomatous inflammation. *Tuberculoma* - A **tuberculoma** is a localized form of tuberculosis and **also contains Langhans' giant cells** within its granulomatous structure [1]. - However, peritoneal tuberculosis represents a broader clinical entity where identification of these cells in peritoneal tissue/fluid is diagnostically significant. - Both are forms of TB, but the question context favors the systemic/cavity involvement over a localized mass lesion. *Lymphoma* - **Lymphoma** shows malignant proliferation of lymphoid cells with effacement of normal architecture. - It does **not** show **granulomatous inflammation** or Langhans' giant cells. - Histology reveals sheets of atypical lymphoid cells, not epithelioid granulomas. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 383-384. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 109.

Question 1

Which of the following is NOT a characteristic feature of a granuloma?

Accepted Answer

PMNs with fibrinoid necrosis and cellular infiltrates

Answer

Chronic inflammatory infiltrate

Answer

Epithelioid cells

Answer

Giant cells

Question 2

Which of the following is not a proinflammatory cytokine?

Accepted Answer

IL 10

Answer

IL 8

Answer

IL 11

Answer

TNF alpha

Question 3

A 95-year-old woman touches a pot of boiling water. Within 2 hours, she has marked erythema of the skin of the fingers of her hand, and small blisters appear on the finger pads. This has led to which one of the following inflammatory responses?

Accepted Answer

Serous inflammation

Answer

Fibrinous inflammation

Answer

Granulomatous inflammation

Answer

Purulent inflammation

Question 4

A 40-year-old man presents with a 5-day history of productive cough and fever. *Pseudomonas aeruginosa* is isolated from a pulmonary abscess. A complete blood count (CBC) shows a marked leukocytosis (50,000/mL) with a left shift in granulocytes. Which of the following terms best describes these hematologic findings?

Accepted Answer

Leukemoid reaction

Answer

Leukopenia

Answer

Myeloid metaplasia

Answer

Neutrophilia

Question 5

Caspase-1 mediated cell death with inflammation is known as

Accepted Answer

Pyroptosis

Answer

Necroptosis

Answer

Necrosis

Answer

Ferroptosis

Question 6

The image shows presence of which cells?

Accepted Answer

Langhans cells

Answer

Epithelioid cells

Answer

Anitschkow cells

Answer

Mott cells

Question 7

The image shows a histological section of intestinal tissue with a granuloma. What is the most likely diagnosis?

Accepted Answer

Crohn's

Answer

TB

Answer

Cat scratch disease

Answer

Syphilis

Question 8

A patient presents with a solitary bone lesion. Histopathological examination shows the following microscopic features. What is the most likely diagnosis?

Accepted Answer

Unifocal Langerhans cell histiocytosis

Answer

Monoclonal Gammopathy of unknown significance

Answer

Multiple myeloma

Answer

Paget's disease

Question 9

The maximum tensile strength that a wound can reach after healing is complete, in comparison to normal skin, is

Accepted Answer

60%–80%

Answer

30%–50%

Answer

20%–30%

Answer

50%–60%

Question 10

Langhans' giant cells are characteristically seen in

Accepted Answer

peritoneal tuberculosis

Answer

typhoid Peyer's patch

Answer

tuberculoma

Answer

lymphoma

Inflammation and Repair — MCQs

Inflammation and Repair — MCQs

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