Inflammation and Repair Practice Questions

Q: Regeneration is characterized by:

Repairing by same type of tissue. ***Repairing by same type of tissue*** - **Regeneration** involves the replacement of damaged cells and tissues with cells of the **same type**, leading to a complete restoration of normal structure and function [1]. - This process is seen in tissues with high proliferative capacity, like the **epidermis** or the **liver**, following injury [2]. *Granulation tissue* - **Granulation tissue** is characteristic of **repair by fibrosis** (scar formation), not regeneration [1]. - It consists of proliferating fibroblasts, new blood vessels (angiogenesis), and inflammatory cells, which eventually mature into a fibrous scar. *Repairing by different type of tissue* - The replacement of damaged tissue with a **different type of tissue** (typically fibrous connective tissue) is known as **repair by fibrosis** or **scar formation** [1]. - This occurs when the tissue's regenerative capacity is limited or when the injury is severe, resulting in the loss of normal tissue architecture and function [3]. *Cellular proliferation is largely regulated by biochemical factors* - While **cellular proliferation** is indeed regulated by **biochemical factors** (growth factors, cytokines) in both regeneration and repair, this statement describes a mechanism common to cellular growth and healing in general, not a defining characteristic unique to regeneration [1]. - This regulation guides both the replacement with original tissue (regeneration) and scar formation, so it's not specific enough to define regeneration alone. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 113-115. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 112-113. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 113.

Q: A young lady presented with bilateral nodular lesions on shins. She was also found to have bilateral hilar lymphadenopathy on chest X-ray. Mantoux test reveals indurations of 5 mms. Skin biopsy would reveal:

Non caseating Granuloma. ***Non-caseating Granuloma*** - This clinical presentation of **bilateral nodular lesions on shins** (**erythema nodosum**) [1] and **bilateral hilar lymphadenopathy** is highly suggestive of **sarcoidosis**. [2] - **Sarcoidosis** is characterized by the presence of **non-caseating granulomas** in affected tissues, including the skin (erythema nodosum) and lymph nodes. [2] *Vasculitis* - While vasculitis can cause skin lesions, the characteristic presentation of erythema nodosum is a form of **panniculitis** (inflammation of subcutaneous fat) rather than true vasculitis. - Vasculitis typically involves inflammation and damage to **blood vessel walls**, which is not the primary histological finding in sarcoidosis-associated skin lesions. *Caseating Granuloma* - **Caseating granulomas** are the hallmark of **tuberculosis** and certain fungal infections, and they involve central necrosis ("caseation"). - The positive Mantoux test (5 mm induration) is equivocal; while it could indicateMycobacterium exposure, the overall constellation of findings points away from active TB as the primary diagnosis, which would typically show caseating granulomas. *Malignant cells* - This clinical picture does not align with a primary malignancy. While malignancies can cause various skin lesions or lymphadenopathy, the specific combination strongly suggests an inflammatory or granulomatous disease. - Skin biopsies would reveal **granulomatous inflammation** rather than malignant cellular proliferation in this context. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 641-642. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 700-701.

Q: Granulomas in lymph nodes are seen in all of the following infections EXCEPT:

Staph Aureus. ***Staph Aureus*** - *Staphylococcus aureus* typically causes **suppurative (pus-forming)** infections leading to **abscesses** and **pyogenic inflammation**, not granulomas [2], [3]. - Lymph node involvement with *S. aureus* usually manifests as **acute lymphadenitis** with neutrophil infiltration, not organized granulomatous structures [2]. *Histoplasmosis* - **Histoplasmosis**, caused by *Histoplasma capsulatum*, is a fungal infection that commonly forms **granulomas** in affected tissues, including lymph nodes [1]. - These granulomas often resemble those seen in tuberculosis and can be **caseating or non-caseating** [1]. *Brucellosis* - **Brucellosis**, caused by *Brucella* species, is a zoonotic bacterial infection that classically forms **non-caseating granulomas** in multiple organs including lymph nodes, liver, and spleen. - The granulomas are characterized by epithelioid histiocytes and may contain multinucleated giant cells. *TB* - **Tuberculosis (TB)**, caused by *Mycobacterium tuberculosis*, is the classic example of an infection that forms **caseating granulomas** in affected lymph nodes [3]. - These granulomas are characterized by **central caseous necrosis** surrounded by epithelioid histiocytes, lymphocytes, and Langhans giant cells [4]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 717. [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, pp. 592-593. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, p. 360. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 379-380.

Q: Onion peel appearance of splenic capsule is seen in

SLE. ### SLE [1] - The **onion peel appearance** of the splenic capsule is a characteristic histological finding in **Systemic Lupus Erythematosus (SLE)**. - It results from **concentric perivascular fibrosis** and **lamellar thickening** around central arterioles in the spleen, a manifestation of autoimmune damage [1]. *Scleroderma* - **Scleroderma** is characterized by excessive **collagen deposition** and fibrosis in tissues, which would not typically manifest as an "onion peel" appearance in the spleen. - While it can affect connective tissue throughout the body, splenic involvement is usually not described with this specific histological finding. *Rheumatoid arthritis* - **Rheumatoid arthritis** primarily affects synovial joints and is associated with **chronic inflammation** and pannus formation. - Splenic changes in RA, if present (e.g., Felty's syndrome), involve splenomegaly due to lymphoid hyperplasia, not concentric perivascular fibrosis. *Sjögren's syndrome* - **Sjögren's syndrome** is an autoimmune disease primarily affecting **exocrine glands**, leading to dry eyes and mouth. - While systemic manifestations can occur, the characteristic "onion peel" splenic changes are not associated with Sjögren's syndrome. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 685-686.

Q: In a patient with gouty arthritis, synovial fluid aspiration will show which of the following:

Monosodium urate crystals. ***Monosodium urate crystals*** - **Gouty arthritis** is pathognomonically characterized by the presence of **monosodium urate (MSU) crystals** in the synovial fluid [1]. - These crystals are typically **needle-shaped** and display **strong negative birefringence** under polarized light microscopy [1]. *Mononuclear leucocytosis* - While present in inflammatory conditions, a predominance of **mononuclear cells** is less typical for acute gout [1]. - **Pseudogout** or even some chronic arthritides are more likely to exhibit this pattern. *Calcium pyrophosphate crystals* - These crystals are characteristic of **pseudogout**, also known as **calcium pyrophosphate deposition disease (CPPD)** [2]. - They are typically **rhomboid-shaped** and show **positive birefringence** [2]. *Polymorphonuclear leukocytosis* - Although there is an inflammatory response with increased **polymorphonuclear leukocytes (PMNs)** in gout, their presence alone is not specific for gout [1]. - **Septic arthritis** also presents with a significant increase in PMNs, and the definitive diagnosis relies on identifying the specific crystals or infectious agents. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1218-1220. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 683-684.

Q: In Still's disease the transient cutaneous rash coincides with the fever spike. The rash is due to:

Neutrophil infiltration in the dermis. ***Neutrophil infiltration in the dermis*** - The characteristic rash of Still's disease (juvenile idiopathic arthritis systemic onset or adult-onset Still's disease) is a **transient, salmon-pink, macular or maculopapular eruption** that typically appears during **febrile spikes**. - Histologically, this rash is characterized by a **superficial perivascular infiltrate of neutrophils** and sometimes lymphocytes, without significant epidermal changes. *Lymphocyte infiltration in the dermis* - While lymphocytes can be present, the predominant inflammatory cell type associated with the classic rash of Still's disease during fever spikes is the **neutrophil**. - Conditions like chronic dermatitis or viral exanthems are more commonly associated with prominent lymphocytic infiltrates. *Eosinophil infiltration in the dermis* - Eosinophils are typically associated with **allergic reactions**, parasitic infections, or certain drug eruptions. - Their presence is not a primary feature of the rash seen in Still's disease. *None of the options* - This option is incorrect because **neutrophil infiltration** is the recognized histological feature of the rash in Still's disease.

Question 1

Characteristic of acute inflammation is

Accepted Answer

Vasodilation and increase permeability

Answer

Vasoconstriction

Answer

Platelet aggregation

Answer

Infiltration by neutrophils

Question 2

A 45 year old patient presents with history of fever, night sweats and weight loss. On X-ray, a mass in apical lobe of lung is seen. On histopathology, it was found to have caseous necrosis. What is the likely underlying process involved -

Accepted Answer

Hypersensitivity reaction with modified macrophages, lymphocytes and giant cells

Answer

Acute decrease in blood supply

Answer

Decreased supply of growth factors

Answer

Enzymatic degeneration

Question 3

Regeneration is characterized by:

Accepted Answer

Repairing by same type of tissue

Answer

Granulation tissue

Answer

Repairing by different type of tissue

Answer

Cellular proliferation is largely regulated by biochemical factors

Question 4

A young lady presented with bilateral nodular lesions on shins. She was also found to have bilateral hilar lymphadenopathy on chest X-ray. Mantoux test reveals indurations of 5 mms. Skin biopsy would reveal:

Accepted Answer

Non caseating Granuloma

Answer

Vasculitis

Answer

Caseating Granuloma

Answer

Malignant cells

Question 5

Granulomas in lymph nodes are seen in all of the following infections EXCEPT:

Accepted Answer

Staph Aureus

Answer

Histoplasmosis

Answer

Brucellosis

Answer

TB

Question 6

Michaelis-Gutmann bodies are seen in

Accepted Answer

Malacoplakia

Answer

Thimble Bladder

Answer

Transitional cell carcinoma of bladder

Answer

Interstitial cystitis

Question 7

Onion peel appearance of splenic capsule is seen in

Accepted Answer

SLE

Answer

Scleroderma

Answer

Rheumatoid arthritis

Answer

Sjögren's syndrome

Question 8

In a patient with gouty arthritis, synovial fluid aspiration will show which of the following:

Accepted Answer

Monosodium urate crystals

Answer

Calcium pyrophosphate crystals

Answer

Polymorphonuclear leukocytosis

Answer

Mononuclear leukocytosis

Question 9

In Still's disease the transient cutaneous rash coincides with the fever spike. The rash is due to:

Accepted Answer

Neutrophil infiltration in the dermis

Answer

Lymphocyte infiltration in the dermis

Answer

Eosinophil infiltration in the dermis

Answer

None of the options

Question 10

Endotoxin shock is initiated by:

Accepted Answer

Cytokine action

Answer

Endothelial injury

Answer

Peripheral vasodilation

Answer

Increased vascular permeability

Inflammation and Repair — MCQs

Inflammation and Repair — MCQs

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