Inflammation and Repair — MCQs
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A patient undergoing chest x-ray following an automobile accident is found to have an enlarged mediastinum with bilateral hilar and right paratracheal adenopathy. The patient has been asymptomatic, but careful examination demonstrates an enlarged cervical lymph node. This node is biopsied and demonstrates involvement by small, non-caseating granulomas. Occasional giant cells with stellate inclusions are seen within the granulomas. These are most likely which of the following?
The most important function of epithelioid cells in tuberculosis is -
Which of the following type of collagen is present in healing and granulation tissue?
Which is NOT a feature of chronic inflammation?
Which feature is most consistent with chronic inflammation?
Which of the following does not cause granulomatous inflammation?
Which of the following is/are characteristic features of chronic inflammation?
A 30-year-old man with a history of Crohn's disease presents with abdominal pain and diarrhea. A biopsy reveals numerous non-caseating granulomas. What is the mechanism behind the formation of these granulomas?
What is the primary effect of the cytokine interleukin-1 on the acute phase response?
Which of the following statements is MOST accurate regarding keloids?
Inflammation and Repair Indian Medical PG Practice Questions and MCQs
Question 391: A patient undergoing chest x-ray following an automobile accident is found to have an enlarged mediastinum with bilateral hilar and right paratracheal adenopathy. The patient has been asymptomatic, but careful examination demonstrates an enlarged cervical lymph node. This node is biopsied and demonstrates involvement by small, non-caseating granulomas. Occasional giant cells with stellate inclusions are seen within the granulomas. These are most likely which of the following?
- A. Aschoff bodies
- B. Anitschkow cells
- C. Paget's cells
- D. Asteroid bodies (Correct Answer)
Explanation: ***Asteroid bodies*** - The presence of **non-caseating granulomas** with giant cells containing **stellate inclusions** (asteroid bodies) is characteristic of **sarcoidosis** [1]. - **Sarcoidosis** often presents with **hilar** and **paratracheal lymphadenopathy**, as well as constitutional symptoms which can be subtle or absent [2]. *Aschoff bodies* - **Aschoff bodies** are pathognomonic for **rheumatic fever** and consist of fibrinoid necrosis surrounded by lymphocytes, plasma cells, and Anitschkow cells. - They are typically found in the **myocardium** and other connective tissues in the heart, not in lymph nodes with sarcoidosis-like features. *Anitschkow cells* - **Anitschkow cells** are large, activated macrophages, often described as "caterpillar cells" due to their wavy chromatin, characteristic of **Aschoff bodies** in **rheumatic fever**. - They are primarily seen in the context of **myocardial inflammation** due to rheumatic fever and are not associated with granulomatous lymphadenopathy. *Paget's cells* - **Paget's cells** are large, malignant epithelial cells with abundant pale cytoplasm and prominent nucleoli, associated with **Paget's disease of the nipple** (intraepidermal adenocarcinoma). - They are not found in granulomas within lymph nodes and are unrelated to the described clinical and histological findings. **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. 198-200. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 700-701.
Question 392: The most important function of epithelioid cells in tuberculosis is -
- A. Secretory (Correct Answer)
- B. Phagocytosis
- C. Healing
- D. Antigenic
Explanation: ***Secretory*** - Epithelioid cells are **modified macrophages** characterized by abundant eosinophilic cytoplasm due to increased endoplasmic reticulum and Golgi apparatus [1]. - Their **most important function is secretory** - they actively secrete cytokines (TNF-α, IL-1, IL-12), chemokines, and enzymes that maintain the granuloma structure and modulate the immune response [1]. - These secretory products help **contain the infection**, activate T-cells, and recruit other immune cells to form the organized granuloma [1]. - This secretory function is the defining characteristic that distinguishes them from ordinary macrophages. *Phagocytosis* - While epithelioid cells are derived from macrophages, their differentiation leads to **reduced phagocytic capacity**. - They have less prominent lysosomes and reduced ability to engulf pathogens compared to activated macrophages. - Their primary role has shifted from active phagocytosis to secretion and barrier formation. *Healing* - Epithelioid cells contribute to containment and eventual resolution of infection, but "healing" is not their direct primary function. - Healing involves fibrosis, collagen deposition (by fibroblasts), and tissue remodeling - processes distinct from the epithelioid cell's secretory role. - The granuloma itself (formed by epithelioid cells) may undergo **fibrosis or caseation**, but this is a consequence rather than the primary function. *Antigenic* - While epithelioid cells can present antigens (being derived from antigen-presenting macrophages), this is not their most important function in TB granulomas. - Antigen presentation is mainly carried out by dendritic cells and macrophages at earlier stages of immune response. - The defining role of epithelioid cells is their secretory activity that maintains granuloma structure. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 109.
Question 393: Which of the following type of collagen is present in healing and granulation tissue?
- A. Type II
- B. Type I
- C. Type III (Correct Answer)
- D. Type IV
Explanation: ***Type III*** - **Type III collagen** is prominently found in **granulation tissue** during the early stages of wound healing [1]. - It provides a **scaffold** for cellular migration and proliferation [2], contributing to the initial strength of the healing tissue. *Type II* - **Type II collagen** is the primary collagen type found in **cartilage**, particularly **hyaline cartilage**. - It is crucial for the **structural integrity** and resilience of articular surfaces, not typically in granulation tissue. *Type I* - **Type I collagen** is the most abundant collagen in the body, providing **tensile strength** to tissues like bone, skin, tendons, and ligaments. - While ultimately replacing type III collagen in mature scar tissue, it is **less prevalent in initial granulation tissue** compared to type III [1]. *Type IV* - **Type IV collagen** is a major component of **basement membranes**, forming a mesh-like network [3]. - It provides **structural support** and acts as a selective filter in tissues such as the kidneys and lungs, but not in healing granulation tissue. **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. 105-106. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 117-119. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. With Illustrations By, pp. 32-34.
Question 394: Which is NOT a feature of chronic inflammation?
- A. Mononuclear cells
- B. Neutrophil predominance (Correct Answer)
- C. Fibrosis
- D. Granulation tissue
Explanation: ***Neutrophil predominance*** - **Neutrophil predominance** is characteristic of **acute inflammation**, where these cells are among the first responders to injury or infection [1]. - In chronic inflammation, neutrophils are typically present in much smaller numbers compared to mononuclear cells, or their presence indicates an acute exacerbation [3]. *Mononuclear cells* - **Mononuclear cells**, such as **macrophages**, **lymphocytes**, and **plasma cells**, are the hallmark cellular infiltrates of chronic inflammation [1]. - These cells are responsible for sustained immune responses, tissue destruction, and repair processes [2]. *Fibrosis* - **Fibrosis**, or the deposition of **collagen** by fibroblasts, is a common outcome of chronic inflammation as the body attempts to repair ongoing tissue damage [3]. - It leads to **scarring** and functional impairment of affected organs [4]. *Granulation tissue* - **Granulation tissue** is an early phase of **tissue repair** during chronic inflammation, characterized by the proliferation of **fibroblasts** and new **blood vessels (angiogenesis)** [5]. - It represents the body's effort to fill tissue defects and prepare for eventual fibrous scar formation [5]. **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. 195-196. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 107-109. [3] 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. 196-197. [4] 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. 200-202. [5] 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 395: 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 396: Which of the following does not cause granulomatous inflammation?
- A. Sarcoidosis
- B. Tuberculosis
- C. Pneumonia (Correct Answer)
- D. Histoplasmosis
Explanation: ***Pneumonia*** - **Pneumonia**, in its typical bacterial form, usually causes an **acute inflammatory response** with neutrophil infiltration in the alveoli [1], [2]. - While some atypical pneumonias can have chronic or granulomatous features, the term "pneumonia" alone generally refers to acute inflammation without granulomas. *Sarcoidosis* - **Sarcoidosis** is characterized by distinctive **non-caseating granulomas** in multiple organs, most commonly the lungs, lymph nodes, and skin [3], [4]. - The formation of these granulomas is a hallmark of the disease and is crucial for diagnosis [3]. *Tuberculosis* - **Tuberculosis** is classically characterized by the formation of **caseating granulomas** (tubercles) with central necrosis, surrounded by epithelioid macrophages and giant cells [2]. - The host immune response to *Mycobacterium tuberculosis* is primarily granulomatous, aiming to contain the infection. *Histoplasmosis* - **Histoplasmosis**, a fungal infection caused by *Histoplasma capsulatum*, often leads to the formation of **granulomas**, both caseating and non-caseating [2]. - The granulomatous response is an essential part of the host's defense mechanism against this intracellular pathogen. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 317-318. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, p. 360. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 700-701. [4] 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.
Question 397: Which of the following is/are characteristic features of chronic inflammation?
- A. Infiltration of neutrophils
- B. Tissue fibrosis and lymphocyte infiltration (Correct Answer)
- C. Increased blood flow (hyperemia)
- D. Presence of fluid accumulation (edema) in tissues
Explanation: ***Tissue fibrosis and lymphocyte infiltration*** - **Chronic inflammation** is characterized by the persistent presence of lymphocytes, plasma cells, and macrophages as the predominant inflammatory cells [1]. - **Tissue fibrosis** (scarring) and destruction are hallmarks of chronic inflammation as the body attempts to repair ongoing damage, often leading to loss of organ function [1]. *Infiltration of neutrophils* - **Neutrophils** are the primary inflammatory cells seen in **acute inflammation**, being the first responders to injury or infection [2]. - Their presence typically signifies an active, recent inflammatory process, usually resolving within hours to days. *Increased blood flow (hyperemia)* - **Hyperemia** is a classic sign of **acute inflammation**, contributing to the **redness and warmth** observed at the site. - While some vascular changes can persist in chronic inflammation, pronounced and primary hyperemia is characteristic of the acute phase. *Presence of fluid accumulation (edema) in tissues* - **Edema** primarily results from increased vascular permeability, a key feature of **acute inflammation**, causing swelling [2]. - While some edema may be present in chronic inflammation due to persistent vascular leakage, it is a dominant feature of acute inflammatory responses. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 109-110. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 103-104.
Question 398: A 30-year-old man with a history of Crohn's disease presents with abdominal pain and diarrhea. A biopsy reveals numerous non-caseating granulomas. What is the mechanism behind the formation of these granulomas?
- A. Activated macrophages secrete TNF-alpha (Correct Answer)
- B. Neutrophils release elastase and myeloperoxidase
- C. B cells produce specific antibodies against self-antigens
- D. CD8+ cytotoxic T cells are the primary mediators of granuloma formation
Explanation: ***Activated macrophages secrete TNF-alpha*** - In the formation of non-caseating granulomas, **activated macrophages** secrete **TNF-alpha**, which is crucial for granuloma formation and maintenance [2]. - These macrophages differentiate into epithelioid cells, contributing to the structure of granulomas seen in **Crohn's disease** [1][3]. *Mast cells release histamine* - While **mast cells** are involved in allergic responses and release **histamine**, they do not play a significant role in granuloma formation. - Granulomas are primarily mediated by **mononuclear phagocytes** rather than **mast cells** [1][3]. *Eosinophils form giant cells* - **Eosinophils** primarily respond to parasitic infections and allergic reactions, and their role is not to form giant cells in granulomas. - Giant cells are formed by the fusion of **activated macrophages** rather than by eosinophils [1]. *CD8+ T cells recruit neutrophils* - **CD8+ T cells** primarily target virus-infected cells and do not primarily recruit **neutrophils** for granuloma formation. - Granulomas are a result of **macrophage activation**, rather than the action of **neutrophils** and CD8+ T cells [1][2]. **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. Inflammation and Repair, pp. 105-106. [3] 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.
Question 399: What is the primary effect of the cytokine interleukin-1 on the acute phase response?
- A. Increases C-reactive protein synthesis (Correct Answer)
- B. Enhances insulin secretion
- C. Promotes fibrinogen production
- D. Enhances white blood cell production
Explanation: ***Increases C-reactive protein synthesis*** - **Interleukin-1 (IL-1)**, along with **IL-6** and **TNF-α**, is a key cytokine that stimulates hepatocytes to synthesize **acute phase proteins**, including **C-reactive protein (CRP)** [1]. - Elevated CRP levels are a hallmark of the **acute phase response**, indicating systemic inflammation or infection [1]. *Promotes fibrinogen production* - While **fibrinogen** is an acute phase reactant, its production is primarily stimulated by **IL-6**, rather than IL-1 directly [1]. - Fibrinogen plays a crucial role in **coagulation** and also contributes to the **erythrocyte sedimentation rate (ESR)**. *Enhances white blood cell production* - **Granulocyte-colony stimulating factor (G-CSF)** and **granulocyte-macrophage colony-stimulating factor (GM-CSF)** are the primary cytokines responsible for enhancing **white blood cell production** (leukopoiesis) [1]. - While IL-1 can indirectly promote the release of these factors, it is not its primary and direct effect on the acute phase response. *Enhances insulin secretion* - **Insulin secretion** is primarily regulated by **blood glucose levels** and factors like **glucagon-like peptide-1 (GLP-1)**. - IL-1 is associated with **insulin resistance** and pancreatic beta-cell dysfunction in chronic inflammation, rather than directly enhancing insulin secretion [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 111.
Question 400: Which of the following statements is MOST accurate regarding keloids?
- A. It is associated with elevated growth factors (Correct Answer)
- B. It does not extend beyond the wound
- C. It does not recur after simple excision
- D. None of the options
Explanation: ***It is associated with elevated growth factors*** - Keloids are characterized by an **overproduction of collagen** by fibroblasts [1], which is stimulated by elevated levels of various **growth factors**, such as transforming growth factor-beta (TGF-̢), platelet-derived growth factor (PDGF), and insulin-like growth factor-1 (IGF-1) - This dysregulation of growth factor signaling contributes to the **excessive fibroblast proliferation** and **extracellular matrix deposition** seen in keloids [1] - Understanding growth factor involvement is crucial for developing targeted therapies *It does not extend beyond the wound* - This statement accurately describes a **hypertrophic scar**, not a keloid - Keloids are distinguished by their **uncontrolled growth that extends beyond the original wound margins**, invading adjacent normal tissue [1] - This is the key clinical feature differentiating keloids from hypertrophic scars *It does not recur after simple excision* - This is **FALSE** - Keloids have a **very high recurrence rate** (45-100%) after simple excision alone - Treatment typically requires **combination therapy** such as excision with intralesional steroids, radiation therapy, or pressure therapy - The high recurrence rate reflects the underlying pathophysiologic abnormality that persists even after removal *None of the options* - This is incorrect because the statement about keloids being associated with **elevated growth factors** accurately describes a key aspect of their pathogenesis **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. 106-107.
Practice by Chapter
Acute Inflammation: Vascular Events
Practice Questions
Acute Inflammation: Cellular Events
Practice Questions
Chemical Mediators of Inflammation
Practice Questions
Chronic Inflammation
Practice Questions
Granulomatous Inflammation
Practice Questions
Systemic Effects of Inflammation
Practice Questions
Wound Healing
Practice Questions
Tissue Regeneration
Practice Questions
Fibrosis and Repair
Practice Questions
Resolution of Inflammation
Practice Questions
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