Inflammation and Repair — MCQs

Inflammation and Repair Indian Medical PG Practice Questions and MCQs

Question 401: 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.

Question 402: Which of the following cytokines stimulate acute phase reactants?

A. IL-1
B. All of the options (Correct Answer)
C. IL-6
D. TNF-α

Explanation: ***All of the above*** - Acute phase reactants are stimulated by various **cytokines**, including IL-6, TNF-α, and IL-1, highlighting a coordinated immune response [1]. - The presence of multiple cytokines indicates that a range of **inflammatory processes** contributes to the activation of the acute phase response [1]. *IL-6* - While IL-6 is indeed a **key mediator** in acute phase reactions, it is not the only cytokine responsible for stimulating this response [1]. - Other cytokines like **TNF-α** and **IL-1** also play significant roles, making this option incomplete [1][2]. *TNF-a* - TNF-α is a crucial cytokine that can stimulate acute phase reactants, but it does not act alone in this process [2]. - The role of **multiple cytokines** (including IL-6 and IL-1) makes this option insufficient on its own [1]. *IL-1* - IL-1 is known to activate acute phase reactants, but similar to the others, it is **not the sole factor** and works in conjunction with other cytokines [2]. - Therefore, like TNF-α and IL-6, its contribution alone does not capture the complete picture [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 97-99. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 110-111.

Question 403: Primary granules contain which enzyme?

A. Hydrolases
B. Lactoferrin
C. Phospholipase A2
D. Myeloperoxidase (MPO) (Correct Answer)

Explanation: ***Myeloperoxidase*** - Primary granules of neutrophils predominantly contain **myeloperoxidase** [1], which is crucial for converting hydrogen peroxide into hypochlorous acid during the respiratory burst [2]. - This enzyme plays a significant role in the **antimicrobial activity** of neutrophils, aiding in the destruction of pathogens [1] [3]. *Hydrolases* - While hydrolases are enzymes that catalyze hydrolysis processes, they are primarily found in **secondary granules**, not in primary granules. - They do not specifically define the primary granule contents, which are mainly involved in **bacterial killing**. *Phospholipase A2* - Phospholipase A2 is involved in the **releasing fatty acids** from phospholipids but is not a major component of the primary granules. - This enzyme is predominantly associated with **inflammatory processes**, not directly with the granule content being questioned. *Lactoferrin* - Lactoferrin is an antimicrobial protein commonly found in **neutrophil secondary granules** and is involved in iron binding and limiting bacterial growth. - It is not a component of primary granules, which are more focused on **enzymes like myeloperoxidase** for immediate defense [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 91-92. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 91. [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. 190-191.

Question 404: What is the primary mediator of vasodilatation following endothelial damage?

A. IL-2
B. TGF-β3
C. FGF
D. Histamine (Correct Answer)

Explanation: ***Histamine*** - Histamine is a ** potent vasodilator** released during endothelial damage, leading to increased vascular permeability and blood flow [1]. - It causes **smooth muscle relaxation** in the blood vessels, contributing to vasodilatation [1]. - Histamine is one of the most important mediators of acute inflammation, normally sequestered in intracellular granules and rapidly secreted by granule exocytosis from mast cells [2]. *TGF-3* - Transforming growth factor-beta 3 (TGF-3) primarily plays a role in **cell differentiation and inflammation**, rather than immediate vasodilatation. - It is not directly involved in the acute vascular response to endothelial injury. *IL-2* - Interleukin-2 (IL-2) is mainly associated with **T-cell proliferation** and activation in the immune response, not with vasodilatation. - Its effects are more related to **adaptive immunity** rather than direct vascular effects. *FGF* - Fibroblast growth factor (FGF) is involved in **angiogenesis** and tissue repair but does not induce immediate vasodilatation post-endothelial damage. - It primarily promotes **cell proliferation** and differentiation rather than causing direct vasodilatation. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 84-85. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 93-94.

Question 405: Nuclei are arranged at the cell periphery in which type of cell?

A. Langhans giant cells (Correct Answer)
B. Merkel cells in the skin
C. Natural Killer (NK) cells
D. Neutrophils in the immune response

Explanation: ***Langhans giant cells*** - These are **multinucleated giant cells** formed by the fusion of multiple epithelioid macrophages. - Their nuclei typically form a **horseshoe or ring-like arrangement** at the periphery of the cell cytoplasm. *Merkel cells in the skin* - Merkel cells are **neuroendocrine cells** found in the basal layer of the epidermis. - They possess a **single, irregularly lobed nucleus** and are associated with touch sensation, not multiple peripheral nuclei. *Natural Killer (NK) cells* - NK cells are **lymphocytes** characterized by a **single, round nucleus** and granular cytoplasm. - Their primary function is to kill infected or cancerous cells, and their nuclear arrangement is not peripheral. *Neutrophils in the immune response* - Neutrophils are **polymorphonuclear leukocytes** with a characteristic **multi-lobed nucleus**. - While the nucleus is segmented, it is not arranged peripherally in a ring, but rather centrally within the cell.

Question 406: Anitschkow cells are?

A. Modified neutrophils
B. Modified B cells
C. Modified RBCs
D. Modified macrophages (Correct Answer)

Explanation: ***Modified macrophages*** - Antischkow cells are indeed **modified macrophages**, specifically found in the context of **rheumatic fever** [1]. - They are associated with **Aschoff bodies** and play a role in the **immune response** in the heart tissue [1]. *Modified neutrophils* - Neutrophils are primarily involved in **acute inflammatory responses**, not chronic conditions like those associated with Antischkow cells. - They do not exhibit the characteristic features or roles in **rheumatic fever** pathology that Antischkow cells do. *Modified B cells* - B cells primarily function in **humoral immunity** producing antibodies, whereas Antischkow cells are related to **macrophagic activity**. - They do not share the same histopathological significance in the context of rheumatic heart disease. *Modified RBCs* - Red blood cells (RBCs) lack nuclei and are not involved in the immune response, unlike macrophages. - Antischkow cells' characteristics are unrelated to any modifications related to RBCs' function or pathology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Heart, p. 566.

Question 407: Leukocyte adhesion to endothelium is mediated by all except?

A. L-selectin
B. VCAM-1
C. E-selectin
D. VCAM-4 (Correct Answer)

Explanation: ***VCAM 4*** - **VCAM-4** is not a recognized mediator for leukocyte adhesion; instead, **VCAM-1** plays a significant role in this process. - Adhesion is primarily mediated by interactions between leukocyte integrins and endothelial **selectins** and **VCAM-1** [1]. *E selectin* - **E selectin** is involved in the adhesion of leukocytes to endothelium, particularly during inflammation [1]. - It helps in the adhesion process during the **rolling** phase of leukocyte extravasation [2]. *L selectin* - **L selectin** is crucial for the initial adhesion of leukocytes to the **high endothelial venules** in lymphoid tissues [1]. - It facilitates leukocyte **homing** to lymphoid organs, aiding in a variety of immune responses. *VCAM 1* - **VCAM-1** is a key adhesion molecule that facilitates the binding of leukocytes to endothelial cells, particularly in inflammation [3]. - Interacts with the integrin **VLA-4** on leukocytes, promoting firm adhesion during the immune response. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 87. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Migration in the tissues toward a chemotactic stimulus, pp. 86-87. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 87-89.

Question 408: What is the definition of exudate?

A. Extravascular fluid that has a high protein concentration and contains cellular debris (Correct Answer)
B. Extravascular fluid that has a low protein concentration
C. Extravascular fluid with high glucose concentration
D. Extravascular fluid with low glucose concentration

Explanation: ***Extravascular fluid that has a high protein concentration and contains cellular debris*** [1] - Exudate is typically characterized by a **high protein concentration**, indicating an inflammatory process. - It often contains **cellular debris**, reflecting tissue damage and infection. *Extravascular fluid with low glucose concentration* - Low glucose concentration is more indicative of **infectious processes** but does not define exudate. - Exudates can have varying glucose levels depending on the underlying condition. *Extravascular fluid that has a low protein concentration* - This description better fits **transudate**, which occurs due to systemic factors like hydrostatic pressure [1]. - Exudate, by definition, has a **high protein concentration**, showing its difference from transudate [1]. *Extravascular fluid with high glucose concentration* - High glucose concentration typically indicates an **absence of infection or inflammation**, inconsistent with exudate. - Exudates are usually associated with low glucose levels due to cellular metabolism in inflammatory conditions. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 84-85.

Question 409: First mediator of inflammation to be released is

A. Nitric oxide
B. PAF
C. Histamine (Correct Answer)
D. IL-1

Explanation: ***Histamine*** - Histamine is the **first mediator of inflammation released** by mast cells and basophils during an allergic or inflammatory response [1][3]. - It promotes **vasodilation** and increased vascular permeability, leading to typical symptoms of inflammation [1][2]. *PAF* - Platelet-activating factor (PAF) is released later in the inflammatory process and is primarily involved in **amplifying** the response rather than initiating it. - It plays a role in **platelet aggregation** and acting on vascular smooth muscle but is not the first released mediator. *Nitric oxide* - Nitric oxide is produced by endothelial cells and plays a role in **vascular relaxation and inflammation**, but it is not among the first mediators released. - It is involved in more **regulatory functions** in the inflammatory response rather than the initial trigger. *IL-1* - Interleukin-1 (IL-1) is a cytokine that is important for the **inflammatory response**, but it is produced after the initial release of mediators like histamine [2]. - It is primarily secreted by **activated macrophages** and contributes to the **amplification** of the immune response [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 84-85. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 101. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 93-94.

Question 410: Rolling of leucocytes on endothelial cells is mediated by which of the following?

A. ICAM-1
B. Integrin
C. IL-8
D. P-selectin (Correct Answer)

Explanation: ***P- selectin*** - P-selectin is a **cell adhesion molecule** crucial for the **rolling** of leukocytes on endothelial cells during the inflammatory response [1]. - It is expressed on activated endothelial cells and binds to **sialylated carbohydrates** on leukocytes, facilitating their transient adhesion [1]. *IL-8* - IL-8 is a **chemokine** that primarily acts as a chemotactic factor for neutrophils rather than mediating rolling on endothelium. - While it attracts leukocytes to sites of inflammation, it does not play a role in the initial contact or rolling process. *ICAM-1* - ICAM-1 is an **intercellular adhesion molecule** that facilitates **firm adhesion** rather than rolling of leukocytes. - It primarily interacts with **integrins** on leukocytes to stabilize their adhesion after rolling has occurred. *(3, integrin* - Integrins play a significant role in **firm adhesion** and not the rolling phase, interacting with receptors like ICAM-1. - The binding of integrins to their ligands occurs after leukocytes have initially rolled on the endothelium. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 87.

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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