Inflammation and Repair Practice Questions

Q: In Rheumatoid arthritis, which type of cells are prominently present ?

Macrophages. ***Macrophages*** - **Macrophages** are abundant in the inflamed synovial tissue of patients with **rheumatoid arthritis**, contributing significantly to inflammation and joint destruction [1]. - They produce various **pro-inflammatory cytokines** (e.g., TNF-̑, IL-1, IL-6) and enzymes that degrade cartilage and bone. *B cells* - While **B cells** play a role in **rheumatoid arthritis** by producing autoantibodies like **rheumatoid factor (RF)**, they are not the most prominently present immune cell type in the synovium compared to macrophages [2]. - Their presence is often concentrated in lymphocytic aggregates within the synovium [1]. *T cells* - **T cells**, particularly **CD4+ helper T cells**, are important in orchestrating the immune response in **rheumatoid arthritis** and are found in the inflamed synovium [2]. - However, **macrophages** are generally more numerous and critical for the sustained inflammatory destruction. *Dendritic cells* - **Dendritic cells** are **antigen-presenting cells** that initiate and shape immune responses in **rheumatoid arthritis**. - While present in the synovium, their numbers are generally lower than those of **macrophages** and **T cells**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 677-678. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1212-1214.

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

Langhans giant cells. ***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.

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

Histamine. ***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.

Q: Which of the following cytokines stimulate acute phase reactants?

All of the options. ***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.

Q: Anitschkow cells are?

Modified macrophages. ***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.

Q: Leukocyte adhesion to endothelium is mediated by all except?

VCAM-4. ***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.

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

P-selectin. ***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.

Q: First mediator of inflammation to be released is

Histamine. ***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 1

In Rheumatoid arthritis, which type of cells are prominently present ?

Accepted Answer

Macrophages

Answer

B cells

Answer

T cells

Answer

Dendritic cells

Question 2

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

Accepted Answer

Langhans giant cells

Answer

Merkel cells in the skin

Answer

Natural Killer (NK) cells

Answer

Neutrophils in the immune response

Question 3

Primary granules contain which enzyme?

Accepted Answer

Myeloperoxidase (MPO)

Answer

Hydrolases

Answer

Lactoferrin

Answer

Phospholipase A2

Question 4

What is the primary mediator of vasodilatation following endothelial damage?

Accepted Answer

Histamine

Answer

IL-2

Answer

TGF-β3

Answer

FGF

Question 5

Which of the following cytokines stimulate acute phase reactants?

Accepted Answer

All of the options

Answer

IL-1

Answer

IL-6

Answer

TNF-α

Question 6

Anitschkow cells are?

Accepted Answer

Modified macrophages

Answer

Modified neutrophils

Answer

Modified B cells

Answer

Modified RBCs

Question 7

What is the definition of exudate?

Accepted Answer

Extravascular fluid that has a high protein concentration and contains cellular debris

Answer

Extravascular fluid that has a low protein concentration

Answer

Extravascular fluid with high glucose concentration

Answer

Extravascular fluid with low glucose concentration

Question 8

Leukocyte adhesion to endothelium is mediated by all except?

Accepted Answer

VCAM-4

Answer

L-selectin

Answer

VCAM-1

Answer

E-selectin

Question 9

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

Accepted Answer

P-selectin

Answer

ICAM-1

Answer

Integrin

Answer

IL-8

Question 10

First mediator of inflammation to be released is

Accepted Answer

Histamine

Answer

Nitric oxide

Answer

PAF

Answer

IL-1

Inflammation and Repair — MCQs

Inflammation and Repair — MCQs

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