Pathology (Robbins) Chapter 3 Acute
and Chronic Inflammation
1. 1 In a 6-month randomized trial of a pharmacologic agent, one group of patients
receives a cyclooxygenase-2 (COX-2) inhibitor, and a control group does not.
Laboratory measurements during the trial show no significant differences between the
groups in WBC count, platelet count, hemoglobin, and creatinine. The group receiving
the drug reports subjective findings different from those of the control group, however.
Which of the following findings was most likely reported by the group receiving the
drug?
□ (A) Ankle swelling □ (B) Increased bouts of asthma □ (C) Easy bruisability □ (D)
Reduced urticaria □ (E) Increased febrile episodes □ (F) Reduced arthritis pain - correct
answers 1 (F) Reduced arthritis pain. The COX-2 (cyclooxygenase-2) enzyme is
inducible with acute inflammatory reactions, particularly in neutrophils, in synovium, and
in the central nervous system. The cyclooxygenase pathway of arachidonic acid
metabolism generates prostaglandins, which mediate pain, fever, and vasodilation.
Ankle swelling is most likely to result from peripheral edema secondary to congestive
heart failure.
Asthma results from bronchoconstriction mediated by leukotrienes that are generated
by the lipoxygenase pathway of arachidonic acid metabolism.
Easy bruisability results from prolonged glucocorticoid administration, which also
causes leukopenia.
Inhibition of histamine released from mast cells helps reduce urticaria.
Fever can be mediated by prostaglandin release, not inhibition.
1. An experiment introduces bacteria into a perfused tissue preparation. Leukocytes
leave the vasculature and migrate to the site of bacterial inoculation. The movement of
these leukocytes is most likely to be mediated by which of the following substances?
□ (A) Bradykinin
□ (B) Chemokines
□ (C) Histamine
□ (D) Prostaglandins
□ (E) Complement C3a - correct answers 2(B) Chemokines include many molecules
that are chemotactic for neutrophils, eosinophils, lymphocytes, monocytes, and
basophils.
,Bradykinin causes pain and increased vascular permeability.
Histamine causes vascular leakage, and prostaglandins have multiple actions, but they
do not cause chemotaxis.
Complement C3a causes increased vascular permeability by releasing histamine from
mast cells.
1. 3 A 53-year-old woman has had a high fever and cough productive of yellowish
sputum for the past 2 days. Her vital signs include temperature of 37.8°C (100 F), pulse
of 83/min, respirations of 17/min, and blood pressure of 100/60 mm Hg. On auscultation
of the chest, crackles are audible in both lung bases. A chest radiograph shows bilateral
patchy pulmonary infiltrates and fluid in the right pleural cavity. Thoracentesis yields 500
mL of cloudy yellow fluid. Which of the following inflammatory cell types is most likely to
be seen in greatly increased numbers in a sputum specimen? □ (A) Macrophages □ (B)
Neutrophils □ (C) Mast cells □ (D) Small lymphocytes □ (E) Langhans giant cells -
correct answers 3 (B) Neutrophils- The patient's signs and symptoms suggest acute
bacterial pneumonia. Such infections induce an acute inflammation dominated by
neutrophils, which gives the sputum its yellowish, purulent appearance.
Macrophages become more numerous after acute events, cleaning up tissue and
bacterial debris through phagocytosis.
Mast cells are better known as participants in allergic and anaphylactic responses.
Lymphocytes are a feature of chronic inflammation.
Langhans giant cells are seen with granulomatous inflammatory responses. ( Langhans
giant cells are large cells found in granulomatous conditions.)
1. 4 A 63-year-old man develops worsening congestive heart failure 2 weeks after an
acute myocardial infarction. An echocardiogram shows a markedly decreased ejection
fraction. He dies 1 day later. At autopsy, a section of the infarct shows that the necrotic
myocardium has largely been replaced by capillaries, fibroblasts, and collagen. Various
inflammatory cells are present. Which of the following inflammatory cell types in this
lesion plays the most important role in the healing process? □ (A) Macrophages □ (B)
Plasma cells □ (C) Neutrophils □ (D) Eosinophils □ (E) Epithelioid cells - correct
answers (A) Macrophages, present in such lesions, play a prominent role in the healing
process. Activated macrophages can secrete various cytokines that promote
angiogenesis and fibrosis, including platelet-derived growth factor, fibroblast growth
factor, interleukin-1, and tumor necrosis factor.
Plasma cells can secrete immunoglobulins and are not instrumental to healing of an
area of tissue injury.
Neutrophils are most numerous within the initial 48 hours after infarction, but are not
numerous after the first week.
, Eosinophils are most prominent in allergic inflammations and in parasitic infections.
Epithelioid cells, which are aggregations of activated macrophages, are typically seen
with granulomatous inflammation. The healing of acute inflammatory processes does
not involve granulomatous inflammation.
**Granulomatous inflammation is a histologic pattern of tissue reaction which appears
following cell injury. Granulomatous inflammation is caused by a variety of conditions
including infection, autoimmune, toxic, allergic, drug, and neoplastic conditions.**
1. 5 A 10-year-old child developed a sore throat and fever over 24 hours. Physical
examination shows pharyngeal erythema and swelling. Laboratory findings include
leukocytosis. The child is given acetylsalicylic acid (aspirin). Which of the following
features of the inflammatory response is most affected by this drug? □ (A) Vasodilation
□ (B) Chemotaxis □ (C) Phagocytosis □ (D) Emigration of leukocytes □ (E) Release of
leukocytes from bone marrow - correct answers 5(A) Vasodilation- Aspirin
(acetylsalicylic acid) blocks the cyclooxygenase pathway of arachidonic acid
metabolism, which leads to reduced prostaglandin generation. Prostaglandins promote
vasodilation at sites of inflammation.
Chemotaxis is a function of various chemokines, and complement C3b may promote
phagocytosis, but neither is affected by aspirin.
Leukocyte emigration is aided by various adhesion molecules.
Leukocyte release from the marrow can be driven by the cytokines interleukin-1 and
tumor necrosis factor.
1. 6 A woman who is allergic to cats visits a neighbor who has several cats. During the
visit, she inhales cat dander, and within minutes, she develops nasal congestion with
abundant nasal secretions. Which of the following substances is most likely to produce
these findings? □ (A) Bradykinin □ (B) Complement C5a □ (C) Histamine □ (D)
Interleukin-1 □ (E) Phospholipase C □ (F) Platelet-activating factor □ (G) Tumor necrosis
factor - correct answers 6 (C) Histamine is found in abundance in mast cells, which are
normally present in connective tissues next to blood vessels beneath mucosal surfaces
in airways. Binding of an antigen (allergen) to IgE antibodies that have previously
attached to the mast cells by the Fc receptor triggers mast cell degranulation, with
release of histamine. This response causes increased vascular permeability and
mucous secretions.
Bradykinin, generated from the kinin system on surface contact of Hageman factor
(Factor XII) with collagen and basement membrane from vascular injury, promotes
vascular permeability, smooth muscle contraction, and pain.
Complement C5a is a potent chemotactic factor for neutrophils.
Interleukin-1 and tumor necrosis factor, both produced by activated macrophages,
mediate many systemic effects, including fever, metabolic wasting, and hypotension.
and Chronic Inflammation
1. 1 In a 6-month randomized trial of a pharmacologic agent, one group of patients
receives a cyclooxygenase-2 (COX-2) inhibitor, and a control group does not.
Laboratory measurements during the trial show no significant differences between the
groups in WBC count, platelet count, hemoglobin, and creatinine. The group receiving
the drug reports subjective findings different from those of the control group, however.
Which of the following findings was most likely reported by the group receiving the
drug?
□ (A) Ankle swelling □ (B) Increased bouts of asthma □ (C) Easy bruisability □ (D)
Reduced urticaria □ (E) Increased febrile episodes □ (F) Reduced arthritis pain - correct
answers 1 (F) Reduced arthritis pain. The COX-2 (cyclooxygenase-2) enzyme is
inducible with acute inflammatory reactions, particularly in neutrophils, in synovium, and
in the central nervous system. The cyclooxygenase pathway of arachidonic acid
metabolism generates prostaglandins, which mediate pain, fever, and vasodilation.
Ankle swelling is most likely to result from peripheral edema secondary to congestive
heart failure.
Asthma results from bronchoconstriction mediated by leukotrienes that are generated
by the lipoxygenase pathway of arachidonic acid metabolism.
Easy bruisability results from prolonged glucocorticoid administration, which also
causes leukopenia.
Inhibition of histamine released from mast cells helps reduce urticaria.
Fever can be mediated by prostaglandin release, not inhibition.
1. An experiment introduces bacteria into a perfused tissue preparation. Leukocytes
leave the vasculature and migrate to the site of bacterial inoculation. The movement of
these leukocytes is most likely to be mediated by which of the following substances?
□ (A) Bradykinin
□ (B) Chemokines
□ (C) Histamine
□ (D) Prostaglandins
□ (E) Complement C3a - correct answers 2(B) Chemokines include many molecules
that are chemotactic for neutrophils, eosinophils, lymphocytes, monocytes, and
basophils.
,Bradykinin causes pain and increased vascular permeability.
Histamine causes vascular leakage, and prostaglandins have multiple actions, but they
do not cause chemotaxis.
Complement C3a causes increased vascular permeability by releasing histamine from
mast cells.
1. 3 A 53-year-old woman has had a high fever and cough productive of yellowish
sputum for the past 2 days. Her vital signs include temperature of 37.8°C (100 F), pulse
of 83/min, respirations of 17/min, and blood pressure of 100/60 mm Hg. On auscultation
of the chest, crackles are audible in both lung bases. A chest radiograph shows bilateral
patchy pulmonary infiltrates and fluid in the right pleural cavity. Thoracentesis yields 500
mL of cloudy yellow fluid. Which of the following inflammatory cell types is most likely to
be seen in greatly increased numbers in a sputum specimen? □ (A) Macrophages □ (B)
Neutrophils □ (C) Mast cells □ (D) Small lymphocytes □ (E) Langhans giant cells -
correct answers 3 (B) Neutrophils- The patient's signs and symptoms suggest acute
bacterial pneumonia. Such infections induce an acute inflammation dominated by
neutrophils, which gives the sputum its yellowish, purulent appearance.
Macrophages become more numerous after acute events, cleaning up tissue and
bacterial debris through phagocytosis.
Mast cells are better known as participants in allergic and anaphylactic responses.
Lymphocytes are a feature of chronic inflammation.
Langhans giant cells are seen with granulomatous inflammatory responses. ( Langhans
giant cells are large cells found in granulomatous conditions.)
1. 4 A 63-year-old man develops worsening congestive heart failure 2 weeks after an
acute myocardial infarction. An echocardiogram shows a markedly decreased ejection
fraction. He dies 1 day later. At autopsy, a section of the infarct shows that the necrotic
myocardium has largely been replaced by capillaries, fibroblasts, and collagen. Various
inflammatory cells are present. Which of the following inflammatory cell types in this
lesion plays the most important role in the healing process? □ (A) Macrophages □ (B)
Plasma cells □ (C) Neutrophils □ (D) Eosinophils □ (E) Epithelioid cells - correct
answers (A) Macrophages, present in such lesions, play a prominent role in the healing
process. Activated macrophages can secrete various cytokines that promote
angiogenesis and fibrosis, including platelet-derived growth factor, fibroblast growth
factor, interleukin-1, and tumor necrosis factor.
Plasma cells can secrete immunoglobulins and are not instrumental to healing of an
area of tissue injury.
Neutrophils are most numerous within the initial 48 hours after infarction, but are not
numerous after the first week.
, Eosinophils are most prominent in allergic inflammations and in parasitic infections.
Epithelioid cells, which are aggregations of activated macrophages, are typically seen
with granulomatous inflammation. The healing of acute inflammatory processes does
not involve granulomatous inflammation.
**Granulomatous inflammation is a histologic pattern of tissue reaction which appears
following cell injury. Granulomatous inflammation is caused by a variety of conditions
including infection, autoimmune, toxic, allergic, drug, and neoplastic conditions.**
1. 5 A 10-year-old child developed a sore throat and fever over 24 hours. Physical
examination shows pharyngeal erythema and swelling. Laboratory findings include
leukocytosis. The child is given acetylsalicylic acid (aspirin). Which of the following
features of the inflammatory response is most affected by this drug? □ (A) Vasodilation
□ (B) Chemotaxis □ (C) Phagocytosis □ (D) Emigration of leukocytes □ (E) Release of
leukocytes from bone marrow - correct answers 5(A) Vasodilation- Aspirin
(acetylsalicylic acid) blocks the cyclooxygenase pathway of arachidonic acid
metabolism, which leads to reduced prostaglandin generation. Prostaglandins promote
vasodilation at sites of inflammation.
Chemotaxis is a function of various chemokines, and complement C3b may promote
phagocytosis, but neither is affected by aspirin.
Leukocyte emigration is aided by various adhesion molecules.
Leukocyte release from the marrow can be driven by the cytokines interleukin-1 and
tumor necrosis factor.
1. 6 A woman who is allergic to cats visits a neighbor who has several cats. During the
visit, she inhales cat dander, and within minutes, she develops nasal congestion with
abundant nasal secretions. Which of the following substances is most likely to produce
these findings? □ (A) Bradykinin □ (B) Complement C5a □ (C) Histamine □ (D)
Interleukin-1 □ (E) Phospholipase C □ (F) Platelet-activating factor □ (G) Tumor necrosis
factor - correct answers 6 (C) Histamine is found in abundance in mast cells, which are
normally present in connective tissues next to blood vessels beneath mucosal surfaces
in airways. Binding of an antigen (allergen) to IgE antibodies that have previously
attached to the mast cells by the Fc receptor triggers mast cell degranulation, with
release of histamine. This response causes increased vascular permeability and
mucous secretions.
Bradykinin, generated from the kinin system on surface contact of Hageman factor
(Factor XII) with collagen and basement membrane from vascular injury, promotes
vascular permeability, smooth muscle contraction, and pain.
Complement C5a is a potent chemotactic factor for neutrophils.
Interleukin-1 and tumor necrosis factor, both produced by activated macrophages,
mediate many systemic effects, including fever, metabolic wasting, and hypotension.
