INFLAMMATION

1. In acute inflammation
a. A hallmark is reduced vascular permeability
b. Vasodilation is a late manifestation
c. Extravasation involves movement of leukocytes from interstitial tissue to the vessel lumen
d. Chemotaxis is migration of leukocytes along a chemical gradient
e. Selectins have a minor role

2. In acute inflammation which event occurs first

a. Arteriolar dilatation
b. Arteriolar constriction – vasodilatation follows transient arteriolar constriction lasting a few seconds
c. Oedema
d. Leucocyte migration
e. Blood flow stasis

3. The first vascular response to injury is

a. Slowing of the circulation
b. Venular dilation
c. Recruitment of vascular beds
d. Capillary engorgement
e. Arteriolar vasoconstriction – vasodilatation follows transient arteriolar constriction lasting a few
seconds

4. leukocytes move into tissues from the vasculature (extravasation)

a. by the action of actin and myosin - correct
b. predominantly as monocytes on the first day post injury - neutrophils
c. in response to C3b
d. in response to the Fc fragment of IgG
e. largely in the arterioles – in venules

5. Regarding chemical mediators of inflammation

a. Histamine is derived from plasma – and serotonin released from preformed stores from mast cells,
basophils and platelets
b. C3b is within macrophages – synthesized in liver
c. The kinin system is activated in platelets – on platelets?
d. Nitric oxide is preformed in leukocytes – short half life, lasts seconds
e. Serotonin is preformed in mast cells – actually not in humans! It is preformed and in platelets and
neuroendocrine cells

6. Chronic inflammation is
a. Always preceded by acute inflammation – no, can result from low-grade persistent insult
b. Characterized by hyperaemia, oedema and leukocyte infiltration
c. Most frequently results in resolution
d. The factors underlying monocyte infiltration are the same as for acute inflammation
e. ?
7. In the triple response the reactive hyperaemia is due to:
- something wrong with the question, reactive hyperaemia is due to an increase in blood flow after re-
establishment after occlusion. The redness in the triple response is erythema.
a. Blushing
b. Exercise
c. Arteriolar dilation – true (if the question read initial then it would be incorrect, the initial is due to
capillary dilation)
d. Inflammatory mediators
e. Still present after sympathectomy – true

Tripple response = normal response to injury w/ red reaction, wheal and flare. Reddening in 10sec
due to capillary dilation, then oedema due to permeability, then flare due to arterioloar dilation.
Because it is an axon reflex with antidromic conduction sympathectomy or higher nerve block doesn’t
effect (although local block will prevent flare)

8. regarding chronic inflammation all of the following are true EXCEPT:

a. it can be caused by persistent infections
b. it primarily involves tissue destruction
c. it may contribute to the formation of athersclerosis
d. it involves mononuclear inflammatory cells
e. it can be caused by exposure to toxic agents

9. Regarding leucocyte adhesion and transmigration during acute inflammation:

a. There is reduced binding of integrins
b. Transmigration is mediated by E-selectin
c. Leukocyte adhesion deficiency type II is associated with resistance to bacterial infection
d. Leukocyte rolling is reduced
e. There is initial redistribution of pre-formed adhesion molecules to the cell surface

10. In acute inflammation

a. Vasoconstriction is the primary event
b. Direct injury is due to histamine
c. Vascular leakage occurs mainly by formation of endothelial gaps in arterioles
d. There is outpouring of a transudate due to increased vascular permeability
e. Leukocyte dependent injury occurs mainly in arterioles

11. In chronic inflammation:

a. The most important cells are lymphocytes – are present, but macrophages more important
b. Mast cells are not involved – plasma cells are (?Mast cells)
c. Is always associated with tissue damage – associated with mononuclear cells (Macrophages),
tissue destruction and attempts at healing (angiogenesis and fibrosis)
d. The most important cells are neutrophils – monocytes -> macrophages
e. Caseous necrosis is only seen in tuberculosis – characteristic of, not indicative
12. granulomatous inflammatory reactions:
a. can be caused by syphilitic infections - true
b. are a type II hypersensitivity reaction
c. predominantly contain eosinophils with a modified “epithelial like” appearance – modified
macrophages with epithelioid appearance (enlargement and flattening)
d. are surrounded by natural killer cells
e. are not associated with inert foreign bodies – can be e.g. silicosis, foreign body granuloma around
sutures

13. Leukotrienes play a role in all of the following EXCEPT:

a. Chemotaxis
b. Vasoconstriction
c. Platelet aggreagation – don’t cause this
d. Bronchospasm – more potent than histamine
e. Increased permeability

14. Platelet activating factor

a. Is produced by platelets – this is true, also mast cells, leukocytes and endothelium
b. Induces bronchodilation - bronchoconstriction
c. Increases vascular permeability – at extremely low concentrations potent vasodilator and
increases permeability (100-10,000 more potent than histamine)
d. Decreases leukocyte adhesion - increases
e. Is not produced by mast cells

15. A preformed mediator of inflammation is:

a. Prostaglandin
b. Histamine
c. Leukotriene
d. Nitric oxide
e. Platelet activating factor

16. Interleukin 1 causes:

a. Neutropenia
b. Decreased sleep
c. Decreased prostaglandin synthesis
d. Increased collagen synthesis - Vascular endothelium and leukocytes -> inflammation
Fibroblasts (promote proliferation and collagen synthesis) -> repair, Fever, Anorexia, Lethargy,
Neutrophilia, Corticotrophin and corticosteroid release
e. Decreased leukocyte adherence

17. With regard to the acute inflammatory response, which is the most common mechanism of
vascular leakage?
a. Endothelial cell contraction
b. Junctional retraction
c. Direct injury
d. Leukocyte-dependent leakage
e. Regeneration indothelium

18. With regard to the role of complement in the acute inflammatory response, which is
INCORRECT?
a. C5a is a powerful chemotactic agent for neutrophils, monocytes and eosinophils
b. C5a increases leukocyte adhesion to endothelium by activating leukocytes
c. C3a and C5a are called anaphylatoxins because they cause mast cell degranulation
d. C3a activated the lipooxygenase pathway in leukocytes – C5a does…
e. C3 and C5 can be activated in inflammatory exudates by lysosomal enzymes

19. Granulomatous inflammation

a. May sometimes be a component of the acute inflammatory response
b. Indicates the presence of tuberculosis
c. Consists in part of microscopic aggregates of transformed lymphocytes
d. Is always associated with the presence of giant cells – often, especially if older
e. May result from non-immune mechanisms – foreign body granuloma

20. In acute inflammation, all of the following are true EXCEPT:

a. There is contraction of endothelial cells
b. There is a mononuclear infiltrate – this seems true, neutrophils first 6-24, then monocytes 24-48
c. There is induction of adhesion molecules on endothelium
d. There is production of arachadonic acid metabolites
e. Cytokines induce a systemic acute phase response

21. Cellular events in acute inflammation include all of the following EXCEPT:
a. Redistribution of preformed adhesion molecules to the cell surface of leukocytes
b. Adhesion and transmigration of leukocytes to endothelium
c. Leukocyte activation
d. Margination of macrophages to vessel walls
e. Extracellular release of lysosomal enzymes and products of arachidonic acid metabolism

22. Which is true of chronic inflammation?

a. Macrophages have a half life of 5 days
b. It commonly follows acute inflammation
c. Frequently resolves
d. It is characterized by increased vascular permeability and oedema
e. Has the same chemotactic factors as for acute inflammation

23. Which is not chemotactic?

a. Histamine – just causes vasodilatation, increased permeability (and endothelial activation)
b. C5a - powerful
c. Leukotriene B4 – main leukotriene
d. Bacterial polypeptides - true
e. Cytokines - definitiely

24. The alternative pathway of complement activation can be triggered by:

a. IgG antigen-antibody complexes
b. Properdin
c. Microbial surfaces
d. Lysosomal proteases
e. C5-9 Membrane attack complex
25. Which factor ties together activation of the clotting cascade, kinins and the fibrinolytic
system?
a. Stuart Factor
b. Prothrombin
c. Plasminogen
d. Factor XII – aka Hageman factor -> XIIa:
1. induces the intrinsic pathway,
2. prekallikrein -> kallikein
i. autocatalytic loop-> XII
ii. HMWK - > bradykinin (dilation/permeability)
iii. C5->C5a
3. pasminogen -> plasmin (fibrinolytic), plasmin also C3->C3a
e. Kallikrein

26. Which of the following statements regarding prostaglandins is INCORRECT?

a. Prostacyclin and thromboxane A2 are synthesized from the same precursor
b. Leukocyte adhesion is mediated by thromboxane A2 - selectins
c. Vasodilation is mediated by PGE
d. Vasoconstriction is mediated by LTD4
e. Chemotaxis is mediated by HETE

27. Chronic inflammation

a. Is characterized by prolonged duration and usually results in resolution
b. Is associated with structural changes in microvasculature leading to exudation of proteins
c. Is characterized by angiogenesis <- true, as part of the healing
d. Features infiltration by polymorphonuclear cells, mast cells and lymphocytes – may have infiltration
from these cells…
e. Is usually associated with markedly symptomatic response to persistent infection by certain
microorganisms – low grade response to

28. In chronic inflammation the life span of tissue macrophages is closest to:
a. 4-8 hours
b. 1 day
c. 8 days
d. 2-4 weeks
e. 2 months

29. With regard to chemical mediators of inflammation:

a. Are solely derived from plasma
b. Leukotrienes are preformed mediators
c. Nitric oxide results in vasodilation
d. Source of serotonin is leukocytes
e. Histamine results in vascular leakage

30. Regarding chemical mediators of inflammation:

a. Histamine exerts its proinflammatory effects mainly on venules – arteriolar dilation, venule leakage
b. C5a, LTB4, IL8 are chemotactic - IL8 is a chemokine
c. Fever and pain are mediated by prostaglandins, IL1, TNF and kinins (?kinins – pain, not fever)
d. Oxygen metabolites are important in host defence – definitely true
e. All of the above

31. Vascular changes in acute inflammation include:

a. Slowing of the circulation leading to leukocyte margination - true
b. Initial transient vasodilation of arterioles – initial transient arteriolar vasoconstriction
c. Decreased hydrostatic pressure caused by vasodilation - increased
d. Leakage of high protein fluid into vessels – out of
e. Increased osmotic pressure within vessels - outside

32. Leukocyte extravasation occurs in the following order:

a. Activation, rolling, transmigration, adhesion
b. Rolling, activation, adhesion, immigration
c. Adhesion, rolling, activation, transmigration
d. Rolling, activation, adhesion, transmigration
e. Transmigration, adhesion, activation, rolling

33. In acute inflammation, which is the correct sequence of events with regard to vascular
flow and caliber?
a. Vasodilation, margination, stasis, vasoconstriction
b. Vasoconstriction, stasis, margination, vasodilation
c. Vasodilation, stasis, vasoconstriction, marginaiton
d. Vasoconstriction, vasodilation, stasis, margination
e. Vasodilation, vasoconstriction, stasis, margination

34. The epithelioid cells of follicular granulomas are:

a. Reticular
b. Fibroblasts
c. Modified macrophages
d. Plasma cells
e. Lymphocytes

35. Vascular permeability in inflammation is increased by:

a. C3b and C3bI - opsinisation
b. C3b - opsinisation
c. C3a and C5a – via histamine release (anaphylatoxins)
d. C5-9 – C6-9 are important in MAC formation (multiples of C9’s)
e. C3bI – iC3b impt in opsinisation

36. Regarding acute inflammation:

a. Occurs in apoptosis
b. Increased vascular permeability resulting in increased colloid osmotic pressure and reduced
hytdrostatic pressure
c. Leukocyte migration through blood vessels is required by binding to selectin and integrin receptors
d. Causes venule dilation but not arteriole dilation
e. Typically produces transudate – normally exudate
37. Mononuclear phagocytes
a. Are the predominant cells in three day old wounds
b. Are common in liver, spleen and pancreas
c. Produce fibroblast growth factor
d. Secrete interferon-g
e. Have a half-life of one day

38. With regard to the leukocyte extravasation of the acute inflammatory response, which of
the following is INCORRECT?
a. ELAM-1 is a selectin found on endothelium – aka E-selectin
b. E and P-selectins bind to oligosaccharides found on neutrophils and monocytes
c. L-selectin is found on neutrophils, monocytes and lymphocytes
d. ICAM-1 belongs to the immunoglobulin family of molecules, and is found on leukocytes – ICAM is
an intergrin ligand found on endolthelial cells
e. VCAM-1 binds to integrins

39. Phagocytosis
a. Occurs in 2 steps – 3 steps: recognition, engulfment and killing
b. C5a is an opsonin – C3b and iC3b
c. IgM is a potent opsonin
d. Bacterial killing occurs by mainly O2 dependent mechanisms
e. Doesn’t occur without opsonisation