Path JeopardyAcute and Chronic Inflammation

Path is Lots O’ Fun

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Topic 1: 1 point• A 22-year-old man develops marked right lower

quadrant abdominal pain over the past day. On physical examination there is rebound tenderness on palpation over the right lower quadrant. Laparoscopic surgery is performed, and the appendix is swollen, erythematous, and partly covered by a yellowish exudate. It is removed, and a microscopic section shows infiltration with numerous neutrophils. The pain experienced by this patient is predominantly the result of the formation of two chemical mediators.

Prostaglandin and Bradykinin

Topic 1: 2 points• A 40-year-old woman had bilateral silicone

breast implants placed two years ago. Since that time, she has noted increased firmness with slight deformity of the breast on the left. The implants are removed, and there is evidence for leakage of the implant contents on the left. This cell type is the most characteristic of the inflammatory response in this situation.

Giant Cell

Topic 1: 3 points• A clinical study is performed of patients with

pharyngeal infections. Most of these patients experience fever and chills. On physical examination, the most common findings include swelling, erythema, and pharyngeal purulent exudate. Which of the following types of inflammation did these patients most likely have?

Acute Inflammation

Topic 1: 4 points• A 20-year-old man has experienced painful

urination for 4 days following spring break. Urethritis is suspected, and Neisseria gonorrheae is cultured. Numerous neutrophils are present in a smear of the exudate from the penile urethra. These neutrophils undergo diapedesis to reach the organisms. Release of this chemical mediator is most likely to drive neutrophil exudation.

Complement C5a

Topic 1: 5 points

An episode of marked chest pain brings a 51-year-old man to the emergency room. An angiogram reveals a complete blockage of the left circumflex artery. This substance is elaborated around the region of tissue damage in the next 3 days as an initial response to increase myocardial function and promote healing?

Vascular Endothelial Growth Factor (VEGF)

Topic 2: 1 pointA 90-year-old woman has developed a fever and

cough over the past 2 days. Staphylococcus aureus is cultured from her sputum. She receives a course of antibiotic therapy. Two weeks later she no longer has a productive cough, but she still has a fever. A chest radiograph reveals a 3 cm rounded density whose liquefied contents form a central air-fluid level. This is the most likely outcome

Abscess formation

Topic 2: 2 pointsA 35-year-old woman has been taking aspirin for

arthritis for the past 4 years. Her joint pain is temporarily reduced. Radiographs of her knees reveals continuing joint destruction with loss of articular cartilage and joint space narrowing. This pain reduction is most likely to be the result of this diminishing chemical mediator.

Prostaglandin

Topic 2: 3 pointsAn inflammatory process that has continued for 3

months includes the transformation of tissue macrophages to epithelioid cells. There are also lymphocytes present. Over time, fibroblasts lay down collagen as the focus of inflammation heals. These events occur as an inflammatory response to this infectious agent.

Mycobacterium tuberculosis

Topic 2: 4 pointsA 37-year-old man has had nausea and vomiting

for 5 weeks. On physical examination he has no abnormal findings. Upper GI endoscopy is performed, and there is a 1.5 cm diameter lesion in the gastric antrum with loss of the epithelial surface. These findings are most typical for this pathologic process.

Ulcer

Topic 2: 5 pointsA 15-year-old girl has had episodes of sneezing

with watery eyes and runny nose for the past 2 weeks. She has had similar episodes each spring and summer when the amount of ragweed pollen in the air is high. Her symptoms are most likely to be mediated by the release of this chemical mediator.

Histamine

Topic 3: 1 pointThis is excess interstitial fluid that can be

classified as a transudate or exudate.

Edema

Topic 3: 2 pointsThis is one of the earliest manifestations

of acute inflammation.

Vasodilation

Topic 3: 3 pointsWithin minutes following a bee sting, a 37-year-

old man develops marked respiratory stridor with dyspnea and wheezing. He also develops swelling and erythema seen in his arms and legs. An injection of epinephrine helps to reverse these events and he recovers within minutes. This chemical mediator is most important in the pathogenesis of this man's condition.

Histamine

Topic 3: 4 pointsThese are the characteristics of an exudate.

Inflammatory extravascular fluid High protein concentrationSpecific gravity > 1.020Usually due to permeability

Topic 3: 5 points• These are characteristics of a transudate.

Fluid with low protein concentrationSpecific gravity < 1.012Permeability usually not increased

Topic 4: 1 point

This is the hallmark of acute inflammation.

Increased vascular permeability

Topic 4: 2 points

This is the increased transport of fluids and proteins through the endothelial cell.

Transcytosis

Topic 4: 3 pointsA 9-year-old girl sustains a small 0.5 cm long laceration

to her right index finger while playing "Queen of Swords" with a letter opener. This substances, on contact with injured vascular basement membrane, activates both the coagulation sequence and the kinin system as an initial response to this injury.

Hageman Factor (XII)

Topic 4: 4 points

This is the journey of the leukocyte (four steps).

MarginationRolling

AdhesionMigration

Topic 4: 5 pointsDuring the first 6-24 hours, this cell will

be the predominant cell type in acute inflammation.

Neutrophil