a = new Array(341);
var f = "<FONT FACE=ARIAL SIZE=2>"
a[0] = ""
a[1] = f + "(A) Incorrect. These two compounds can act as opsonins."
a[2] = f + "(B) Incorrect. Il-1 and TNF act to produce fever."
a[3] = f + "(C) Incorrect. These are vasodilators."
a[4] = f + "(D) CORRECT. The findings are those of acute appendicitis. The acute inflammation is marked by neutrophil exudation. Release of a variety of chemical mediators results in the findings associated with inflammation: calor (warmth), rubur (erythema), tumor (swelling), dolor (pain). Aspirin, by inhibiting the cyclooxygenase pathway, can decrease prostaglandin synthesis."
a[5] = f + "(E) Incorrect. These products of the lipooxygenase pathway promote chemotaxis of inflammatory cells such as the neutrophils."
a[6] = f + "(A) Incorrect. Mast cells are not numerous in tissues and do not proliferate significantly as part of a foreign body inflammatory response."
a[7] = f + "(B) Incorrect. Eosinophils are typical of parasitic and allergic inflammatory responses, not of inflammatory responses to foreign bodies."
a[8] = f + "(C) CORRECT. The silicone is a foreign material and produces a foreign body reaction. Persistence of the stimulus recruits macrophages that are activated and transformed to giant cells, in this case foreign body giant cells."
a[9] = f + "(D) Incorrect. A few neutrophils can be present, but giant cells are more specific for a foreign body inflammatory response."
a[10] = f + "(E) Incorrect. Plasma cells are more typical for chronic inflammation."
a[11] = f + "(A) Incorrect. Cardiac output may determine if the patient survives, but not whether the skin regenerates. Tissue perfusion is needed to maintain all tissues, not just the skin."
a[12] = f + "(B) CORRECT. The skin appendages have epithelium from which the surface epidermis can regenerate. This is why a full thickness burn is much worse."
a[13] = f + "(C) Incorrect. Even if collagen is present, the skin may still not regenerate."
a[14] = f + "(D) Incorrect. These features by themselves give no indication of the prognosis."
a[15] = f + "(E) Incorrect. Regeneration is dependent upon the presence of remaining epithelium."
a[16] = f + "(A) Incorrect. Platelet activating factor leads to leukocyte aggregation, adhesion, and chemotaxis, but does not directly facilitate bacterial destruction."
a[17] = f + "(B) Incorrect. Prostaglandins potentiate vasodilation, but not neutrophil function."
a[18] = f + "(C) Incorrect. Kallikrein is released from neutrophil lysosomes and promotes bradykinin formation, leading to vasodilation."
a[19] = f + "(D) Incorrect. Leukotrienes promote vascular permeability, but not leukocyte function."
a[20] = f + "(E) CORRECT. Hydrogen peroxide is reduced by myeloperoxidase to a powerful oxidant that kills bacteria. She has an acute inflammatory response to a bacterial organism, and the majority of inflammatory cells responding will be neutrophils."
a[21] = f + "(A) Incorrect. Granulomatous inflammation typically pursues a course over months to years, and the most important inflammatory cell is an activated macrophage."
a[22] = f + "(B) CORRECT. The short course of days and the purulent exudate are typical features of acute inflammation with a neutrophilic response."
a[23] = f + "(C) Incorrect. An abscess usually takes a bit longer to form as a resolution to acute inflammation, and the purulent exudate is localized within the abscess cavity, where liquefaction occurs."
a[24] = f + "(D) Incorrect. With complete resolution, the purulent exudate should be removed, and the course to this point would probably be longer. The process may resolve to an abscess, become more chronic, or lead to scarring."
a[25] = f + "(E) Incorrect. Chronic inflammation generally pursues a course of weeks. Purulent exudate is not typical for chronic inflammation, where the predominant cell types are mononuclears: lymphocytes, monocyte-macrophages, plasma cells."
a[26] = f + "(A) Incorrect. Leukotrienes are more important mediators in acute inflammation, leading to chemotaxis and increased vascular permeability, among other functions."
a[27] = f + "(B) Incorrect. Foreign body giant cells are not a significant feature of silicosis."
a[28] = f + "(C) Incorrect. Plasma cell proliferation is not a key feature of silicosis or other pneumoconioses."
a[29] = f + "(D) Incorrect. This is an acute inflammatory response, but a chronic process, and he has no fever."
a[30] = f + "(E) CORRECT. Growth factors are released from macrophages that have ingested silica crystals, and these factors stimulate collagen production by fibroblasts, producing interstitial fibrosis and nodule formation that reduces the amount of normal lung parenchyma and makes breathing more difficult."
a[31] = f + "(A) Incorrect. Increased immunoglobulin production from plasma cells takes time and is a feature of chronic inflammatory processes."
a[32] = f + "(B) CORRECT. This mediator of acute inflammation promotes labor through its effects on smooth muscle and blood vessels."
a[33] = f + "(C) Incorrect. Complement components are not as important as the prostaglandins in this setting."
a[34] = f + "(D) Incorrect. Fibrinogen is converted to fibrin during coagulation."
a[35] = f + "(E) Incorrect. Lymphokines such as TNF and interleukins have a greater effect in producing fever."
a[36] = f + "(A) Incorrect. Obstruction of the arterial supply of blood to the foot would be necessary for necrosis to occur, and this patient has evidence for venous thrombosis. Necrosis from venous stasis is rare."
a[37] = f + "(B) Incorrect. She has thrombosis, but this does not typically lead to vascular rupture."
a[38] = f + "(C) Incorrect. DIC is unlikely to occur with large venous vessel thrombosis."
a[39] = f + "(D) CORRECT. She has deep and superficial venous thrombosis as a consequence of venous stasis from immobilization following the accident. The large deep venous thrombi can embolize to the lungs and lead to death."
a[40] = f + "(E) Incorrect. Thrombosis does not predispose to neoplasia."
a[41] = f + "(A) CORRECT. Epithelioid cells and giant cells are derived from activated macrophages. Tissue macrophages are derived from blood monocytes. These cells are important in the development of granulomatous inflammation."
a[42] = f + "(B) Incorrect. Although collagen is laid down around a granuloma as part of the response, it is not the major component involved in granuloma formation."
a[43] = f + "(C) Incorrect. Although some neutrophils may be present in a granuloma, they are not the major contributors to granuloma formation."
a[44] = f + "(D) Incorrect. Mast cells are few in number. They are involved in release of mediators primarily in acute inflammatory responses."
a[45] = f + "(E) Incorrect. Platelets are mainly involved in coagulation."
a[46] = f + "(A) Incorrect. Histamine increases vascular permeability and promotes vasodilation."
a[47] = f + "(B) Incorrect. Prostaglandin is more important as a mediator of inflammation in producing pain, vascular permeability, and vasodilation."
a[48] = f + "(C) Incorrect. Hageman factor is Factor XII of the coagulation sequence and is activated by contact with collagen and basement membrane in damaged tissues."
a[49] = f + "(D) Incorrect. Bradykinin, a product of the kinin system and derived from high molecular weight kininogen, causes pain and promotes vasodilation and vascular permeability."
a[50] = f + "(E) CORRECT. The C5a component of complement, along with TNF, leukotrienes, and bacterial products is chemotactic for neutrophils."
a[51] = f + "(A) Incorrect. Histamine produces vasodilation as part of an immediate inflammatory response. It is not part of the healing process."
a[52] = f + "(B) Incorrect. Immunoglobulins are secreted by plasma cells as part of a response to inflammation, particularly with infectious agents."
a[53] = f + "(C) Incorrect. C3b is an opsonin."
a[54] = f + "(D) Incorrect. Leukotrienes are best known as acute inflammatory mediators generated by the cyclo-oxygenase pathway of arachidonic acid metabolism."
a[55] = f + "(E) CORRECT. The VEGF stimulates angiogenesis to aid in establishing collateral circulation and restoring blood flow to the myocardium in this patient with an acute myocardial infarction."
a[56] = f + "(A) Incorrect. A hypertrophic scar is an exaggerated healing response with extensive collagen deposition that is most likely to occur with injury to the skin."
a[57] = f + "(B) CORRECT. The formation of a fluid filled cavity following an infection with <I>S. aureus</I> suggests that liquefactive necrosis has occurred. The cavity is filled with tissue debris and viable and dead neutrophils (pus). Localized, pus filled cavities are called abscesses."
a[58] = f + "(C) Incorrect. If lung tissue is destroyed, it does not regenerate. However, there is considerable pulmonary reserve capacity, so pulmonary failure is not an outcome of a resolved pneumonia."
a[59] = f + "(D) Incorrect. Neoplasia is not a consequence of acute inflammatory processes."
a[60] = f + "(E) Incorrect. Pneumonias caused by bacterial organisms tend to resolve without becoming chronic."
a[60.1] = f + "(F) Incorrect. Granulomas can become large and cavitate from central caseous necrosis. However, this process takes months. In this case, acute inflammation was complicated by abscess formation with liquefactive necrosis. The most common organism causing pulmonary granulomas is <I>Mycobacterim tuberculosis</I>."
a[61] = f + "(A) Incorrect. LTB4 is generated through the lipooxygenase pathway of arachidonic acid metabolites, which is not affected by aspirin. Leukotrienes affect neutrophil chemotasis and don't play a major role in pain."
a[62] = f + "(B) Incorrect. IL-1 is a cytokine that is not part of the arachidonic acid metabolic pathway. It is not generally associated with pain."
a[63] = f + "(C) CORRECT. Prostaglandins are produced via the cyclooxygenase pathway of arachidonic acid metabolism. Aspirin and non-steroidal anti-inflammatory drugs block the synthesis of prostaglandins, which can produce pain. Acetaminophen, which does not have the effect upon platelets that aspirin does, would be a better choice for the arthritis pain."
a[64] = f + "(D) Incorrect. Aspirin has no direct effect upon bradykinin generation, even though bradykinin has role to play in appearance of pain."
a[65] = f + "(E) Incorrect. Aspirin does not affect Hageman factor. The anticoagulant effect of aspirin occurs mainly through its action on platelets."
a[66] = f + "(A) Incorrect. Interferons are produced by a variety of cells and are mainly part of inflammatory reactions involving lymphocytes."
a[67] = f + "(B) Incorrect. Hageman factor is involved in coagulation."
a[68] = f + "(C) Incorrect. Lysozyme within the neutrophils aids in bacterial killing."
a[69] = f + "(D) CORRECT. Selectins are adhesive molecules expressed on endothelial cell surfaces and attract leukocytes, mainly neutrophils. P-selectin is expressed rapidly, while E-selectin is expressed within several hours."
a[70] = f + "(E) Incorrect. Prostacyclin is produced by endothelium to reduce platelet adhesion."
a[71] = f + "(A) CORRECT. Mycobacterial organisms are difficult to kill, because of their lipid coat of mycolic acid. Hence a neutrophilic response has little effect. This persistent infection requires macrophage activation that leads to granuloma formation."
a[72] = f + "(B) Incorrect. Bacteria tend to elicit an acute inflammatory response."
a[73] = f + "(C) Incorrect. Viral infections tend to produce chronic inflammatory responses."
a[74] = f + "(D) Incorrect. This intestinal parasite produces little inflammation."
a[75] = f + "(E) Incorrect. Syphilis can produce gummatous necrosis, which is a form of granulomatous response, but neutrophils predominate."
a[76] = f + "(A) Incorrect. An abscess is a localized collection of pus. Ulceration may occur secondarily over an abscess."
a[77] = f + "(B) Incorrect. Serositis is inflammation of a mesothelial surface, such as the pleura or peritoneum."
a[78] = f + "(C) Incorrect. A granuloma is a localized area of inflammation including epithelioid macrophages."
a[79] = f + "(D) Incorrect. Gangrenous necrosis includes coagulative and liquefactive necrosis involving a body part."
a[80] = f + "(E) CORRECT. The loss of an epithelial surface is called an ulceration. The presence of hydrochoric acid in the stomach promotes this process when epithelial injury occurs."
a[81] = f + "(A) Incorrect. Smooth muscle cells may proliferate in response to injury."
a[82] = f + "(B) Incorrect. Endothelium proliferates and helps to revascularize injured areas."
a[83] = f + "(C) CORRECT. Skeletal and cardiac muscle cells do not typically proliferate in response to injury, and necrotic cells are replaced by connective tissue. Remaining striated muscle cells, however, can undergo hypertrophy."
a[84] = f + "(D) Incorrect. Fibroblasts form an important part of the response to injury."
a[85] = f + "(E) Incorrect. Hepatocytes can proliferate in response to injury."
a[86] = f + "(A) Incorrect. Leukotriene-induced neutrophil aggregation is a function of the lipooxygenase pathway. There will be inflammation following the fetal demise, but this will not induce abortion in a timely fashion."
a[87] = f + "(B) Incorrect. Complement is present in serum and can be activated in inflammatory processes, but hemolysis is an undesirable effect."
a[88] = f + "(C) Incorrect. Histamine is released from mast cells with allergic responses."
a[89] = f + "(D) Incorrect. Endotoxin is a bacterial product. DIC is to be avoided."
a[90] = f + "(E) CORRECT. Prostaglandins are generated through the cyclooxygenase pathway and induce smooth muscle contraction in the uterus."
a[91] = f + "(A) CORRECT. This non-caseating granulomatous inflammation is typical for sarcoidosis. Granulomas are a form of type IV hypersensitivity reaction. There are cytokines such as interferon gamma produced by lymphocytes that recruit blood monocytes and stimulate macrophages to develop a granulomatous response."
a[92] = f + "(B) Incorrect. Bradykinin is mainly a product of acute inflammatory responses and results in pain."
a[93] = f + "(C) Incorrect. Complement C5a is a chemotactic factor for neutrophils in acute inflammatory reactions."
a[94] = f + "(D) Incorrect. Histamine release results in vasodilation leading to edema with acute inflammation."
a[95] = f + "(E) Incorrect. Prostaglandins participate in acute inflammatory reactions."
a[96] = f + "(A) Incorrect. Although the WBC count may increase with inflammation and infarction, it is non-specific."
a[97] = f + "(B) Incorrect. The sedimentation rate is elevated in a variety of inflammatory conditions."
a[98] = f + "(C) Incorrect. Complement decrease is more typical for inflammatory conditions with immunologic mechanisms."
a[99] = f + "(D) CORRECT. CK is an enzyme released from the damaged striated muscle. CK-MB would be more specific for cardiac muscle, while CK-MM mainly comes from skeletal muscle."
a[100] = f + "(E) Incorrect. Reduction of the platelet count suggests a coagulopathy or hematologic disorder."
a[100.1] = f + "(F) Incorrect. We already know that his cholesterol has been elevated, and this is a measure of his risk for coronary artery disease, but does not help diagnose an acute coronary event."
a[101] = f + "(A) Incorrect. C3b acts as an opsonin."
a[102] = f + "(B) Incorrect. Although one of the actions of PAF is to increase vascular permeability, PAF is not as important as histamine in this setting."
a[103] = f + "(C) Incorrect. TNF is involved in chemotaxis and in producing fever."
a[104] = f + "(D) CORRECT. Histamine, mainly released from mast cells in perivascular locations in the submucosa beneath the nasal respiratory epithelium, leads to vasodilation and fluid exudation. That is why people with allergies take antihistamines."
a[105] = f + "(E) Incorrect. IgG is directed against specific antigens. It is not as important as IgE in an allergic response."
a[106] = f + "(A) Incorrect. However, aspirin is felt to diminish platelet function and may have a longer term benefit in prevention of thrombosis."
a[107] = f + "(B) CORRECT. Aspirin, indomethacin, and NSAIDS block the cyclo-oxygenase arm of the arachidonic acid pathway, which generates the prostaglandins that play a role in development of pain as a consequence of the inflammatory process. The inflammation here is minimal but widespread as a consequence of the overuse of the connective tissues in the arms."
a[108] = f + "(C) Incorrect. Necrosis results in cell death. Normal activities generally do not produce significant tissue damage. It generally takes a disease process, such as infection producing inflammation, or tissue trauma, or ischemia from loss of blood supply, to produce necrosis."
a[109] = f + "(D) Incorrect. The fibrinolytic mechanisms are not affected."
a[110] = f + "(E) Incorrect. Collagen deposition is not affected."
a[111] = f + "(A) Incorrect. Bradykinin can be released with acute inflammatory reactions, but it mainly produces pain, and it is not released by mast cells with allergic responses."
a[112] = f + "(B) Incorrect. Complement C5a is a chemoattractant for neutrophils, but the response in this case is more immediate."
a[113] = f + "(C) Incorrect. Nitric oxide can be released by macrophages and endothelial cells and is not a major part of an allergic response."
a[114] = f + "(D) Incorrect. TNF can be released by activated macrophages and is not a signficant part of an allergic response."
a[115] = f + "(E) CORRECT. This is systemic anaphylaxis, a type I hypersensitivity reaction in which the antigen contacts preformed IgE antibody attached to mast cells, leading to mast cell degranulation with release of bioactive compounds such as histamine and production of symptoms. The initial response typically occurs within minutes."
a[116] = f + "(A) Incorrect. Mass lesions are more typical for neoplasms or granulomatous diseases."
a[117] = f + "(B) CORRECT. Viral illnesses, including those caused by common viral respiratory pathogens such as influenza, produce chronic inflammation that is mainly interstitial in the lungs. The lack of an alveolar filling process results in the lack of a productive cough."
a[118] = f + "(C) Incorrect. Lymphadenopathy is more typical for acute inflammatory processes, granulomatous diseases, and metastatic disease."
a[119] = f + "(D) Incorrect. Consolidation is a more typical feature for acute infectious processes in the lung caused by bacterial organisms."
a[120] = f + "(E) Incorrect. Pleural thickening with effusion is a feature of neoplasia or empyema."
a[121] = f + "(A) CORRECT. The C3b fragment generated from the complement cascade serves as an effective opsonin, attaching to the bacteria so that phagocytes will find and engulf them more easily."
a[122] = f + "(B) Incorrect. Glutathione peroxidase does not act as an opsonin, but is involved in scavenging free radicals."
a[123] = f + "(C) Incorrect. IgM does not act as an opsonin, though IgG does."
a[124] = f + "(D) Incorrect. Selectins aid in initial binding of leukocytes to endothelial surfaces so that the leukocytes slow down and attach in preparation for their exit into tissues."
a[125] = f + "(E) Incorrect. NADPH oxidase in leukocytes aids in the respiratory burst that leads to killing of phagocytized microbes."
a[126] = f + "(A) Incorrect. Bacterial infections are typically accompanied by acute inflammation, including abscesses in the case of septicemia with dissemination of infection."
a[127] = f + "(B) Incorrect. Local irritants such as the capsaicin in the chilis typically produce a short-lived acute inflammatory response."
a[128] = f + "(C) Incorrect. Diabetes mellitus is associated with an increased risk for acute infections, but the stomach is not often involved."
a[129] = f + "(D) Incorrect. Tuberculosis produces a granulomatous inflammatory response and rarely involves the stomach."
a[130] = f + "(E) CORRECT. This is a chronic inflammatory process, based upon the mononuclear inflammatory cell components present. <I>H. pylori</I> organisms live in the mucus above the gastric epithelium and release chemical substances that alter epithelial function and defense."
a[131] = f + "(A) Incorrect. There are valves in the lymphatics (just as in veins) which result in a one-way flow of lymph from peripheral tissues to lymph nodes."
a[132] = f + "(B) Incorrect. Excess tissue fluid is drained by lymphatics, but this does not specifically serve an immune function, though antigens may be contained within the lymphatic fluid."
a[133] = f + "(C) CORRECT. Antigen presenting cells such as dendritic cells and macrophages which have trapped antigen in peripheral tissues can be transported to lymph nodes where they encounter specific clones of memory cells capable of responding to those specific antigens, and this typically happens within a day."
a[134] = f + "(D) Incorrect. Infectious agents can gain access to lymphatics and go to lymph nodes to produce lymphadenitis. This spread of infection is not advantageous to the host."
a[135] = f + "(E) Incorrect. Most neutrophils marginate, roll, adhere, and diapedese through venules and capillaries."
a[136] = f + "(A) Incorrect. PDGF is released from macrophages as well as activated platelets and can stimulate fibroblast growth for collagen synthesis."
a[137] = f + "(B) Incorrect. Phospholipases aid in stimulation of intracellular protein kinases that promote protein phosphorylation."
a[138] = f + "(C) Incorrect. Fibronectin is a component of the extracellular matrix that helps to link cells together."
a[139] = f + "(D) CORRECT. FGF can stimulate all aspects of angiogenesis."
a[140] = f + "(E) Incorrect. EGF is a stimulator of cell growth through activation of tyrosine kinases in the cells; it can also stimulate angiogenesis to a degree."
a[141] = f + "(A) Incorrect. A cloudy appearance suggests the presence of increased cells, characteristic of an exudate."
a[142] = f + "(B) Incorrect. Increased protein is characteristic of an exudate."
a[143] = f + "(C) CORRECT. A transudate resembles a filtrate of plasma and has few cells or protein and has a clear appearance."
a[144] = f + "(D) Incorrect. Fibrin comes from exuded fibrinogen, a blood protein."
a[145] = f + "(E) Incorrect. The size of an effusion does not define exudate or transudate."
a[146] = f + "(A) Incorrect. Fibronectin acts in the extracellular matrix to bind macromolecules (such as proteoglycans) via integrin receptors to aid attachment and migration of cells."
a[147] = f + "(B) Incorrect. Laminin is an extracellular matrix component that is abundant in basement membranes."
a[148] = f + "(C) CORRECT. Cell surface growth factor receptors recruit intracellular protein kinases that begin a sequence of events leading to cell division and growth."
a[149] = f + "(D) Incorrect. Hyaluronic acid is one of the proteoglycans in the extracellular matrix."
a[150] = f + "(E) Incorrect. Collagen fibers are part of the extracellular matrix that gives strength and stability to connective tissues."
a[151] = f + "(A) Incorrect. The wound site has granulation tissue in this first week, but little collagen to provide tensile strength at this point."
a[152] = f + "(B) Incorrect. Collagen is being laid down during this month, but a plateau phase has not been reached, and wound strength is still increasing."
a[153] = f + "(C) CORRECT. About 70 to 80% of the tensile strength in the scar, compared to non-wounded skin, is reached at 3 months, which is about as much as will be obtained."
a[154] = f + "(D) Incorrect. After 3 months, there will be little additional gain in tensile strength, so little more tensile strength will be achieved in another 3 months."
a[155] = f + "(E) Incorrect. After 3 months, there will be little additional gain in tensile strength, so little more tensile strength will be achieved in another 9 months."
a[156] = f + "(A) Incorrect. Thromboxane, a product of the cyclooxygenase pathway, is produced by endothelial cells and promotes vasoconstriction and platelet aggregation."
a[157] = f + "(B) Incorrect. Plasmin, derived from plasminogen, is one of the anticoagulants generated to break down thrombi."
a[158] = f + "(C) Incorrect. PAF promotes platelet aggregation and release. It is also chemotactic to neutrophils and causes them also to aggregate and adhere."
a[159] = f + "(D) CORRECT. Hageman factor (factor XII in the intrinsic coagulation pathway) activates with injured, exposed vascular basement membrane."
a[160] = f + "(E) Incorrect. Histamine functions as a vasodilator of arterioles and increases vascular permeability in venules."
a[161] = f + "(A) CORRECT. Nitric oxide (NO) acts as a vasodilator. Small amounts released from endothelial cells causes vasodilation and prevents thrombosis. Macrophages release NO to kill bacteria, but large amounts released body-wide can cause hypotension and shock."
a[162] = f + "(B) Incorrect. Bradykinin produces pain. It is generated via the kinin system from substances in plasma activated during acute inflammation."
a[163] = f + "(C) Incorrect. Histamine can contribute to vasodilation, edema, and vascular collapse, but much of it is preformed and released from mast cells or basophils. Widespread histamine release can be part of anaphylaxis with type I hypersensitivity, but infections typically do not produce this effect."
a[164] = f + "(D) Incorrect. Prostacyclin is generated by the arachidonic acid pathway and it promotes vasodilation."
a[165] = f + "(E) Incorrect. C3a can promote vasodilation and increase vascular permeability to promote vascular collapse, but complement is found in plasma, not cells."
a[166] = f + "(A) Incorrect. This is a serious postoperative complication."
a[167] = f + "(B) Incorrect. Diabetics and persons with severe atherosclerosis have notoriously poor wound healing."
a[168] = f + "(C) CORRECT. Although any foreign body will delay wound healing to some degree, the net effect of having sutures is to aid the process of healing more than to hinder it, since the sutures close the wound."
a[169] = f + "(D) Incorrect. Corticosteroids dampen the inflammatory response that contributes to the healing process."
a[170] = f + "(E) Incorrect. Poor nutrition is a detriment to wound healing."
a[171] = f + "(A) Incorrect. Tuberculosis produces a granulomatous pattern of infection that develops over weeks to months."
a[172] = f + "(B) Incorrect. Viral infections typically do not cause acute inflammation with neutrophils."
a[173] = f + "(C) CORRECT. This is an acute chorioamnionitis, and bacterial infections that precede or follow premature rupture of membranes are most often to blame. Bacterial infections tend to elicit neutrophilic inflammatory responses."
a[174] = f + "(D) Incorrect. Syphilis is not known for producing acute infection with neutrophilic infiltrates."
a[175] = f + "(E) Incorrect. This parasitic organism produces a congenital infection over weeks' time."
a[176] = f + "(A) CORRECT. Some persons have an exaggerated, inappropriate wound healing response with excessive collagenization."
a[177] = f + "(B) Incorrect. Trauma does not lead to neoplasia."
a[178] = f + "(C) Incorrect. Diabetes mellitus leads to severe peripheral vascular disease that delays wound healing, but the wound would not have excessive collagen."
a[179] = f + "(D) Incorrect. Sutures can produce small foreign body granulomas that are typically not visible."
a[180] = f + "(E) Incorrect. A wound infection will produce dehiscence and abscess formation that delays or disrupts collagenization."
a[181] = f + "(A) Incorrect. A transudate in a serous effusion has few cells."
a[182] = f + "(B) CORRECT. The neutrophils suggest an acute process; the fluid is characteristic for an exudate. Such a large amount of purulent exudate in the pleural space can be termed an empyema."
a[183] = f + "(C) Incorrect. Fibrin can often accompany acute inflammatory processes, but a process with so many neutrophils is best characterized as a purulent exudate."
a[184] = f + "(D) Incorrect. Chronic inflammation has a preponderance of mononuclear cells, not neutrophils."
a[185] = f + "(E) Incorrect. A granulomatous response is characterized by mononuclear cells."
a[186] = f + "(A) Incorrect. There is no tissue damage in this situation to activate Hageman factor."
a[187] = f + "(B) Incorrect. Normal renal function will maintain water and electrolyte balance."
a[188] = f + "(C) Incorrect. Though swelling could come from venous obstructiom with thrombosis, there would likely be pain and tenderness with thrombosis, and swelling in more than just her feet. However, the immobilization with venous stasis from such a long flight is a risk for thrombosis."
a[189] = f + "(D) Incorrect. She would be unlikely to develop a cellulitis over this short a time."
a[190] = f + "(E) CORRECT. The longest non-stop flight in the world has its drawbacks. Extracellular fluid builds up when hydrostatic pressure is increased over a long time."
a[191] = f + "(A) Incorrect. Neutrophils participate in acute inflammatory processes and release enzymes to cause non-specific destruction of anything nearby."
a[192] = f + "(B) Incorrect. B cells are activated to become plasma cells that secrete immunoglobulins."
a[193] = f + "(C) CORRECT. Blood monocytes can migrate into tissues and become macrophages. Macrophages play an important role in delayed hypersensitivity reactions with cell-mediated immunity."
a[194] = f + "(D) Incorrect. Natural killer cells selectively bind to a target site to destroy it."
a[195] = f + "(E) Incorrect. Basophils play a role in allergic responses."
a[196] = f + "(A) CORRECT. The decrease in oncotic pressure from decreased serum albumin, the blood protein that accounts for most of the oncotic pressure, can be significant. This can be a cause for edema and fluid transudates. Too little circulating protein doesn't keep in or draw water into the vasculature."
a[197] = f + "(B) Incorrect. Glucosuria with diabetes mellitus can explain loss of free water with dehydration, not edema."
a[198] = f + "(C) Incorrect. Neutrophilia suggests an acute inflammatory response, which can produce localized edema in the area of inflammation."
a[199] = f + "(D) Incorrect. Anemia reduces oxygen carrying capacity; if severe, it could eventually lead to a high output congestive heart failure that would initially involve mainly the left heart, with consequent pulmonary congestion and edema."
a[200] = f + "(E) Incorrect. An increased serum sodium suggests loss of free water and dehydration, not edema."
a[201] = f + "(A) Incorrect. The kinin system can be activated with acute inflammatory processes, but cell lysis is not an end point."
a[202] = f + "(B) Incorrect. IL-1 is a cytokine that promotes a variety of inflammatory reactions, but does not directly lead to cell lysis."
a[203] = f + "(C) Incorrect. Thromboxane is a substance that promotes platelet aggregation and vasoconstriction to diminish hemorrhage."
a[204] = f + "(D) CORRECT. This hemolytic transfusion reaction is a form of type II hypersensitivity reaction in which antibody present in the patient's serum attaches to the transfused red blood cells to activate complement and lead to cell lysis."
a[205] = f + "(E) Incorrect. Nitric oxide released from macrophages promotes vasodilation but does not produce red blood cell lysis in a transfusion reaction."
a[206] = f + "(A) Incorrect. Tuberculosis produces a granulomatous pattern of inflammation."
a[207] = f + "(B) CORRECT. Neutrophilic exudates are typical for bacterial infections, and C5a is a neutrophilic chemotactic factor."
a[208] = f + "(C) Incorrect. Aspergillus can produce a variety of inflammatory reactions. Prostaglandin promotes vasodilation but is not chemotactic."
a[209] = f + "(D) Incorrect. Viral infections do not typically produce neutrophilic exudates."
a[210] = f + "(E) Incorrect. Although streptococci can produce neutrophilic exudates, Hageman factor has no direct effect upon neutrophils."
a[211] = f + "(A) Incorrect. Bronchopneumonia is typically caused by bacterial organisms, producing alveolar infiltrates and productive cough with fever. The fluid is not an exudate."
a[212] = f + "(B) CORRECT. She has pulmonary disease with right heart failure leading to serous pleural effusions. The fluid is characteristic for a transudate."
a[213] = f + "(C) Incorrect. Mitral stenosis would produce left sided heart failure with pulmonary edema forming before effusions were present. The left atrium would be prominent on a chest x-ray."
a[214] = f + "(D) Incorrect. Influenza should be accompanied by a fever, and the radiographic pattern is that of interstitial infiltrates."
a[215] = f + "(E) Incorrect. Lung carcinoma produces a mass seen on a chest x-ray. Carcinomas that extend to the pleura often produce a hemorrhagic, exudative form of effusion."
a[216] = f + "(A) Incorrect. Influenza A, as well as many other viral infections, produce lymphocytic interstitial infiltrates in the lung."
a[217] = f + "(B) CORRECT. Tuberculosis produces a granulomatous inflammatory reaction."
a[218] = f + "(C) Incorrect. Bacterial pneumonias have patchy areas of consolidation with neutrophilic infiltrates. The time course is usually over a period of days."
a[219] = f + "(D) Incorrect. CMV pneumonias are seen in immunocompromised patients and produce interstitial inflammation."
a[220] = f + "(E) Incorrect. Pneumocystis pneumonia appears in immunocompromised patients and the foamy alveolar exudates produce extensive consolidation."
a[221] = f + "(A) Incorrect. The thrombus has already occurred. The effects of aspirin on platelets have usefulness in patients with recurrent myocardial infarction to help prevent coronary thrombosis."
a[222] = f + "(B) Incorrect. Macrophages will be useful mainly in the resolution of the infarct."
a[223] = f + "(C) Incorrect. Liquefactive necrosis in the brain is not marked by fibrosis."
a[224] = f + "(D) CORRECT. There is evidence that nitric oxide can decrease ischemic damage by promoting vasodilation."
a[225] = f + "(E) Incorrect. Fibrinogen is an acute phase reactant that increased with inflammation and tissue injury. Given that there is an embolus, there is plenty of fibrinogen to form clots."
a[226] = f + "(A) Incorrect. Measuring complement levels is most useful for chronic immunologic diseases such as systemic lupus erythematosus."
a[227] = f + "(B) Incorrect. The sed rate is nonspecifically elevated in many inflammatory conditions, acute as well as chronic."
a[228] = f + "(C) CORRECT. The findings suggest acute appendicitis, and an elevated WBC count with a left shift will be most supportive of this diagnosis."
a[229] = f + "(D) Incorrect. His findings do not suggest pancreatitis, which has more diffuse, severe pain, or pain localized to the upper abdomen."
a[230] = f + "(E) Incorrect. The CK is best used to detect cardiac muscle injury (infarction)."
a[231] = f + "(A) CORRECT. The findings are characteristic for an acute staphylococcal pneumonia with spread to the pleural to produce a purulent exudate."
a[232] = f + "(B) Incorrect. Macrophages may be more numerous in a chronic or healing process."
a[233] = f + "(C) Incorrect. Lympocytes are more numerous with chronic inflammatory processes."
a[234] = f + "(D) Incorrect. Mesothelial cells may be shed with ongoing inflammatory processes, but not usually in large numbers."
a[235] = f + "(E) Incorrect. Plasma cells are not usually numerous outside of tissues of the mononuclear phagocyte system, such as lymph nodes and bone marrow."
a[236] = f + "(A) Incorrect. Bradykinin is a mediator for pain and vasodilation."
a[237] = f + "(B) Incorrect. Hageman factor begins the intrinsic coagulation sequence."
a[238] = f + "(C) CORRECT. There should be a pronounced neutrophilic response with a bacterial infection, with C5a as the major chemotactic agent for neutrophils, but Group B strep inhibits this."
a[239] = f + "(D) Incorrect. Thromboxane is generated via the cyclo-oxygenase pathway and is a vasoconstrictor that also promotes platelet aggregation."
a[240] = f + "(E) Incorrect. Gamma interferon from T lymphocytes activates macrophages."
a[241] = f + "(A) Incorrect. Persons who receive corticosteroids or who have Cushing's syndrome have poorer wound healing."
a[242] = f + "(B) Incorrect. Healthy persons should not require additional dietary sources of nutrition."
a[243] = f + "(C) Incorrect. The wound site can be monitored for signs of infection and then treated."
a[244] = f + "(D) CORRECT. A surgical wound heals by first intention (primary union), which is quick. Suture material over time can induce local granuloma formation."
a[245] = f + "(E) Incorrect. One of the advantages of laparoscopic surgery is the small size of the incisions, which heal quickly and have little risk for dehiscence."
a[246] = f + "(A) Incorrect. Plasminogen activation to plasmin is part of the anticoagulant system that limits the size of a clot."
a[247] = f + "(B) Incorrect. Neutrophils respond to the scene of inflammation, but are not primarily responsible for hemostasis."
a[248] = f + "(C) Incorrect. Vasoconstriction can occur with mediators such as thromboxane from platelets, but this is not the major means for hemostasis."
a[249] = f + "(D) Incorrect. Organization in a thrombus occurs after hemostasis has been achieved."
a[250] = f + "(E) CORRECT. Platelets are mainly responsible for hemostasis in small vessels, which is the principle behind the laboratory test known as the 'bleeding time', which is not normally done nowadays, because platelet function analysis is more useful. A normal bleeding time is 2 to 7 minutes."
a[251] = f + "(A) Incorrect. Viral infections of the lung tend to produce interstitial inflammation without an alveolar exudate."
a[252] = f + "(B) Incorrect. Tuberculosis is most likely to produce granulomatous inflammation."
a[253] = f + "(C) CORRECT. Bacterial infections of the lung are known to produce exudates containing PMN's. Pneumococcus is a very common etiology for pneumonia."
a[254] = f + "(D) Incorrect. CMV is most often seen in immunocompromised patients. It can produce a variety of histologic patterns of disease."
a[255] = f + "(E) Incorrect. PCP is seen in immunocompromised patients and produces a relatively acellular foamy alveolar exudate."
a[256] = f + "(A) Incorrect. Gummas are rarely seen nowadays, but are one complication of infection with <I>Treponema pallidum</I> (syphilis)."
a[257] = f + "(B) Incorrect. C. neoformans, as well as other pathogenic fungi, tend to produce granulomatous inflammation. This would be an unusual site for a fungal infection."
a[258] = f + "(C) CORRECT. The chronic obstruction has led to inflammation. Mostly round cells (lymphocytes) are present, so this is chronic inflammation of the salivary gland."
a[259] = f + "(D) Incorrect. Coagulative necrosis tends to be accompanied by a variable amount of acute inflammation."
a[260] = f + "(E) Incorrect. Gangrenous necrosis tends to have acute inflammation more than chronic."
a[261] = f + "(A) Incorrect. Thromboxane released by platelets produces vasoconstriction."
a[262] = f + "(B) Incorrect. The C3b component of complement is an opsonin."
a[263] = f + "(C) CORRECT. Endothelial cells contain nitric oxide synthetase which can be used to generate nitric oxide and produce vasodilation."
a[264] = f + "(D) Incorrect. TNF has a variety of functions including production of fever, but not vasodilation."
a[265] = f + "(E) Incorrect. Phospholipases break down cell membranes in ischemic injury."
a[266] = f + "(A) Incorrect. Viral pneumonias tend to produce interstitial inflammation without significant tissue destruction or hemorrhage."
a[267] = f + "(B) CORRECT. Local hemorrhagic exudates may suggest a neoplasm has spread to a body cavity. Neoplasms tend to infiltrate, with necrosis and hemorrhage."
a[268] = f + "(C) Incorrect. CHF tends to produce transudates."
a[269] = f + "(D) Incorrect. The decreased intravascular oncotic pressure with decreased serum albumin tends to produce transudates."
a[270] = f + "(E) Incorrect. Chronic renal failure tends to produce edema and transudates."
a[271] = f + "(A) Incorrect. Thromboxane is made by platelets to promote aggregation and clotting."
a[272] = f + "(B) Incorrect. Leukotrienes are generated by the lipo-oxygenase arm of the arachidonic acid pathway and help to produce vasoconstriction."
a[273] = f + "(C) CORRECT. Prostacyclin is generated by endothelium and helps to promote vasodilation and inhibit platelet aggregation."
a[274] = f + "(D) Incorrect. IL-1 is a cytokine involved mainly with promotion of thrombogenicity of endothelium."
a[275] = f + "(E) Incorrect. Prostaglandins aid in promotion of vasodilation and edema."
a[276] = f + "(A) Incorrect. A normal RBC does not have a nucleus, but it functions properly for about 120 days in circulation."
a[277] = f + "(B) Incorrect. Atherosclerosis by itself does not damage RBC's in vessels."
a[278] = f + "(C) CORRECT. This is the 'membrane attack complex' and leads to cell lysis when attached to the RBC. This is the mechanism for immune induced hemolysis."
a[279] = f + "(D) Incorrect. RBC's are powered by glycolytic metabolism."
a[280] = f + "(E) Incorrect. Hyperglycemia may lead to increased glycosylation of hemoglobin (Hgb A1c), but this does not signficantly interfere with RBC function."
a[281] = f + "(A) Incorrect. A hemorrhagic effusion would be red in color."
a[282] = f + "(B) Incorrect. Empyema refers to a collection of pus (purulent exudate) in a body cavity (such as the pleural space)."
a[283] = f + "(C) Incorrect. A simple serous effusion is just fluid collection with few cells and protein, so it appears clear."
a[284] = f + "(D) Incorrect. Resolution of inflammation would lead to resolution of the fluid collection."
a[285] = f + "(E) CORRECT. Fibrin has this gross appearance. Underlying inflammation, such as a pneumonia, may lead to exudation onto the pleural surfaces."
a[286] = f + "(A) Incorrect. C1q is an early component of the classical pathway of complement activation."
a[287] = f + "(B) Incorrect. C2 is a component of the classical pathway of complement activation."
a[288] = f + "(C) CORRECT. C3b acts as an opsonin."
a[289] = f + "(D) Incorrect. The C5a component of complement exerts a strong chemotactic influence on neutrophils."
a[290] = f + "(E) Incorrect. The 'membrane attack complex' of C5-9 creates perforations in cell membranes that aids in killing."
a[291] = f + "(A) CORRECT. Connective tissue cells, including endothelium, are quiescent until stimulated during injury and repair to enter the cell cycle."
a[292] = f + "(B) Incorrect. It would be nice if cardiac muscle could regenerate following injury, but it is replaced by scar tissue."
a[293] = f + "(C) Incorrect. Intestinal epithelial cells are actively dividing cells, and already in the cell cycle."
a[294] = f + "(D) Incorrect. Germ cells are actively dividing cells and not quiescent cells."
a[295] = f + "(E) Incorrect. Stem cells in the bone marrow are actively dividing cells that are not quiescent."
a[296] = f + "(A) CORRECT. Endothelial cells encourage circulating leukocytes to attach in the regions of inflammation."
a[297] = f + "(B) Incorrect. Neutrophils are attracted to sites of acute inflammation and adhere to ICAM's."
a[298] = f + "(C) Incorrect. Macrophages can release a variety of cytokines, but they do not elaborate ICAM for neutrophilic adhesion."
a[299] = f + "(D) Incorrect. Histamine released from mast cells is a powerful vasodilator; mast cells may also release eosinophil chemotactic factor."
a[300] = f + "(E) Incorrect. Langhans giant cells are usually seen in association with granulomatous inflammation with stimulation of epithelioid macrophages by interferon gamma, such as occurs with infection by Mycobacteria."
a[301] = f + "(A) Incorrect. Anasarca is edema involving most of the body."
a[302] = f + "(B) Incorrect. Ascites is a fluid collection in the peritoneal cavity."
a[303] = f + "(C) Incorrect. Phlebothrombosis is most likely to occur in a lower extremity, and there can be warmth and pain. It is not likely to occur months after surgery."
a[304] = f + "(D) CORRECT. The surgery disrupts the lymphatic drainage from the left arm. Lymphatics scavenge the small amount of intercellular fluid which collects slowly over time."
a[305] = f + "(E) Incorrect. Cellulitis is inflammation of soft tissues with pain, warmth, and erythema."
a[306] = f + "(A) Incorrect. Obstruction of lymphatics is most typical for neoplasms, post-operative states, and rare chronic infectious processes."
a[307] = f + "(B) CORRECT. Standing up creates increased hydrostatic pressure, particularly in the lower extremities. There are valves in the veins to help aid return of blood flow, but these work less efficiently with aging. Decreased muscle tone and some degree of congestive heart failure don't help either."
a[308] = f + "(C) Incorrect. Hypoalbuminemia from liver disease or from proteinuria, for example, leads to decreased oncotic pressure."
a[309] = f + "(D) Incorrect. Standing up for long periods does not lead to inflammation."
a[310] = f + "(E) Incorrect. Persons who are mobile generally do not develop thrombophlebitis. Thrombophlebitis develops over days."
a[311] = f + "(A) Incorrect. C3b is a good opsonin."
a[312] = f + "(B) CORRECT. There is vasodilation to produce the erythema, along with the pain, as a consequence of generation of bradykinin."
a[313] = f + "(C) Incorrect. IL-1 mediates the appearance of fever, among other functions."
a[314] = f + "(D) Incorrect. CRP is one of the 'acute phase reactants' that can be measured in serum that non-specifically indicates the presence of an acute inflammatory process."
a[315] = f + "(E) Incorrect. ICAM-1 is an adhesion molecule that functions in leukocyte adherence."
a[316] = f + "(A) Incorrect. Foreign body inflammation is typical for aspiration pneumonitis."
a[317] = f + "(B) Incorrect. Granulomatous inflammation is typical for mycobacterial infection."
a[318] = f + "(C) Incorrect. Fibrosis and calcification is more typical for mycobacterial infection. Viral infections rarely produce significant scarring in the lungs."
a[319] = f + "(D) Incorrect. Neutrophilic exudates are more typical for bacterial infections."
a[320] = f + "(E) CORRECT. Viral illnesses produce chronic inflammation that is interstitial in the lungs. The lack of an alveolar filling process results in the lack of a productive cough."
a[321] = f + "(A) CORRECT. The catalase produced by the staphylococci results in degradation of the oxygen radicals generated by the NADPH oxidase. This is one of the ways that makes staphylococci more virulent."
a[322] = f + "(B) Incorrect. Cyclo-oxygenase is in one arm of the arachidonic acid pathway generating substances involved in inflammation. One key substance generated by this pathway is prostaglandin. Platelets use this pathway to produce thromboxane, while endothelial cells use it to produce prostacyclin."
a[323] = f + "(C) Incorrect. Glutathione in human cells is involved in pathways that scavenge free radicals."
a[324] = f + "(D) Incorrect. Lipoxygenase is one arm of the arachidonic acid metabolic pathways in the inflammatory process, generating mediators of inflammation such as leukotrienes."
a[325] = f + "(E) Incorrect. Myeloperoxidase, as the name implies, is found in myeloid cells, including neutrophils."
a[325.1] = f + "(F) Incorrect. Forms of nitric oxide synthase NOS are present in various cells. Endothelial cells use NOS to generate NO that aids in vasodilation. NOS within macrophages, upregulated by interferon-gamma, produces NO for killing phagocytized organisms."
a[326] = f + "(A) CORRECT. Complement components are being generated and cleared normally. C3b that attaches to abnormal surfaces such as bacteria then acts as an opsonin for phagocytic cells such as neutrophils to find and ingest the offending materials tagged by the C3b."
a[327] = f + "(B) Incorrect. E-selectin on cytokine activated endothelial cells aids as a homing device for leukocytes to areas of inflammation."
a[328] = f + "(C) Incorrect. Histamine is a biogenic amine that can be released during inflammatory reactions to produce vascular permeability."
a[329] = f + "(D) Incorrect. Kallikreins are proteases that activate kininogens to produce vasoactive peptides such as bradykinin that mediate increased vascular permeability, vasodilation, and pain."
a[330] = f + "(E) Incorrect. Leukotrienes are generated in the lipoxygenase pathway of arachidonic acid metabolism and produce vasoconstriction, bronchospasm, and increased vascular permeability."
a[330.1] = f + "(F) Incorrect. Nitric oxide generated in endothelial cells promotes vasodilation. NO generated in phagocytic cells is used to destroy ingested micro-organisms."
a[330.2] = f + "(G) Incorrect. TNF has many functions including increasing leukocyte adherance, but it is not an opsonin."
a[331] = f + "(A) Incorrect. The cyclo-oxygenase pathway of arachidonic acid metabolism generates mediators of inflammation such as prostaglandins."
a[332] = f + "(B) Incorrect. Tyrosine kinases act as messengers within the cell to upregulate transcription promoting protein synthesis."
a[333] = f + "(C) CORRECT. The matrix metalloproteinases include collagenases that act on extracellular matrix components. MMPs are essential in the debridement and remodeling of wounds. MMPs are dependent upon zinc ions for their activity."
a[334] = f + "(D) Incorrect. Myeloperoxidase in neutrophils is part of the phagocytic and killing function of these neutrophils, acting on hydrogen peroxide to convert it to hypochlorite in the presence of halide."
a[335] = f + "(E) Incorrect. NADPH oxidase in granulocytes helps generate reactive oxygen intermediates such as hydrogen peroxide."
a[335.1] = f + "(F) Incorrect. Nitric oxide generated in endothelial cells promotes vasodilation. NO generated in phagocytic cells is used to destroy ingested micro-organisms."