Inflammation SEQs

Q.1.A. Tabulate at least four principal arachadonic acid metabolites involved in inflammation with their
respective actions. (0.5x4=2)

B.Out of many classifications, give any two types of classifications of a granuloma. Draw a neat and
labelled diagram of a tuberculous granuloma. (2+1)

Q.2.A.Briefly describe the four morphologic patterns of inflammation. (0.5x4=2)

B. Draw a neat and labelled flow chart diagram to show the classical and alternative macrophage
activation pathway. (1.5x2=3)

3.A. Vasoactive amines are released readily in response to a wide variety of stimuli.

i. Name the two most abundant vasoactive amines. (0.5)

ii. Enumerate at least three stimuli for their release. (1.5)

3.B. What is acute phase response? Enumerate its important clinical manifestations. (0.5+1.5)

3.C. Give a difference in functions of acid and neutral proteases. (1)

4. A 4 year old child reaches up to the stove and touches a pot of boiling water. Within several hours,
there is marked erythema of the skin of the fingers on the child’s right hand, and small blisters appear
on the finger pads.
a. What morphological type of acute inflammation best describes this process? (1)
b. Enlist four morphologic types of acute inflammation. (2)
c. Name two inflammatory conditions showing abundant eosinophils in the peripheral blood film. (1)
d. Name three physiologic giant cells. (1)

5.A. Tabulate at least four valid differences between an exudate and a transudate, while giving a
condition causing their production too. (2)
B. Enlist four groups of chemokines according to the arrangement of cysteine amino acid, giving one
example of each group. (2)
C. Give names of macrophages of these organs (belonging to the reticuloendothelial system) : Placenta,
Skin, Spleen and Lymph nodes (1)

6. A 67 year old man presents with high grade fever, shaking chills and shortness of breath for 3
days. Physical examination show rales and decreased breath sounds under both lung fields on
auscultation. The patient exhibits grunting respiration, 30-35 breaths / minutes. With flaring of
the nares. The sputum is rusty yellow. Chest X-ray shows opacity in the entire lower lobe of right
lung.
 a. Which inflammatory cells will you expect the most in the sputum of this patient? (1)
b. Which mediator of inflammation is chiefly responsible for the development of fever in this
patient? (1)
c. Sputum culture obtained from this patient is positive for Streptococcus pneumoniae.
Removal of bacteria from the alveolar air spaces in this patient involves opsonisation by
complement. The opsonisation is an important step in mediating which function of
leukocytes? (1)
d. Which of the proteins inhibits fibrinolysis, activation of the complement system and
protease-mediated damage in the lungs of this patient? (1)
e. Which mediator of inflammation is primarily responsible for secondary injury to alveolar
basement membrance and lung parenchyma in this patient? (1)

7. A 33 year old man presents with a 5 weeks history of calf pain and swelling of with a low grade
fever. Serum levels of creatinine kinase are elevated. A muscle biopsy reveals numerous
eosinophils.

a. Which is the most likely etiology of this patient’s myalgia? (1)

b. Which of the inflammatory bowel disease is associated with granuloma formation? (1)
c. Name two parasitic diseases showing granulomatous inflammation? (1)
d. Enlist two fungal granulomatous diseases? (1)
e. Name a granulomatous disease in humans caused by algae. (1)

8. A 28 year old woman cuts her hand while dicing vegetables in the kitchen. The wound is cleaned
and sutured. Five days later, the site of injury contains an abundance of chronic inflammatory
cells that actively secrete interleukin-1, tumor necrosis factor alpha, interferon alpha, numerous
arachidonic acid derivatives and various enzymes.
a. Name the above mentioned cells? (1)
b. What is the aim of inflammation? (1)

c. Define chemotaxis. (1)

d. What are the signs of leukocyte activation? (2)

9. A 40 year old tailor is injured by a needle, a small portion of which got into the finger. The
patient goes to the emergency room to have that portion of needle removed.
a. Which mediator of inflammation plays the most important role in stimulating platelet
aggregation at the site of injury following the above mentioned minor surgical
procedure? (1)
b. What are the main arachidonic acid derived mediators of inflammation? (2)

c. What are the effects of inhibitors of arachidonic acid metabolism? (1)

d. Which mediators of inflammation act as pyrogens? (1)
10. A 24 year old woman presents with severe pain during menes (dysmenorrhea). To treat her
symptoms, you advise her to take indomethacin.
a. The given drug may reduce her pain because it interferes with the production of which substance? (1)
b. What are the vasoactive amines in the acute phase of inflammation? (1)
c. What is the term for exudates rich in neutrophils and parenchymal cell debris? (1)
d. What are the four possible outcomes of acute inflammation? (2)

11. A 68 year man with prostate cancer and bone metastases presents with shaking chills and
fever. The peripheral WBC count is 1,000/ul (normal: 4,000 – 11,000/ul)
a. Which term best describes this haematologic finding? (1)
b. What mediators of inflammation cause pain? (1)

c. What is the outcome of acute inflammation? (3)

12. The macrophage is the pivotal cell in regulating chronic inflammation.

a. What are the functions of macrophages in chronic inflammation? (3)
b. Define granuloma. (1)

c. Draw a foreign body and a Langhan’s giant cell to show their morphological differences.
(1)

13. What is the difference between cell injury and inflammation? (2)

14. What is pseudomembranous inflammation? (2)

15. A 59 year old man suffers a massive heart attack and expires 24 hours later due to
ventricular arrhythmia.

a. Histologic examination of the affected heart muscle at autopsy would show an abundance
of which of the inflammatory cells? (1)
b. Describe the major biological functions of complement activation during inflammation. (2)
c. What are the main events leading to transmigration of leukocytes across the vessel wall? (2)

16. A 53 year old man develops weakness, malaise, cough with bloody sputum and night
sweats. Chest X-ray reveals numerous apical densities bilaterally. Exposure to
Mycobacterium tuberculosis was documented 20 years ago and Mycobacterium
tuberculosis is identified in the sputum.
a. How is chronic granulomatous inflammation classified etiologically? Give examples of each
class. (3)
b. Classify giant cells in detail with examples. (2)
 17. Inflammation:

a. Which mediators of inflammation cause pain? (1)

b. What is chemotaxis? (1)
c. Describe in detail the two mechanisms of phagocytosis of a bactericidal substance by
neutrophils. (3)