MCQ Book Questions

Q60042. A 59-year-old man suffers a massive heart attack and expires 24 hours later due to ventricular arrhythmia. Histologic exam- ination of the affected heart muscle at autopsy would show an abundance of which of the following infl ammatory cells?

Q60043. A 5-year-old boy punctures his thumb with a rusty nail. Four hours later, the thumb appears red and swollen. Initial swell- ing of the boy’s thumb is primarily due to which of the follow- ing mechanisms?

Q60044. Which of the following serum proteins activates the comple- ment, coagulation, and fi brinolytic systems at the site of injury in the patient described in Question 5?

Q60045. An 80-year-old woman presents with a 4-hour history of fever, shaking chills, and disorientation. Her blood pressure is 80/40 mm Hg. Physical examination shows diffuse purpura on her upper arms and chest. Blood cultures are positive for Gram- negative organisms. Which of the following cytokines is pri- marily involved in the pathogenesis of direct vascular injury in this patient with septic shock?

Q60046. A 25-year-old woman presents with a history of recurrent shortness of breath and severe wheezing. Laboratory stud- ies demonstrate that she has a defi ciency of C1 inhibitor, an esterase inhibitor that regulates the activation of the classical complement pathway. What is the diagnosis?

Q60047. A 40-year-old man complains of a 2-week history of increasing abdominal pain and yellow discoloration of his sclera. Physi- cal examination reveals right upper quadrant pain. Laboratory studies show elevated serum levels of alkaline phosphatase (520 U/dL) and bilirubin (3.0 mg/dL). A liver biopsy shows portal fi brosis, with scattered foreign bodies consistent with schistosome eggs. Which of the following infl ammatory cells is most likely to predominate in the portal tracts in the liver of this patient?

Q60048. A 41-year-old woman complains of excessive menstrual bleeding and pelvic pain of 4 months. She uses an intrauterine device for contraception. Endometrial biopsy (shown in the image) reveals an excess of plasma cells (arrows) and mac- rophages within the stroma. The presence of these cells and scattered lymphoid follicles within the endometrial stroma is evidence of which of the following conditions?

Q60049. A 36-year-old woman with pneumococcal pneumonia develops a right pleural effusion. The pleural fl uid displays a high specifi c gravity and contains large numbers of polymorphonuclear (PMN) leukocytes. Which of the following best characterizes this pleural effusion?

Q60050. A 33-year-old man presents with a 5-week history of calf pain and swelling and low-grade fever. Serum levels of cre- atine kinase are elevated. A muscle biopsy reveals numerous eosinophils. What is the most likely etiology of this patient’s myalgia?

Q60051. A 10-year-old boy with a history of recurrent bacterial infec- tions presents with fever and a productive cough. Biochemi- cal analysis of his neutrophils demonstrates that he has an impaired ability to generate reactive oxygen species. This patient most likely has inherited mutations in the gene that encodes which of the following proteins?

Q60052. Sputum cultures obtained from the patient described in Question 17 are positive for Streptococcus pneumoniae. Removal of bacteria from the alveolar air spaces in this patient involves opsonization by complement, an important step in mediating which of the following leukocyte functions?

Q60053. Which of the following mediators of infl ammation is primarily responsible for secondary injury to alveolar basement membranes and lung parenchyma in the patient described in Questions 17 and 18?

Q60054. Which of the following proteins inhibits fi brinolysis, activation of the complement system, and protease-mediated damage in the lungs of the patient described in the previous questions?

Q60055. A 62-year-old woman undergoing chemotherapy for breast cancer presents with a 3-day history of fever and chest pain. Cardiac catheterization reveals a markedly reduced ejection fraction with normal coronary blood fl ow. A myocardial biopsy is obtained, and a PCR test for coxsackievirus is positive. Histologic examination of this patient’s myocardium will most likely reveal an abundance of which of the following infl ammatory cells?

Q60056. A 58-year-old woman with long-standing diabetes and hypertension develops end-stage renal disease and dies in uremia. A shaggy fi brin-rich exudate is noted on the visceral pericardium at autopsy (shown in the image). Which of the following best explains the pathogenesis of this fi brinous exudate?

Q60057. A 68-year-old man with prostate cancer and bone metastases presents with shaking chills and fever. The peripheral WBC count is 1,000/μL (normal = 4,000 to 11,000/μL). Which of the following terms best describes this hematologic fi nding?

Q60058. A 25-year-old machinist is injured by a metal sliver in his left hand. Over the next few days, the wounded area becomes reddened, tender, swollen, and feels warm to the touch. Redness at the site of injury in this patient is caused primarily by which of the following mechanisms?

Q60059. The patient described in Question 28 goes to the emergency room to have the sliver removed. Which of the following mediators of infl ammation plays the most important role in stimulating platelet aggregation at the site of injury following this minor surgical procedure?

Q60060. Twenty-four hours later, endothelial cells at the site of injury in the patient described in Questions 28 and 29 release a chemical mediator that inhibits further platelet aggregation. Name this mediator of infl ammation.

Q60061. A 37-year-old man with AIDS is admitted to the hospital with a 3-week history of chest pain and shortness of breath. An X-ray fi lm of the chest shows bilateral nodularities of the lungs. A CT-guided lung biopsy is shown in the image. The multinucleated cell in the center of this fi eld is most likely derived from which of the following infl ammatory cells?