Inflammation — MCQs

A 33-year-old woman presents to the emergency department with a 3-day history of backache, progressive bilateral lower limb weakness, and a pins-and-needles sensation in both of her legs. She has not passed urine for the past 24 hours. Her medical history is unremarkable. Her blood pressure is 112/74 mm Hg, heart rate is 82/min, and temperature is 37°C (98.6°F). She is alert and oriented to person, place, and time. Higher mental functions are intact. Muscle strength is 5/5 in the upper limbs and 3/5 in the lower limbs. The lower limb weakness is accompanied by increased muscle tone, brisk deep tendon reflexes, and a bilateral upgoing plantar reflex. Pinprick sensations are decreased at and below the level of the umbilicus. The bladder is palpable on abdominal examination. What is the most likely pathophysiology involved in the development of this patient’s condition?

A 31-year-old woman scrapes her finger on an exposed nail and sustains a minor laceration. Five minutes later, her finger is red, swollen, and painful. She has no past medical history and does not take any medications. She drinks socially with her friends and does not smoke. The inflammatory cell type most likely to be prominent in this patient's finger has which of the following characteristics?

A 14-year-old boy is brought to the physician by his parents for the evaluation of a skin rash for one day. The patient reports intense itching. He was born at 39 weeks' gestation and has a history of atopic dermatitis. He attends junior high school and went on a camping trip with his school the day before yesterday. His older brother has celiac disease. Examination shows erythematous papules and vesicles that are arranged in a linear pattern on the right forearm. Laboratory studies are within normal limits. Which of the following is the most likely underlying cause of this patient's symptoms?

A 62-year-old woman with type 2 diabetes mellitus is brought to the emergency room because of a 3-day history of fever and shaking chills. Her temperature is 39.4°C (103°F). Examination of the back shows right costovertebral angle tenderness. Analysis of the urine shows WBCs, WBC casts, and gram-negative rods. Ultrasound examination of the kidneys shows no signs of obstruction. Biopsy of the patient's kidney is most likely to show which of the following?

A 40-year-old man comes to his doctor because of 2 weeks of progressively worsening pain on the outer side of his right elbow. He does not recall any trauma to the area. The patient plays tennis recreationally and has recently gone from playing weekly to playing daily in preparation for a local tournament. He has had some pain relief with ibuprofen. On physical examination, there is tenderness over the lateral surface of the right distal humerus. The pain is reproduced by supinating the forearm against resistance. Which of the following is the most likely underlying cause of this patient's condition?

A 33-year-old man with a history of IV drug and alcohol abuse presents to the emergency department with back pain. He states that his symptoms started 3 days ago and have been gradually worsening. His temperature is 102°F (38.9°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for tenderness over the mid thoracic spine. Laboratory values are only notable for a leukocytosis and an elevated ESR and CRP. Which of the following is the most likely diagnosis?

A 48-year-old male dies in the intensive care unit following a severe Streptococcus pneumoniae pneumonia and septic shock. Autopsy of the lung reveals a red, firm left lower lobe. What would you most likely find on microscopic examination of the lung specimen?

A 68-year-old man is brought to the emergency department 30 minutes after the onset of uncontrollable jerking movements of his arms and legs followed by loss of consciousness. His wife says that he seemed confused this morning and had a headache. Immediately before the shaking episode, he said that he smelled rotten eggs. He is unresponsive. Cerebrospinal fluid (CSF) analysis shows a leukocyte count of 700/μL (70% lymphocytes), a glucose concentration of 60 mg/dL, and a protein concentration of 80 mg/dL. Despite appropriate lifesaving measures, the man dies. Which of the following is most likely to be found on postmortem examination of this patient?

A 45-year-old female is undergoing renal transplantation for management of chronic renal failure secondary to glomerulonephritis. The transplant surgeon placed the donor kidney in the recipient and anastomosed the donor renal artery to the recipient's external iliac artery as well as the donor ureter to the recipient's bladder. After removing the clamps on the external iliac artery, the recipient's blood is allowed to perfuse the transplanted kidney. Within 3 minutes, the surgeon notes that the kidney does not appear to be sufficiently perfused. Upon further investigation, an inflammatory reaction is noted that led to clotting off of the donor renal artery, preventing blood flow to the transplanted organ. Which of the following best describes the pathophysiology of this complication?

A 66-year-old farmer is being evaluated for abnormal lung findings on a low dose chest CT scan obtained as part of his lung cancer screening. He has a 50-pack-year smoking history and has been hesitant to quit. He has a non-productive cough but brushes it away saying he is not bothered by it. He denies ever coughing up blood, breathlessness, chest pain, fatigue, or weight loss. He has never sought any medical care and states that he has always been in good shape. He consumes alcohol moderately and uses marijuana occasionally. He lives with his wife and has not traveled recently. On physical examination, his temperature is 37.1°C (98.8°F), blood pressure is 148/70 mm Hg, and pulse rate is 95/min. His BMI is 32 kg/m2. A general physical examination is unremarkable. Coarse breath sounds are present bilaterally. The cardiac exam is normal. Laboratory studies show a normal complete blood count and comprehensive metabolic panel. A follow-up high-resolution CT scan is performed that shows small irregular subcentimeter pulmonary nodules, several of which are cavitated in both lungs, predominantly distributed in the upper and middle zones. There is no mediastinal or hilar lymphadenopathy. A transbronchial needle aspiration of the lesion is performed which shows a nodular pattern of abundant, granular, mildly eosinophilic cells with grooved nuclei with indented nuclear membranes and a chronic inflammation that consists primarily of eosinophils. Immunohistochemical staining reveals numerous cells that stain positive for S100 and CD1a. Which of the cells of the human immune system are responsible for this lesion?