Chapter review
Bring the chapter together
Start with the case synthesis, answered in 3 separate parts, then work through mixed case-based questions. Every answer explains the clue that matters and why the closest alternative fails.
Case synthesis
Bringing it together: one thorn, from minutes to weeks
A 34-year-old gardener drives a rose thorn into the pad of his thumb. By evening the thumb is red, hot, swollen and throbbing. Two days later a tense yellow collection has formed under the skin; it is incised and drained, and the cavity is left open to heal. Three weeks later a small, firm, pale scar remains.
1. Trigger and vessels
Why was the thumb red, hot and swollen by the same evening?
2. Mechanism
Why did pus collect over the next two days?
3. Outcome
Why did it end as a small scar rather than perfect restoration, and not as a granuloma?
Mixed case review
Morphology, mechanism and application. Some items need two sections at once.
- Q1Sterile inflammation: neutrophils in an infarctConnects 2.1 + 2.2Midterm sim. p.3L1 p.33
A 59-year-old man has a massive myocardial infarction and dies of a ventricular arrhythmia 24 hours later.
Histologic examination of the affected heart muscle at autopsy would show an abundance of which inflammatory cells?
- Q2Brain infarct at one week: microgliaConnects 2.1 + 2.6Ch. II cases p.9L1 p.35
A 78-year-old man with poorly controlled hypertension has 2 hours of right-sided weakness. Imaging shows ischemic changes in the left frontal lobe.
One week after the stroke, which cell type would be most increased at the site of injury?
- Q3Cervical dysplasia (crossover)Connects 2.6 + 2.7Ch. II cases p.18L1 p.28
A 33-year-old woman has an abnormal cervical Pap smear. A biopsy shows epithelium that has lost its normal polarity; the cells have hyperchromatic nuclei, a higher nucleus-to-cytoplasm ratio and a disorderly arrangement.
Which term best describes these changes in her cervical epithelium?
- Q4Recruitment defect vs killing defectConnects 2.2 + 2.3L2 p.14, 21–24
Two boys both have recurrent staphylococcal infections. Boy A has a white count of 45,000/µL and his skin infections never form pus. Boy B has a normal white count and recurrent abscesses with granulomas in his lymph nodes and liver.
Which pair of defects fits?
- Q5Glucocorticoids: demargination and impaired healingConnects 2.2 + 2.4 + 2.7L2 p.13, 26, 51
A 60-year-old man has taken prednisone for years for rheumatoid arthritis. Ten days after abdominal surgery his wound breaks open. His white count is 14,000/µL, all mature neutrophils, and he has no fever.
Which single explanation covers both the blood count and the wound?
- Q6Fever: IL-1/TNF → PGE₂Connects 2.1 + 2.4L2 p.26–27
A 4-year-old with otitis media has a temperature of 39.5 °C. An hour after ibuprofen his temperature is 37.8 °C, although his ear is still inflamed.
Which step did the drug block?
- Q7Granulation tissue vs granulomaConnects 2.6 + 2.7L2 p.42–49
Two biopsies arrive together. Biopsy A is from the base of a 10-day-old leg ulcer. Biopsy B is from a hilar lymph node of a woman with hypercalcemia.
Which description fits both?
- Q8Resolution needs an intact frameworkConnects 2.5 + 2.7L2 p.39, 47Ch. II cases p.6
A 30-year-old woman with pneumococcal lobar pneumonia is treated promptly. Six weeks later her chest radiograph and lung function are normal.
Why did the lung heal without a scar?
- Q9Hepcidin and anemia of chronic diseaseConnects 2.4 + 2.6L2 p.29
A 54-year-old woman with long-standing active rheumatoid arthritis has a hemoglobin of 10.1 g/dL, low serum iron, low transferrin (TIBC) and a high ferritin. Oral iron has not helped.
What is the main mechanism of her anemia?
- Q10Serum amyloid A → AA amyloidosisConnects 2.4 + 2.6L2 p.29L1 p.47
A 61-year-old man has had poorly controlled rheumatoid arthritis for 20 years. He develops nephrotic syndrome, and his renal biopsy shows Congo red-positive deposits with apple-green birefringence.
What is the precursor protein of the deposits?
- Q11Chédiak–Higashi: one defect, many cellsConnects 2.2 + 2.3L2 p.19
A 6-year-old boy with very light, silvery hair has had recurrent staphylococcal skin infections and numbness in his feet. His smear shows large granules in the neutrophils.
Which additional finding is most likely?
- Q12MPO deficiency: no HOClConnects 2.3 + 2.4L2 p.20, 25Midterm sim. p.4
A 50-year-old woman with poorly controlled diabetes has persistent candidiasis. Her NBT test is normal, and her neutrophils do not stain for peroxidase.
Which product can her neutrophils not make?
- Q13Fibrinous exudate → organization → scarConnects 2.5 + 2.7L2 p.35, 39, 47
A 58-year-old man had fibrinous pericarditis after a myocardial infarction. Eight months later he has rising venous pressure and edema; the pericardium is thick, fibrous and adherent.
How did the fibrinous exudate become this?
- Q14Impaired healing in diabetesConnects 2.3 + 2.7L2 p.51Midterm sim. p.5–6
A 67-year-old man with long-standing diabetes has a foot ulcer that has not healed in three months. The base is pale and dry with little granulation tissue.
Which combination best explains the poor healing?
- Q15Exudate: permeabilityConnects 2.1 + 2.5L2 p.4, 10
A 70-year-old man with pneumonia has a pleural effusion. Fluid-to-serum protein ratio is 0.7, LDH ratio 0.8, and the fluid is cloudy with many neutrophils.
What produced this fluid?
- Q16Cellulitis vs abscessConnects 2.1 + 2.5L2 p.32, 34
Two days after scratching her leg on a rose bush, a 45-year-old woman has a spreading, warm red area with red streaks running up the thigh and tender inguinal nodes. There is no collection of pus.
Which bacterial product best explains why this infection spread instead of forming an abscess?
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Timed practice