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Pathophysiology The Biologic Basis for Disease in Adults and Children 8th Edition McCance Test Bank instant download all chapter
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Chapter 07: Innate Immunity: Inflammation and Wound Healing
McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and
Children, 8th Edition
MULTIPLE CHOICE
3. Which secretion is a first line of defense against pathogen invasion that involves antibacterial
and antifungal fatty acids, as well as lactic acid?
a. Optic tears
b. Oral saliva
c. Sweat gland perspiration
d. Sebaceous gland sebum
ANS: D
Sebaceous glands in the skin secrete sebum that is made up of antibacterial and antifungal
fatty acids and lactic acid that provide the first-line barrier against pathogen invasion.
Perspiration, tears, and saliva contain an enzyme (lysozyme) that attacks the cell walls of
gram-positive bacteria.
5. What causes the edema that occurs during the inflammatory process?
a. Vasodilation of blood vessels
b. Increased capillary permeability
c. Endothelial cell expansion
d. Emigration of neutrophils
ANS: B
The increased flow and capillary permeability result in a leakage of plasma from the vessels,
causing swelling (edema) in the surrounding tissue and is solely responsible for
inflammation-induced edema. Vasodilation (increased size of the blood vessels) causes slower
blood velocity and increases blood flow to the injured site. Endothelial cell contraction (not
expansion) leads to increased capillary permeability. Emigration of neutrophils to the area of
infection/injury leads to increased destruction of the offending agent.
6. What process causes heat and redness to occur during the inflammatory process?
a. Vasodilation of blood vessels
b. Platelet aggregation
c. Decreased capillary permeability
d. Endothelial cell contraction
ANS: A
The increased blood flow as a result of vasodilation and increasing concentration of red cells
at the site of inflammation cause locally increased warmth and redness. Platelet aggregation is
important in the clotting cascade. Decreased capillary permeability would affect local edema.
Endothelial cell contraction leads to increased capillary permeability and the formation of
edema.
9. Which component of the plasma protein system tags pathogenic microorganisms for
destruction by neutrophils and macrophages?
a. Complement cascade
b. Coagulation system
c. Kinin system
d. Immune system
ANS: A
C3b (a component of the complement cascade) adheres to the surface of a pathogenic
microorganism and serves as an efficient opsonin. Opsonins are molecules that tag
microorganisms for destruction by cells of the inflammatory system, primarily neutrophils and
macrophages. The other options do not accurately identify a component capable of tagging
pathogenic microorganisms.
10. What is the vascular effect of histamine released from mast cells?
a. Platelet adhesion
b. Initiation of the clotting cascade
c. Vasodilation
d. Increased endothelial adhesiveness
ANS: C
Histamine, when released from mast cells, causes vasodilation. It does not cause platelet
adhesion, initiation of the clotting cascade, or increased endothelial adhesiveness.
13. In the coagulation (clotting) cascade, the intrinsic and the extrinsic pathways converge at
which factor?
a. XII
b. VII
c. X
d. V
ANS: C
The coagulation cascade consists of the extrinsic and intrinsic pathways that converge only at
factor X.
14. Which chemical interacts among all plasma protein systems by degrading blood clots,
activating complement, and activating the Hageman factor?
a. Kallikrein
b. Histamine
c. Bradykinin
d. Plasmin
ANS: D
Only plasmin regulates clot formation by degrading fibrin and fibrinogen, and it can activate
the complement cascade through components C1, C3, and C5. Plasmin can activate the
plasma kinin cascade by activating the Hageman factor (factor XII) and producing
prekallikrein activator.
15. How does the chemotactic factor affect the inflammatory process?
a. By causing vasodilation around the inflamed area
b. By stimulating smooth muscle contraction in the inflamed area
c. By directing leukocytes to the inflamed area
d. By producing edema around the inflamed area
ANS: C
Two chemotactic factors, neutrophil chemotactic factor (NCF) and eosinophil chemotactic
factor of anaphylaxis (ECF-A), are released during mast cell degranulation. NCF attracts
neutrophils (a type of leukocytes), and ECF-A attracts eosinophils to the site of inflammation.
The other options do not accurately describe the affect chemotactic factors have on the
inflammatory process.
16. What effect does the process of histamine binding to the histamine-2 (H2) receptor have on
inflammation?
a. Inhibition
b. Activation
c. Acceleration
d. Termination
ANS: A
Binding histamine to the H2 receptor is generally antiinflammatory because it results in the
suppression of leukocyte function. Binding to H2 receptors does not cause activation,
acceleration, or termination of the inflammatory process.
17. Frequently when H1 and H2 receptors are located on the same cells, they act in what fashion?
a. Synergistically
b. Additively
c. Antagonistically
d. Agonistically
ANS: C
Both types of receptors are distributed among many different cells and are often present on the
same cells and may act in an antagonistic fashion. For instance, neutrophils express both types
of receptors, with stimulation of H1 receptors resulting in the augmentation of neutrophil
chemotaxis and H2 stimulation resulting in its inhibition. The two receptors do not act
synergistically, additively, or agonistically.
PTS: 1 DIF: Cognitive Level: Remembering
18. Some older adults have impaired inflammation and wound healing because of which
problem?
a. Circulatory system cannot adequately perfuse tissues.
b. Complement and chemotaxis are deficient.
c. Underlying chronic illness(es) exists.
d. Number of mast cells is insufficient.
ANS: C
In some cases, impaired healing is not directly associated with aging, in general, but can
instead be linked to a chronic illness such as cardiovascular disease or diabetes mellitus. Older
adults may have circulatory problems, but that would not lead directly to impaired
inflammation and wound healing. Older people do not have deficient complement and
chemotaxis, nor do they have insufficient mast cell numbers.
19. Which chemical mediator derived from mast cells retracts endothelial cells to increase
vascular permeability and to cause leukocyte adhesion to endothelial cells?
a. Chemokines
b. Prostaglandin E
c. Platelet-activating factor
d. Bradykinin
ANS: C
The biologic activity of platelet-activating factor is virtually identical to that of leukotrienes;
namely, it causes endothelial cell retraction to increase vascular permeability, leukocyte
adhesion to endothelial cells, and platelet activation. The other options do not accurately
identify the chemical mediator derived from the process described in the question.
Chemokines function primarily to induce leukocyte chemotaxis. Prostaglandins interact with
the kinin system to stimulate nerve endings and cause pain, among other actions. Bradykinin
is the most important product of the kinin system and causes vascular permeability, smooth
muscle contraction, and pain.
22. When considering white blood cell differentials, acute inflammatory reactions are related to
elevations of which leukocyte?
a. Monocytes
b. Eosinophils
c. Neutrophils
d. Basophils
ANS: C
Only neutrophils are the predominant phagocytes in the early inflammatory site, arriving
within 6 to 12 hours after the initial injury, they ingest (phagocytose) bacteria, dead cells, and
cellular debris at the inflammatory site.
23. In the later stages of an inflammatory response, which phagocytic cell is predominant?
a. Neutrophils
b. Monocytes
c. Chemokines
d. Eosinophils
ANS: B
Only monocytes and macrophages perform many of the same functions as neutrophils but for
a longer time and in a later stage of the inflammatory response.
24. In regulating vascular mediators released from mast cells, the role of eosinophils is to release
what?
a. Arylsulfatase B, which stimulates the formation of B lymphocytes
b. Histaminase, which limits the effects of histamine during acute inflammation
c. Lysosomal enzymes, which activate mast cell degranulation during acute
inflammation
d. Immunoglobulin E, which defends the body against parasites
ANS: B
Eosinophil lysosomes contain several enzymes that degrade vasoactive molecules, thereby
controlling the vascular effects of inflammation. These enzymes include histaminase, which
mediates the degradation of histamine, and arylsulfatase B, which mediates the degradation of
some of the lipid-derived mediators produced by mast cells. The other options do not
accurately describe the role of eosinophils.
26. Which cytokine is produced and released from virally infected host cells?
a. IL-1
b. IL-10
c. TNF-
d. IFN-
ANS: D
Only interferons (IFNs) are produced and released by virally infected cells in response to viral
double-stranded ribonucleic acid (RNA). IFN- and IFN- induce the production of antiviral
proteins, thereby conferring protection on uninfected cells. IFN- or IFN- is released from
virally infected cells and attaches to a receptor on a neighboring cell. IFNs also enhance the
efficiency of developing an acquired immune response. IL-1 is a proinflammatory interleukin.
IL-10 plays a critical role in wound healing. TNF has several systemic effects but is not
released from virally infected host cells.
28. The acute inflammatory response is characterized by fever that is produced by the
hypothalamus being affected by what?
a. Endogenous pyrogens
b. Bacterial endotoxin
c. Antigen-antibody complexes
d. Exogenous pyrogens
ANS: A
Fever-causing cytokines are known as endogenous pyrogens. These pyrogens act directly on
the hypothalamus, which is the portion of the brain that controls the body’s thermostat. The
hypothalamus is not directly affected by bacterial endotoxins, antigen-antibody complexes, or
exogenous pyrogens.
29. What occurs during the process of repair after tissue damage?
a. Nonfunctioning scar tissue replaces destroyed tissue.
b. Regeneration occurs; the original tissue is replaced.
c. Resolution occurs; tissue is regenerated.
d. Epithelialization replaces destroyed tissue.
ANS: A
Repair is the replacement of destroyed tissue with scar tissue. Regeneration is the replacement
of damaged tissue with healthy tissue with complete return to normal structure and function.
Resolution is synonymous with regeneration. Epithelialization is the process by which
epithelial cells grow into the wound from surrounding healthy tissue.
30. What is the role of fibroblasts during the reconstructive phase of wound healing?
a. Generate new capillaries from vascular endothelial cells around the wound.
b. Establish connections between neighboring cells and contract their fibers.
c. Synthesize and secrete collagen and the connective tissue proteins.
d. Provide enzymes that débride the wound bed of dead cells.
ANS: C
Fibroblasts are the most important cells during the reconstructive phase of wound healing
because they synthesize and secrete collagen and other connective tissue proteins.
Macrophage-derived transforming growth factor-beta (TGF-ß) stimulates fibroblasts.
Fibroblasts do not generate new capillaries, establish connections between neighboring cells,
or provide enzymes to debride the wound bed.
32. A student is preparing to irrigate a patient’s wound and gathers supplies, including hydrogen
peroxide. What response by the health care professional is best?
a. Help the student gather the rest of the supplies.
b. Instruct the student to dilute the hydrogen peroxide.
c. Tell the student to get some normal saline instead.
d. Ask the patient if pain medication is needed first.
ANS: C
Normal saline is the most innocuous solution that can be used to cleanse or irrigate a wound
that is primarily healing by epithelialization. The professional should instruct the student to
use it instead of the peroxide to avoid tissue damage. Helping to gather supplies, diluting the
solution, or medicating the patient for pain will not avoid the tissue damage that will be
caused by the hydrogen peroxide.
33. Many neonates have a transient depressed inflammatory response as a result of which
condition?
a. The circulatory system is too immature to perfuse tissues adequately.
b. Complement and chemotaxis are deficient.
c. Mast cells are lacking.
d. The respiratory system is too immature to deliver oxygen to tissues.
ANS: B
Neonates commonly have transiently depressed inflammatory and immune function partially
as a result of a deficiency in components of the alternative pathway. For example, neutrophils
and perhaps monocytes may not be capable of efficient chemotaxis. The circulatory system
should be adequate to perfuse tissues in a normal neonate and would not contribute to
decreased immunity if not. Mast cells are not lacking. The respiratory system should be
adequate to oxygenate tissues, and if not, would not contribute to decreased immunity.
34. During phagocytosis, what is occurring during the step referred to as opsonization?
a. Phagocytes recognize and adhere to the bacteria.
b. Microorganisms are ingested.
c. Microorganisms are killed and digested.
d. An intracellular phagocytic vacuole is formed.
ANS: A
During phagocytosis, opsonization involves only the recognition and adherence of phagocytes
to bacteria.
36. What does the phagosome step result in during the process of endocytosis?
a. Microorganisms are ingested.
b. Microorganisms are killed and digested.
c. Phagocytes recognize and adhere to bacteria.
d. An intracellular phagocytic vacuole is formed.
ANS: D
Small pseudopods that extend from the plasma membrane and surround the adherent
microorganism, forming an intracellular phagocytic vacuole or phagosome, carry out
engulfment (endocytosis). The membrane that surrounds the phagosome consists of inverted
plasma membrane. After the formation of the phagosome, lysosomes converge, fuse with the
phagosome, and discharge their contents, creating a phagolysosome.
37. When cellular damage occurs and regeneration is minor with no significant complications,
what is the process of returning the cells to preinjury function referred to as?
a. Restoration
b. Resolution
c. Regrowth
d. Replacement
ANS: B
If damage is minor with no complications and destroyed tissues are capable of regeneration,
then returning the injured tissues to an approximation of their original structure and
physiologic function is possible. This restoration is called resolution. Resolution is the
restoration of the original tissue structure and function. Regrowth and replacement are not part
of resolution.
38. Newborns often have deficiencies in collectin-like proteins, making them more susceptible to
what type of infection?
a. Cardiac
b. Urinary
c. Respiratory
d. Gastrointestinal
ANS: C
Neonates may also be deficient in some of the collectins and collectin-like proteins. This
deficiency is especially true of preterm neonates. Some preterm infants with respiratory
distress syndrome are deficient in at least one collectin, which negatively affects its innate
defense against respiratory infections. The other options are not necessarily related to collectin
deficiencies.
39. Which cell is the body’s primary defense against parasite invasion?
a. Eosinophil
b. Neutrophils
c. T lymphocytes
d. B lymphocytes
ANS: A
Eosinophils serve as the body’s primary defense against parasites. T lymphocytes and B
lymphocytes are involved in acquired immunity. Neutrophils are the predominant phagocytes
in the early inflammatory site.
MULTIPLE RESPONSE
1. Which chemical mediators induce pain during an inflammatory response? (Select all that
apply.)
a. Prostaglandins
b. Leukotrienes
c. Tryptase
d. Phospholipase
e. Bradykinin
ANS: A, E
The only chemical mediators that induce pain during an inflammatory response are the
prostaglandins and bradykinin. Leukotrienes produce smooth muscle contraction, increased
vascular permeability, and perhaps neutrophil and eosinophil chemotaxis. Tryptase is a
proteinase released from mast cells during an inflammatory response. Phospholipase cleaves
phospholipids.
2. What do sebaceous glands secrete in order to protect the body from infection? (Select all that
apply.)
a. Antibacterial fatty acids
b. Antifungal fatty acids
c. Ascorbic acid
d. Lactic acid
e. Hydrochloric acid
ANS: A, B, D
Sebaceous glands secrete only antibacterial and antifungal fatty acids and lactic acid. They do
not secrete ascorbic acid (which is vitamin C) or hydrochloric acid.
PTS: 1 DIF: Cognitive Level: Remembering
3. Which body fluids have the ability to attack the cell walls of gram-positive bacteria? (Select
all that apply.)
a. Perspiration
b. Semen
c. Tears
d. Saliva
e. Urine
ANS: A, C, D
Only perspiration, tears, and saliva contain an enzyme (lysozyme) that attacks the cell walls of
gram-positive bacteria.
4. What do the main functions of NK cells include? (Select all that apply.)
a. Recognizing virus-infected cells
b. Eliminating virus-infected cells
c. Recognizing bacteria-infected cells
d. Eliminating bacteria-infected cells
e. Eliminating previously identified cancer cells
ANS: A, B, E
The main functions of NK cells are recognizing and eliminating cells infected with viruses,
not bacteria. They are also somewhat effective at eliminating other abnormal host cells,
specifically cancer cells.
5. An individual’s acquired immunity is dependent on the function of which cells? (Select all
that apply.)
a. T lymphocytes
b. B lymphocytes
c. Macrophages
d. Opsonins
e. Neutrophils
ANS: A, B, C
T lymphocytes, B lymphocytes, macrophages, and dendritic cells are involved in acquired
immunity. Opsonins are molecules that tag microorganisms for destruction by cells of the
inflammatory system; these cells are primarily neutrophils. Neutrophils are white blood cells.
7. An older adult is particularly susceptible to infections of which body parts? (Select all that
apply.)
a. Lungs
b. Skin
c. Liver
d. Eyes
e. Bladder
ANS: A, B, E
Older adults have increased susceptibility to bacterial infections of the lungs, urinary tract,
and skin. Other infections may occur but on an individualized basis.
SITTING TIGHT