Leukocyte activation and adhesion to vascular endothelial cells is a critical step in the inflammatory process. This process is regulated by which of the following molecules? a. The selectins b. The b5 integrins c. The immunoglobulin supergene family d. Nitric oxide e. IL-8

Leukocyte activation and adhesion to vascular endothelial cells is a critical step in the inflammatory process. This process is regulated by which of the following molecules? a. The selectins b. The b5 integrins c. The immunoglobulin supergene family d. Nitric oxide e. IL-8
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Answer: a, c, d, e  The temporal events that initiate and propagate neutrophil recruitment and inflammation include endothelial cell activation and expression of endothelial-derived neutrophil adhesion molecules, neutrophil-endothelial cell adherence, and neutrophil transendothelial migration via established neutrophil chemotactic gradients. There are three major families of adhesion molecules which are expressed on the surface of leukocytes and endothelial cells and are important for leukocyte-endothelial cell interactions. These include the immunoglobin supergene family (ICAM-1, VCAM-1, and PECAM-1), the selectins (E-selectin, P-selectin and L-selectin), and the integrins. The leukocyte b2 integrin adhesion molecule family consists of three members with heterodimeric glycoproteins displayed as a variable alpha and a constant beta chain. Nitric oxide regulates the adhesion process both by direct influence on leukocyte binding as well as by regulation of regional blood flow. IL-8 is one of the most potent mediators of chemotaxis in the C-X-C chemokine family. It serves an important role in neutrophil recruitment and activation, and the continued propagation of the inflammatory response
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Which of the following statement(s) is/are true concerning the antibody response to an invading antigen? a. All antibodies are composed of one type of heavy and one type of light protein chain b. The carboxyl terminus of the heavy chain is the antigen binding site c. Antibody of the immunoglobulin G class is the initial antibody produced in response to an antigenic stimulus d. Immunoglobulins A, D, and E play an active role in the circulating humoral response

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Which of the following statement(s) is/are true about the role of macrophages in the wound healing process? a. Macrophages are the dominant cell type during the inflammatory phase of wound healing b. Macrophages are not essential for wound healing c. The macrophage role in wound healing is limited to phagocytosis d. Macrophages are a source of a number of humoral factors essential for wound healing

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Last Answer : Answer: a, c TNFa has a marked procoagulant effect on endothelial cells, precipitating intravascular thrombosis. TNFa causes endothelial cells to release procoagulant activity (tissue factor), ... to produce TNFa, however the most potent stimulus for TNFa production and release is endotoxin

Cytokines with clearly defined actions in acute inflammation and early tissue injury include which of the following? a. Cysteine-X-Cysteine (C-X-C) chemokines b. Tumor Necrosis Factor (TNFa) c. Transforming Growth Factor-b (TGF-b) d. Interleukin-6 (IL-6) e. Platelet Derived Growth Factor (PDGF)

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Last Answer : Answer: a, b, c, d, e Polypeptide mediators, such as TNFa and IL-1, are considered early response cytokines and are actively involved in the initiation of the ... of tissue repair. Thus, coagulation and platelet activation provide the initial foundation for subsequent cellular recruitment

The transport of proteins out of the cell is termed exocytosis. Which of the following statement(s) is/are true concerning this process? a. Secretory vesicles fuse with the plasma membrane b. The process can occur in either a constitutive or regulated process c. A regulated secretion is triggered by a stimulus, most likely a hormone or a neurotransmitter d. A decrease in cytoplasmic calcium occurs as part of the secretion process

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In contrast to adult wound healing with scar formation, which of the following are characteristic of scarless fetal skin repair? A. Matrix rich in hyaluronic acid. B. Increased inflammatory response. C. Increased production of TGF-b. D. No collagen deposition. E. Minimal angiogenesis.

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Which of the following statement(s) is/are true concerning the treatment of MOFS? a. Prevention and therapy of MOFS requires control of the infectious or inflammatory source b. Restoration of normal clinical parameters such as blood pressure, pulse rate, and urine output ensures optimal resuscitation in most patients c. Branch chain amino acids play and important role in the nutritional support of the patient d. Because of the nature of gut injury, total parenteral nutrition is preferred for most patients with MOFS

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Last Answer : Answer: a, c The therapy of MOFS is directed towards interrupting the involving pathophysiologic process and providing an optimal physiologic environment for healing and recovery. ... Enteral absorption and processing of nutrients appears superior to TPN and lessens overall complications

Which of the following statement(s) is/are true concerning tumor necrosis factor (TNF)? a. TNF is a product of activated macrophages secreted in response to contact with endotoxin or lipopolysaccharide, antibody complexes, or inflammatory stimuli b. The liver and gut appear to be a major source of TNF following hypoperfusion c. Circulating levels of TNF correlate well with severity of tissue injury in shock d. Recently completed clinical trials of anti-TNF antibody in septic patients shows a marked improvement in survival

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Last Answer : Answer: a, b Tumor necrosis factor (TNF), a protein product of activated macrophages, is secreted in response to contact with endotoxin or lipopolysaccharide, antibody complexes, or ... patients utilizing infusion of monoclonal antibodies to the TNF molecule have shown no overall survival benefit

Which of the following statement(s) is/are true concerning metabolic derangements in sepsis and the systemic inflammatory response syndrome which may follow progressive shock? a. Alterations in glucose metabolism lead to the development of efficient substrate utilization b. A progressive rise in serum triglyceride levels result from less efficient clearance and increased hepatic lipogenesis c. A net negative nitrogen balance occurs due to the oxidative metabolism of proteins to meet energy needs d. The serum aromatic amino acids fall rapidly as they are actively used in oxidative metabolism

Description : Which of the following statement(s) is/are true concerning metabolic derangements in sepsis and the systemic inflammatory response syndrome which may follow progressive shock? a. Alterations in glucose ... The serum aromatic amino acids fall rapidly as they are actively used in oxidative metabolism

Last Answer : Answer: b, c A broad spectrum of metabolic abnormalities become apparent in sepsis and the systemic inflammatory response syndrome following shock. Disruption of the normal cycles of carbohydrate, ... acetyl coenzyme A. This results in reduced serum level of leucine, isoleucine and valine

Ketorolac: A. Is a nonsteroidal anti-inflammatory drug (NSAID) approved for intravenous, intramuscular, and oral administration. B. Can be used indefinitely for postoperative analgesia. C. Can cause renal dysfunction. D. May decrease surgical blood loss.

Description : Ketorolac: A. Is a nonsteroidal anti-inflammatory drug (NSAID) approved for intravenous, intramuscular, and oral administration. B. Can be used indefinitely for postoperative analgesia. C. Can cause renal dysfunction. D. May decrease surgical blood loss.

Last Answer : Answer: AC DISCUSSION: Ketorolac tromethamine, an NSAID, is approved by the FDA for intravenous, intramuscular, and oral administration. The agent is an effective analgesic with minimal side ... Additionally, it is recommended that ketorolac should not be used for more than 5 consecutive days

True statements regarding eicosanoids include which of the following? A. Prostaglandins and thromboxanes are synthesized via the cyclo-oxygenase pathway. B. The vasoconstricting, platelet-aggregating, and bronchoconstricting effects of thromboxane A 2 are balanced by the actions of prostacyclin, which produces the opposite effects. C. Leukotriene synthesis is inhibited by the action of nonsteroidal anti-inflammatory drugs (NSAIDs). D. The principal prostaglandins have a short circulation half-life and exert most of their effects locally.

Description : True statements regarding eicosanoids include which of the following? A. Prostaglandins and thromboxanes are synthesized via the cyclo-oxygenase pathway. B. The vasoconstricting, platelet-aggregating, ... prostaglandins have a short circulation half-life and exert most of their effects locally.

Last Answer : Answer: ABD DISCUSSION: The eicosanoids are a group of compounds arising from the metabolism of arachidonic acid. The prostaglandins and thromboxanes are synthesized via the cyclo-oxygenase ... effects and may be involved in the physiologic responses associated with anaphylactic and septic shock

In addition to their ability to decrease inflammatory prostaglandin synthesis, some non-steroidal anti-inflammatory drugs (NSAIDs) may owe part of their effects to their ability to (a) Inhibit leukocyte migration (b) Inhibit leukotriene synthesis (c) Stabilize lysosmal membranes (d) All of the above (e) None of the above

Description : In addition to their ability to decrease inflammatory prostaglandin synthesis, some non-steroidal anti-inflammatory drugs (NSAIDs) may owe part of their effects to their ability to (a) Inhibit leukocyte migration (b ... (c) Stabilize lysosmal membranes (d) All of the above (e) None of the above

Last Answer : Ans: D

Which of the following statement(s) is/are true concerning the vascular response to injury? a. Vasoconstriction is an early event in the response to injury b. Vasodilatation is a detrimental response to injury with normal body processes working to avoid this process c. Vascular permeability is maintained to prevent further cellular injury d. Histamine, prostaglandin E2 (PGE2) and prostacyclin (PGI2) are important mediators of local vasoconstriction

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Last Answer : Answer: a After wounding, there is transient vasoconstriction mediated by catecholamines, thromboxane, and prostaglandin F2 (PGF2a). This period of vasoconstriction lasts for only five to ten minutes. Once ... and mast cells and enhance the egress of cells and substrate into the wound and tissue

Which of the following statement(s) is/are true concerning the role of glutamine in total parenteral nutrition? a. Glutamine is an essential amino acid b. Glutamine appears to be of primary benefit in critical illness c. Glutamine is included in most standard TPN solutions d. Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon

Description : Which of the following statement(s) is/are true concerning the role of glutamine in total parenteral nutrition? a. Glutamine is an essential amino acid b. Glutamine appears to be of primary ... . Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon

Last Answer : Answer: b Glutamine is the most studied gut-specific nutrient. Glutamine has been classified as a nonessential or nutritionally dispensable amino acid since glutamine can be synthesized in adequate ... . In contrast to glutamine, short chain fatty acids are primary energy source for colonocytes

Which of the following statement(s) is/are true concerning the cell plasma membrane? a. The plasma membrane is composed of amphipathic molecules b. The hydrophobic core of the lipid bilayer of the cell membrane contains specialized transport proteins which maintain the intracellular ionic milieu different from the extracellular fluid c. Plasma membrane proteins extend externally and bear phospholipid moieties which contribute to the cell coat d. The membrane proteins of nerve cells are highly voltage-dependent

Description : Which of the following statement(s) is/are true concerning the cell plasma membrane? a. The plasma membrane is composed of amphipathic molecules b. The hydrophobic core of the lipid bilayer of the ... contribute to the cell coat d. The membrane proteins of nerve cells are highly voltage-dependent

Last Answer : Answer: a, b, d The plasma membrane defines the boundary of the cell and serves to contain and concentrate enzymes and other macromolecule constituents. The plasma membrane is ... and bear carbohydrate moieties primarily as oligosaccharide chains that contribute to the cell coat or glycocalyx

Which of the following is/are true concerning wound fibroblasts? A. Fibroblasts synthesize and secrete collagen molecules. B. Wound fibroblasts are derived from blood-borne precursor cells. C. Fibroblasts migrate to a wound along fibrin strands, which are used as a scaffold. D. Large amounts of fibrin or blood clot can act as a physical barrier to fibroblast penetration, which delays normal wound healing.

Description : Which of the following is/are true concerning wound fibroblasts? A. Fibroblasts synthesize and secrete collagen molecules. B. Wound fibroblasts are derived from blood-borne precursor cells. C. ... clot can act as a physical barrier to fibroblast penetration, which delays normal wound healing.

Last Answer : Answer: ACD DISCUSSION: Fibroblasts appear in the wound on about the third day of healing and begin to synthesize and secrete collagen molecules. Wound fibroblasts arrive from cells surrounding ... enzymes, and large amounts of fibrin and blood clot prevent fibroblasts from entering the wound

Which of the following statements regarding the complement system are true? a. Complement activation yields products which are directly cytotoxic as well as products which act indirectly via activated leukocytes b. Complement products referred to as anaphylatoxins include C1, C3a, C4a, and C5a c. The principal role of C5a is in bacterial opsonization d. The alternative and classical pathways converge proximal to generating the membrane attack complex (C5b-9)

Description : Which of the following statements regarding the complement system are true? a. Complement activation yields products which are directly cytotoxic as well as products which act indirectly via activated ... and classical pathways converge proximal to generating the membrane attack complex (C5b-9)

Last Answer : Answer: a, d The complement system is composed of two different but linked sequences, the classic and alternative pathways. The pathways involve serum proteins that act to amplify the inflammatory-immune ... the C5 level proximal to generating the membrane attack complex (C5b-9) (Figure 6-3)

Fibrinolytic therapy is based on activation of plasminogen, the inactive proteolytic enzyme of plasma that binds to fibrin during the formation of thrombosis. Activation of plasminogen to plasmin results in selective thrombolysis at the fibrin clot surface. Which of the following statement(s) is/are true concerning agents used in thrombolytic therapy? a. Streptokinase is a bacterial protein which is antigenic in humans, resulting in allergic reactions in up to l5% of cases b. Tissue plasminogen activator acts directly on plasmin without an intermediate drug–plasmin complex c. The half-life of urokinase, streptokinase, and TPA all exceed 30 minutes d. Streptokinase is significantly cheaper than urokinase or TPA

Description : Fibrinolytic therapy is based on activation of plasminogen, the inactive proteolytic enzyme of plasma that binds to fibrin during the formation of thrombosis. Activation of plasminogen to plasmin results ... TPA all exceed 30 minutes d. Streptokinase is significantly cheaper than urokinase or TPA

Last Answer : Answer: a, b, d Streptokinase is a bacterial protein produced by group C b-hemolytic streptococci. It is therefore antigenic in humans and can be associated with allergic reaction in ... one agent over the other. Streptokinase however, is markedly less expensive than either urokinase or TPA

The best understood intracellular messenger is cyclic AMP (cAMP). Which of the following statement(s) concerning this intracellular messenger is/are correct? a. Intracellular cyclic AMP is constantly degraded by a specific enzyme, cAMP phosphodiesterase b. Most of the actions of cAMP are mediated by activation of protein kinase A c. Intracellular levels of cAMP are relatively stable and change solely in response to activation of adenylate cyclase d. cAMP is the only cyclic nucleotide active as an intracellular messenger

Description : The best understood intracellular messenger is cyclic AMP (cAMP). Which of the following statement(s) concerning this intracellular messenger is/are correct? a. Intracellular cyclic AMP is constantly ... of adenylate cyclase d. cAMP is the only cyclic nucleotide active as an intracellular messenger

Last Answer : Answer: a, b The prototypic intracellular messenger is cAMP. To function as a mediator, the concentration of cAMP must change rapidly. In resting cells, cAMP is continuously being degraded by ... produce cGMP. Intracellular calcium ions also serve as second messengers in a large number of cells

Which of the following statements about the coagulation cascade is/are true? A. The intrinsic pathway of coagulation is the predominant pathway in vivo for hemostasis and coagulation. B. The intrinsic pathway beginning with the activation of factor XII is the predominant in vivo mechanism for activation of the coagulation cascade. C. Deficiencies of factor VIII and IX cause highly significant coagulation abnormalities. D. Deficiencies of factor XII cause severe clinical bleeding syndromes.

Description : Which of the following statements about the coagulation cascade is/are true? A. The intrinsic pathway of coagulation is the predominant pathway in vivo for hemostasis and coagulation. ... coagulation abnormalities. D. Deficiencies of factor XII cause severe clinical bleeding syndromes.

Last Answer : Answer: AC DISCUSSION: Although it was previously held that two somewhat distinct pathways existed for the activation of the coagulation cascade, it is now recognized that the predominant ... bleeding. This further emphasizes the secondary role that the intrinsic pathway plays in coagulation

Which of the following factors can be associated with impaired wound healing? a. Chemotherapy b. Chronic steroid use c. Peripheral vascular disease d. Radiation therapy e. Diabetes mellitus

Description : Which of the following factors can be associated with impaired wound healing? a. Chemotherapy b. Chronic steroid use c. Peripheral vascular disease d. Radiation therapy e. Diabetes mellitus

Last Answer : Answer: a, b, c, d, e Bone marrow suppression, a common consequence of chemotherapy, is detrimental to wound healing. Quantitative and qualitative lymphocyte and monocyte deficiency impairs cellular ... be a primary cause of impaired healing, and may be also a cofactor with other conditions

The following are true about chemicals involved in allergic reaction: a. thromboxane -leukocyte activation b. prostaglandin-2 - vasodilatation c. platelet-activating factor - leukocyte activation d. heparin - augments inactivation of prostaglandins

Description : The following are true about chemicals involved in allergic reaction: a. thromboxane -leukocyte activation b. prostaglandin-2 - vasodilatation c. platelet-activating factor - leukocyte activation d. heparin - augments inactivation of prostaglandins

Last Answer : prostaglandin-2 - vasodilatation

The blood-brain-barrier: a. contains the foot processes of astrocytes b. contains endothelial cells with tight junction c. allows transport in one direction only ie from the vascular system into the brain d. does not allow diffusion of water

Description : The blood-brain-barrier: a. contains the foot processes of astrocytes b. contains endothelial cells with tight junction c. allows transport in one direction only ie from the vascular system into the brain d. does not allow diffusion of water

Last Answer : does not allow diffusion of water

With regard to the blood retina barrier: a. the outer blood retina is formed by the retinal pigment epithelium cells and their junctions b. the blood retina barrier is typically defective in the immediate perpapillary region c. the retinal vascular endothelial cells can actively transport fluid and anions from the extracellular space of the retina into the circulation d. all above

Description : With regard to the blood retina barrier: a. the outer blood retina is formed by the retinal pigment epithelium cells and their junctions b. the blood retina barrier is typically defective in the ... fluid and anions from the extracellular space of the retina into the circulation d. all above

Last Answer : all above

Which of the following statement(s) is/are correct concerning the cardiovascular response to shock? a. Changes in cardiac contractile function shift the Frank Starling curve up and down b. Venoconstriction from skeletal muscle is a significant contributor to the restoration of blood volume with shock c. Arterial vasoconstriction affects all vascular beds equally d. The total circulating blood volume is equally split between the arterial and venous system

Description : Which of the following statement(s) is/are correct concerning the cardiovascular response to shock? a. Changes in cardiac contractile function shift the Frank Starling curve up and down b. ... d. The total circulating blood volume is equally split between the arterial and venous system

Last Answer : Answer: a Central in the general cardiovascular response to shock is the action of the heart itself. The principle determinants of cardiac function in the normal heart are the volume of blood ... Blood flow to the skin is sacrificed early, followed by that to the kidneys and splanchnic viscera

A 68-year-old male who underwent a repair of an abdominal aortic aneurysm 5 days ago, develops tachycardia, tachypnea, hypotension with cool, pale, mottled cyanotic extremities. He is agitated and complains of shortness of breath. Which of the following statement(s) is/ are correct concerning his diagnosis and management? a. Myocardial ischemia secondary to preexisting coronary artery disease is most likely the underlying cause of this problem b. Invasive hemodynamic monitoring with a Swan-Gantz catheter will demonstrate a low cardiac output, a high systemic vascular resistance, and elevated cardiac filling pressures c. The use of morphine sulphate and nitrates should be part of the initial management d. The primary pharmacologic treatment involves the use of moderate doses of inotropic ag

Description : A 68-year-old male who underwent a repair of an abdominal aortic aneurysm 5 days ago, develops tachycardia, tachypnea, hypotension with cool, pale, mottled cyanotic extremities. He ... use of moderate doses of inotropic agents e. Afterload reduction with nitroprusside is absolutely contraindicated

Last Answer : Answer: a, b, d Intrinsic cardiogenic shock results from failure of the heart as an effective pump. Coronary artery disease is the most common cause of myocardial ... hemodynamic monitoring. Infusion of afterload-reducing agents can be administered in conjunction with inotropic support