Immunology Review Corner

Immunology Review Corner: Chapter 67 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Prepared by Drs. Karla R. Davis, Walter Reed Medical Center; Anne K. Ellis, McMaster University; and Soo Kim-Delio, Walter Reed Army Medical Center

Chapter 67: Pathology of Asthma Compared with Chronic Obstructive Pulmonary Disease

1. Which of the following statements regarding chronic obstructive pulmonary disease (COPD) and asthma is true?

A. In COPD, the small airways are the major source of the hypersecretion associated with the production of sputum.
B. Bronchial asthma and COPD are chronic inflammatory disorders of the conducting airways and lung parenchyma.
C. The predominant anatomic zone affected by asthma is confined to the large airways.
D. The large airways are considered the main site responsible for airflow limitation in COPD.

2. A characteristic feature found in sputum obtained from asthmatic, but not bronchitic patients, is a corkscrew-shaped twist of condensed mucus. This is referred to as a:

A. Curschmann’s spiral
B. Creola body
C. Charcot-Leyden crystal
D. Clara cell complex

3. Which of the following cell types is most characteristically found in the sputum of patients with chronic obstructive pulmonary disease (COPD)?

A. Eosinophils
B. Metachromatic cells
C. Macrophages
D. Creola bodies

4. Which of the following changes in mucus-secreting elements is found in chronic obstructive pulmonary disease (COPD), rather than in both chronic obstructive pulmonary disease (COPD) and in asthma?

A. Submucosal gland enlargement
B. Excessive production of mucus
C. Change in proportion of serous and mucous acini
D. Goblet cell hyperplasia

5. Which of the following cluster of differentiation (CD) markers is typically found in the cellular infiltrate of chronic obstructive pulmonary disease (COPD), rather than in both chronic obstructive pulmonary disease (COPD) and asthma?

A. CD3
B. CD25
C. CD4
D. CD68

6. Which of the following ratios best describes the CD4/CD8 ratio in inflammatory cells of subjects with atopic asthma?

A. 1:2
B. 1:4
C. 3:1
D. 3:2

7. In symptomatic asthma, which of the following cytokines has been reported to increase during the late-phase response to allergen?

A. IL-2
B. IL-6
C. GM-CSF
D. TNF-alpha

8. Which of the following cytokines encourages the selective recruitment of eosinophils by up-regulating vascular cell adhesion molecule-1 (VCAM-1) on bronchial epithelial cells?

A. IL-4
B. IL-5
C. GM-CSF
D. TGF-beta

9. Which of the following ratios best describes the CD4/CD8 ratio in inflammatory cells of subjects with chronic bronchitis and chronic obstructive pulmonary disease (COPD)?

A. 3:1
B. 1:4
C. 1:2
D. 2:2

10. Which of the following features of the epithelial basement membrane is highly characteristic of asthma?

A. Thickening of the “true” epithelial basement membrane
B. Focal and variable thickening of the lamina reticularis
C. Homogeneous and hyaline thickening of the lamina reticularis
D. Thickening of the lamina basalis

Answers
1. B, page 1209
2. A, page 1211
3. C, page 1210
4. C, page 1212
5. D, page 1210
6. C, page 1219
7. C, page 1218
8. A, page 1217
9. C, page 1219
10. C, page 1211