A 34-year-old woman with rheumatoid arthritis was started on infliximab six months ago without prior screening. She now has fever, weight loss and miliary shadows on chest X-ray, and sputum CBNAAT detects Mycobacterium tuberculosis. Why did the drug lead to this infection?

Loss of TNF that holds granulomas together

Loss of IL-17 that recruits neutrophils

Loss of IL-4 that drives Th2 responses

Loss of IgE that arms mast cells against worms

A 62-year-old man on prednisolone 30 mg daily for three months for bullous pemphigoid has an emergency laparotomy for a perforated ulcer. On the eighth post-operative day, serosanguinous fluid leaks from the wound and the edges separate. How did the steroid contribute to this complication?

Reduced TGF-beta and collagen synthesis

Increased platelet adhesion in the wound

Overgrowth of granulation tissue

Excess myofibroblast contraction

A 45-year-old man has a firm, slightly tender nodule in the scar of an inguinal hernia repair done a year ago. Excision biopsy shows multinucleate giant cells with randomly scattered nuclei surrounding strands of birefringent material under polarised light, with few lymphocytes. What type of granuloma is this?

Necrotising suppurative granuloma

Caseating tuberculous granuloma

A 4-year-old boy with short stature and intellectual disability has had recurrent skin infections and pneumonia with persistently high neutrophil counts. His blood group typing shows the Bombay phenotype. Neutrophil migration studies show that his cells fail at the earliest step of leaving the bloodstream. Which step is defective?

Selectin-mediated rolling on endothelium

Phagolysosome fusion inside the neutrophil

Transmigration through PECAM-1 junctions

Integrin-mediated firm adhesion

Inflammation and repair

20 NEET-PG practice questions on Inflammation and repair, part of Pathology. The first 20 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 34-year-old woman with rheumatoid arthritis was started on infliximab six months ago without prior screening. She now has fever, weight loss and miliary shadows on chest X-ray, and sputum CBNAAT detects Mycobacterium tuberculosis. Why did the drug lead to this infection?
1. ALoss of IL-17 that recruits neutrophils
2. BLoss of TNF that holds granulomas together
3. CLoss of IL-4 that drives Th2 responses
4. DLoss of IgE that arms mast cells against worms
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Answer: B · Loss of TNF that holds granulomas together
Granulomas wall off mycobacteria; Th1 cells secrete IFN-gamma, which activates macrophages, and TNF from macrophages is needed to form and maintain the granuloma. Blocking TNF with infliximab or similar drugs lets latent foci break down, so tuberculosis reactivates, often as extrapulmonary or disseminated disease. In India, every patient should be screened for latent TB (IGRA or tuberculin test, plus chest X-ray) before starting an anti-TNF drug, and treated for latent infection if positive.
- A: IL-17 inhibitors mainly predispose to mucocutaneous candidiasis, not TB.
- C: IL-4 drives Th2 and allergic responses, which do not control mycobacteria.
- D: IgE and mast cells defend against helminths, not intracellular bacteria.
Question 2 · Medium
A 62-year-old man on prednisolone 30 mg daily for three months for bullous pemphigoid has an emergency laparotomy for a perforated ulcer. On the eighth post-operative day, serosanguinous fluid leaks from the wound and the edges separate. How did the steroid contribute to this complication?
1. AReduced TGF-beta and collagen synthesis
2. BIncreased platelet adhesion in the wound
3. COvergrowth of granulation tissue
4. DExcess myofibroblast contraction
Show answerHide answer
Answer: A · Reduced TGF-beta and collagen synthesis
Glucocorticoids suppress inflammation and inhibit TGF-beta production, which reduces fibroblast proliferation and collagen synthesis; the result is a weak scar and a higher risk of dehiscence. Other local and systemic factors that delay healing include infection, poor nutrition, diabetes, poor perfusion and mechanical strain such as coughing or abdominal distension. Serosanguinous discharge around the end of the first week is the classic warning sign of burst abdomen. Vitamin A is sometimes used to counter the effect of steroids on healing.
- B: Steroids do not promote platelet adhesion, and this would not cause dehiscence.
- C: Steroids suppress rather than stimulate granulation tissue.
- D: Steroids reduce wound contraction; excess contraction does not separate wound edges.
Question 3 · Medium
A 45-year-old man has a firm, slightly tender nodule in the scar of an inguinal hernia repair done a year ago. Excision biopsy shows multinucleate giant cells with randomly scattered nuclei surrounding strands of birefringent material under polarised light, with few lymphocytes. What type of granuloma is this?
1. ANecrotising suppurative granuloma
2. BForeign body granuloma
3. CImmune epithelioid granuloma
4. DCaseating tuberculous granuloma
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Answer: B · Foreign body granuloma
Inert material such as suture, talc or wood provokes a foreign body granuloma: macrophages and foreign body giant cells, whose nuclei are scattered at random, gather around material too large to be phagocytosed by a single cell. No T-cell immune response is needed, so lymphocytes are few. The material is often visible, and many types are birefringent in polarised light. Excision is curative.
- A: Suppurative granulomas have central neutrophils, as in cat scratch disease.
- C: Immune granulomas need T-cell activation against a persistent antigen, as in TB.
- D: Caseation would show central cheesy necrosis, absent here.
Question 4 · Hard
A 4-year-old boy with short stature and intellectual disability has had recurrent skin infections and pneumonia with persistently high neutrophil counts. His blood group typing shows the Bombay phenotype. Neutrophil migration studies show that his cells fail at the earliest step of leaving the bloodstream. Which step is defective?
1. APhagolysosome fusion inside the neutrophil
2. BSelectin-mediated rolling on endothelium
3. CTransmigration through PECAM-1 junctions
4. DIntegrin-mediated firm adhesion
Show answerHide answer
Answer: B · Selectin-mediated rolling on endothelium
Leucocyte adhesion deficiency type 2 is caused by a defect in fucose metabolism, so leucocytes lack sialyl-Lewis X, the fucosylated ligand that binds E- and P-selectin on endothelium. Without it, the leucocytes cannot roll, the first step of recruitment, so they stay in the blood and infections recur. The same fucosylation defect prevents formation of the H antigen, giving the Bombay blood group, and also causes growth and intellectual impairment. LAD type 1, in contrast, affects firm adhesion through beta-2 integrins.
- A: Phagolysosome fusion fails in Chediak-Higashi syndrome.
- C: Transmigration follows rolling and adhesion, and is not the defect here.
- D: Firm adhesion is defective in LAD type 1, which lacks CD18.
Question 5 · Easy
A 7-year-old boy has fever of 39.5 °C from a throat infection. His mother asks how paracetamol brings the fever down. Which mediator acting on the hypothalamus is responsible for the raised set point?
1. AProstaglandin E2
2. BHistamine
3. CLeukotriene B4
4. DBradykinin
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Answer: A · Prostaglandin E2
Bacterial products stimulate leucocytes to release IL-1 and TNF, which act on the hypothalamus to increase cyclooxygenase activity and the production of prostaglandin E2. PGE2 raises the thermoregulatory set point, so the body conserves and generates heat until the new set point is reached. Antipyretics such as paracetamol and NSAIDs act by reducing prostaglandin synthesis in the brain. Fever is therefore a systemic effect of inflammation mediated by cytokines and prostaglandins.
- B: Histamine causes vasodilation and increased permeability, not fever.
- C: LTB4 is a chemotactic agent for neutrophils, not the pyrogenic mediator.
- D: Bradykinin causes pain and permeability, not the rise in set point.
Question 6 · Hard
A 28-year-old woman has a cervical lymph node biopsy that shows granulomas with central caseation. In a teaching session, the pathologist lists four statements about how these granulomas formed: 1. Macrophages presenting mycobacterial antigen secrete IL-12, driving Th1 differentiation. 2. Langhans giant cells have nuclei scattered at random through the cytoplasm. 3. Th1 cells secrete IFN-gamma, which activates macrophages. 4. Epithelioid cells are activated macrophages with abundant pink cytoplasm. Which statements are correct?
1. A3 and 4 only
2. B1, 2 and 4 only
3. C1 and 3 only
4. D1, 3 and 4 only
Answer and explanation in LearnFree account
Question 7 · Medium
A 66-year-old bedridden man has a 6 cm sacral pressure ulcer that is being dressed daily. Over two months it shrinks to less than half its size, well before the epithelium has covered it. Which cell is mainly responsible for this shrinkage?
1. AEndothelial cell
2. BMacrophage
3. CKeratinocyte
4. DMyofibroblast
Answer and explanation in LearnFree account
Question 8 · Medium
A 52-year-old woman with long-standing rheumatoid arthritis has Hb 9.6 g/dL, MCV 80 fL, serum iron 35 µg/dL (reference 60-170), TIBC 220 µg/dL (reference 250-450) and ferritin 310 ng/mL. Which mediator mainly drives this pattern of anaemia?
1. AIFN-gamma raising erythropoietin
2. BIL-6 inducing hepatic hepcidin
3. CIL-1 causing marrow fibrosis
4. DTNF directly lysing red cells
Answer and explanation in LearnFree account
Question 9 · Medium
A 29-year-old man spends a full day on the beach in Goa without sunscreen. The skin of his back becomes red and tender about 6 hours later, and the redness and swelling persist for two days. What type of vascular leakage explains this delayed and prolonged response?
1. AIncreased transcytosis induced by VEGF
2. BLeucocyte-mediated injury in immune complexes
3. CHistamine-induced endothelial contraction
4. DDirect endothelial injury from UV radiation
Answer and explanation in LearnFree account
Question 10 · Medium
A 40-year-old woman with nasal polyps and asthma develops severe wheezing within an hour of taking aspirin for a headache. Why did aspirin trigger her bronchospasm?
1. AAspirin released histamine by direct mast cell lysis
2. BArachidonic acid was diverted to cysteinyl leukotrienes
3. CAspirin blocked bronchodilator beta-2 receptors
4. DAspirin caused IgE cross-linking on mast cells
Answer and explanation in LearnFree account
Question 11 · Medium
A 24-year-old woman from Tamil Nadu has a shiny, firm, itchy nodule on her ear lobe that started after piercing and has grown well beyond the margins of the original wound. It was excised once and recurred larger. What is the lesion?
1. ADesmoid tumour
2. BKeloid
3. CHypertrophic scar
4. DExuberant granulation tissue
Answer and explanation in LearnFree account
Question 12 · Hard
A 55-year-old man has fever and right-sided pleural effusion. Pleural fluid: protein 4.6 g/dL, LDH 420 U/L, glucose 60 mg/dL, cells 2,200/µL, mostly lymphocytes. Serum protein is 6.8 g/dL and serum LDH 300 U/L (upper limit of normal 250 U/L). Which mechanism has mainly produced this effusion?
1. ARaised capillary hydrostatic pressure
2. BReduced plasma oncotic pressure
3. CObstruction of lymphatic drainage
4. DIncreased vascular permeability
Answer and explanation in LearnFree account
Question 13 · Medium
A 58-year-old man on dialysis for end-stage kidney disease has chest pain that eases on leaning forward, and a scratchy three-component rub is heard over the precordium. If the pericardium were examined, which pattern of inflammation would most likely be seen?
1. AFibrinous inflammation
2. BSerous inflammation
3. CSuppurative inflammation
4. DGranulomatous inflammation
Answer and explanation in LearnFree account
Question 14 · Medium
A 34-year-old man asks the surgical resident how strong his laparotomy scar will become. The resident explains four points: 1. Granulation tissue fills the incision space by the end of the first week. 2. Type III collagen laid down early is gradually replaced by type I collagen. 3. When sutures are removed at one week, wound strength is about 10% of normal skin. 4. The scar regains full original strength by three months. Which points are correct?
1. A2, 3 and 4 only
2. B2 and 3 only
3. C1, 3 and 4 only
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 15 · Medium
A 38-year-old woman has bilateral hilar lymphadenopathy, erythema nodosum and a serum calcium of 11.8 mg/dL. Transbronchial biopsy shows tight non-caseating granulomas with asteroid bodies in the giant cells. Which mechanism explains her raised calcium?
1. ABone resorption by granulomas in marrow
2. BPTH-related protein from granuloma cells
3. CIncreased PTH from parathyroid hyperplasia
4. DCalcitriol made by activated macrophages
Answer and explanation in LearnFree account
Question 16 · Easy
A 70-year-old widower who lives alone and eats mostly rice and dal has a leg wound that has not healed for two months, bleeding gums and perifollicular haemorrhages. Which step in collagen synthesis is impaired?
1. ACleavage of procollagen propeptides
2. BHydroxylation of proline and lysine
3. CGlycosylation of hydroxylysine
4. DCross-linking by lysyl oxidase
Answer and explanation in LearnFree account
Question 17 · Easy
A 32-year-old labourer has a chronic leg ulcer that is now healing. The base is red, moist and granular, bleeds easily on touch and is painless. A biopsy of the base would show which tissue?
1. ADense, acellular bundles of type I collagen
2. BEpithelioid cells with Langhans giant cells
3. CSheets of neutrophils with necrotic debris
4. DNew capillaries, fibroblasts and loose matrix
Answer and explanation in LearnFree account
Question 18 · Hard
A 48-year-old man has been HBsAg-positive for 20 years. HBeAg is negative, anti-HBe positive and HBV DNA 85,000 IU/mL; ALT is 92 U/L and liver stiffness is high. A biopsy shows bridging fibrosis. Which cell is the main source of the collagen being laid down in his liver?
1. AHepatic stellate (Ito) cell
2. BKupffer cell
3. CPortal tract lymphocyte
4. DSinusoidal endothelial cell
Answer and explanation in LearnFree account
Question 19 · Easy
A 3-week-old baby is brought to the paediatric OPD because the umbilical cord stump has not separated. She has had an infected umbilicus and skin infections without pus formation. TLC is 32,000/µL with 80% neutrophils, though she is not acutely ill. Which molecule is most likely defective?
1. ANADPH oxidase of phagocytes
2. BBeta-2 integrin (CD18)
3. CSialyl-Lewis X on leucocytes
4. DLYST lysosomal trafficking protein
Answer and explanation in LearnFree account
Question 20 · Medium
A 56-year-old hypertensive woman started on enalapril three weeks ago comes to casualty with swelling of the lips and tongue, without urticaria or itching. Her blood pressure is stable. Which mediator is responsible?
1. ABradykinin
2. BHistamine
3. CSerotonin
4. DLeukotriene B4
Answer and explanation in LearnFree account

Inflammation and repair

A 34-year-old woman with rheumatoid arthritis was started on infliximab six months ago without prior screening. She now has fever, weight loss and miliary shadows on chest X-ray, and sputum CBNAAT detects Mycobacterium tuberculosis. Why did the drug lead to this infection?

A 62-year-old man on prednisolone 30 mg daily for three months for bullous pemphigoid has an emergency laparotomy for a perforated ulcer. On the eighth post-operative day, serosanguinous fluid leaks from the wound and the edges separate. How did the steroid contribute to this complication?

A 7-year-old boy has fever of 39.5 °C from a throat infection. His mother asks how paracetamol brings the fever down. Which mediator acting on the hypothalamus is responsible for the raised set point?

A 66-year-old bedridden man has a 6 cm sacral pressure ulcer that is being dressed daily. Over two months it shrinks to less than half its size, well before the epithelium has covered it. Which cell is mainly responsible for this shrinkage?

A 52-year-old woman with long-standing rheumatoid arthritis has Hb 9.6 g/dL, MCV 80 fL, serum iron 35 µg/dL (reference 60-170), TIBC 220 µg/dL (reference 250-450) and ferritin 310 ng/mL. Which mediator mainly drives this pattern of anaemia?

A 29-year-old man spends a full day on the beach in Goa without sunscreen. The skin of his back becomes red and tender about 6 hours later, and the redness and swelling persist for two days. What type of vascular leakage explains this delayed and prolonged response?

A 40-year-old woman with nasal polyps and asthma develops severe wheezing within an hour of taking aspirin for a headache. Why did aspirin trigger her bronchospasm?

A 24-year-old woman from Tamil Nadu has a shiny, firm, itchy nodule on her ear lobe that started after piercing and has grown well beyond the margins of the original wound. It was excised once and recurred larger. What is the lesion?

A 55-year-old man has fever and right-sided pleural effusion. Pleural fluid: protein 4.6 g/dL, LDH 420 U/L, glucose 60 mg/dL, cells 2,200/µL, mostly lymphocytes. Serum protein is 6.8 g/dL and serum LDH 300 U/L (upper limit of normal 250 U/L). Which mechanism has mainly produced this effusion?

A 58-year-old man on dialysis for end-stage kidney disease has chest pain that eases on leaning forward, and a scratchy three-component rub is heard over the precordium. If the pericardium were examined, which pattern of inflammation would most likely be seen?

A 38-year-old woman has bilateral hilar lymphadenopathy, erythema nodosum and a serum calcium of 11.8 mg/dL. Transbronchial biopsy shows tight non-caseating granulomas with asteroid bodies in the giant cells. Which mechanism explains her raised calcium?

A 70-year-old widower who lives alone and eats mostly rice and dal has a leg wound that has not healed for two months, bleeding gums and perifollicular haemorrhages. Which step in collagen synthesis is impaired?

A 32-year-old labourer has a chronic leg ulcer that is now healing. The base is red, moist and granular, bleeds easily on touch and is painless. A biopsy of the base would show which tissue?

A 48-year-old man has been HBsAg-positive for 20 years. HBeAg is negative, anti-HBe positive and HBV DNA 85,000 IU/mL; ALT is 92 U/L and liver stiffness is high. A biopsy shows bridging fibrosis. Which cell is the main source of the collagen being laid down in his liver?

A 3-week-old baby is brought to the paediatric OPD because the umbilical cord stump has not separated. She has had an infected umbilicus and skin infections without pus formation. TLC is 32,000/µL with 80% neutrophils, though she is not acutely ill. Which molecule is most likely defective?

A 56-year-old hypertensive woman started on enalapril three weeks ago comes to casualty with swelling of the lips and tongue, without urticaria or itching. Her blood pressure is stable. Which mediator is responsible?