Download Exam # 12 - AJP December 2012

ASIP 2012 Journal CME Programs
ASIP Semiannual 2012/2 AJP CME Program in Pathogenesis
American Society for Investigative Pathology
The American Journal of Pathology
Volume 181, Number 6 (December 2012)
http://www.asip.org/CME/index.cfm
Mark E. Sobel, MD, PhD, Director of Journal CME Programs
CME Questions December # 1-8
1. Regulatory T (Treg) cell expansion is required for tolerance of the semi-allogeneic fetus in healthy pregnancy
and impaired in preeclampsia in humans. Based on the referenced article and related Commentary, select the ONE
statement that is NOT TRUE: [See Am J Pathol 2012, 181:2149-2160; DOI: 10.1016/j.ajpath.2012.08.032 and related
Commentary Am J Pathol 2012, 181:1900-1901; DOI: 10.1016/j.ajpath.2012.09.020; the authors of the referenced articles
and the planning committee members and staff have no relevant financial relationships with commercial interests to
disclose.]
a.
b.
c.
d.
+
Treg cells are a subset of CD4 T cells specialized in the suppression of the immune response against selfantigens.
Treg cells are characterized by the expression of cAMP response-element-binding protein.
+
+
Helios Foxp3 Treg cells can be generated in the thymus, referred to as naturally occurring Treg (nTreg) cells.
–
+
+
Helios Foxp3 Treg cells can be generated in the periphery as a result of the conversion of naïve CD4 T cells,
referred to as induced Treg (iTreg) cells or peripheral Treg cells.
2. Preeclampsia (PE) is characterized by hypertension and proteinuria after 20 weeks of gestation. Based on the
referenced article and related Commentary, select the ONE statement that is NOT TRUE: : [See Am J Pathol 2012,
181:2149-2160; DOI: 10.1016/j.ajpath.2012.08.032 and related Commentary Am J Pathol 2012, 181:1900-1901; DOI:
10.1016/j.ajpath.2012.09.020; the authors of the referenced articles and the planning committee members and staff have no
relevant financial relationships with commercial interests to disclose.]
a.
b.
c.
d.
PE complicates 13% of all pregnancies and is a leading cause of maternal and perinatal morbidity and mortality.
Epidemiological data suggest that immunological mechanisms may play a role in PE pathogenesis.
Decreased exposure to sperm has been associated with an increased PE risk.
PE risk is higher in first pregnancies, and multiparous women pregnant with a new partner have a risk similar to
nulliparous women.
3. Maternal recognition of fetal alloantigen is largely restricted to indirect antigen presentation by maternal antigenpresenting cells (APCs). Based on the referenced article and related Commentary, select the ONE statement that is
NOT TRUE: : [See Am J Pathol 2012, 181:2149-2160; DOI: 10.1016/j.ajpath.2012.08.032 and related Commentary Am J
Pathol 2012, 181:1900-1901; DOI: 10.1016/j.ajpath.2012.09.020; the authors of the referenced articles and the planning
committee members and staff have no relevant financial relationships with commercial interests to disclose.]
a.
b.
c.
d.
Many studies have reported the role of APCs, including dendritic cells (DCs) and macrophages, in Treg cell
induction.
In pregnancy, DCs may also play a role within the decidual microenvironment in shaping the immune response.
In the murine model, galectin-1 is expressed by endometrial epithelial cells.
+
In humans, decidual CD14 APCs induce Treg cells in vitro, dependent on interferon-γ–induced up-regulation of
indolamine 2,3-dioxygenase.
© The American Society for Investigative Pathology
ASIP Semiannual 2012/2 AJP CME Program in Pathogenesis
The American Journal of Pathology, Volume 181, Number 6, December 2012
4. The membrane protein CD44 is a multifaceted molecule. Based on the referenced article, select the ONE
statement that is NOT TRUE: [See Am J Pathol 2012, 181:2172-2187; DOI: 10.1016/j.ajpath.2012.08.025; the authors of
the referenced article and the planning committee members and staff have no relevant financial relationships with
commercial interests to disclose.]
a.
b.
c.
d.
CD44 is involved in organ development, neuronal axon guidance, immune functions, hematopoiesis, and
migration.
CD44 acts as a receptor for the extracellular matrix component hyaluronic acid (HA) and for the secreted
extracellular protein osteopontin.
CD44 is an important mediator of cellular adhesion and migration due to its active influence on the organization
of the actin cytoskeleton.
Phosphorylation of CD44 on threonine residues within the N-terminal domain is important for CD44 activation.
5. The ezrin-moesin-radixin (ERM) proteins form a bridge between CD44 and the actin cytoskeleton. Based on the
referenced article, select the ONE statement that is NOT TRUE: [See Am J Pathol 2012, 181:2172-2187; DOI:
10.1016/j.ajpath.2012.08.025; the authors of the referenced article and the planning committee members and staff have no
relevant financial relationships with commercial interests to disclose.]
a.
b.
c.
d.
The ERM proteins mediate cell morphology changes that are important for cell migration.
Ezrin interacts with CD44 through its conserved N-terminal band four-point-one, ezrin, radixin, moesin domain.
In the inactive configuration of ezrin, both N- and C-terminal domains interact with each other and block the
binding sites for CD44 and F-actin.
Ezrin activation is mediated by phosphorylation on serine-567.
6. CD44 is enriched in cholesterol- and sphingomyelin-enriched membrane microdomains termed lipid rafts. Based
on the referenced article, select the ONE statement that is NOT TRUE: [See Am J Pathol 2012, 181:2172-2187; DOI:
10.1016/j.ajpath.2012.08.025; the authors of the referenced article and the planning committee members and staff have no
relevant financial relationships with commercial interests to disclose.]
a.
b.
c.
d.
Lipid rafts are involved in regulating different cellular events, including migration.
Lipid rafts have been hypothesized to play a crucial role in regulating cancer progression.
CD44 is usually directed toward lipid rafts via posttranslational lipid modifications called acylation reactions, the
most common of which is palmitoylation.
Palmitoylation plays an important role in CD44-HA turnover, with palmitoylated CD44 promoting CD44-HA
exocytosis.
7. Delayed wound healing is a major complication of diabetes. Based on the referenced article, select the ONE
statement that is NOT TRUE: [See Am J Pathol 2012, 181:2217-2224; DOI: 10.1016/j.ajpath.2012.08.023; the authors of
the referenced article and the planning committee members and staff have no relevant financial relationships with
commercial interests to disclose.]
a.
b.
c.
d.
Delayed wound healing is caused by decreased apoptosis, delayed cellular infiltration, reduced angiogenesis,
and decreased formation and organization of collagen fibers.
Impaired lymphangiogenesis is a major factor in diabetic refractory wound healing.
Delayed wound healing, such as that seen in infections, results from persistent edema and delayed removal of
debris and inflammatory cells due to reduced lymphatic development.
The functions of lymphatic vessels in wounds are to drain the protein-rich lymph from the extracellular space, to
maintain normal tissue pressure, and to mediate the immune response.
8. Statins are 5-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors. Based on the referenced
article, select the ONE statement that is NOT TRUE: [See Am J Pathol 2012, 181:2217-2224; DOI:
10.1016/j.ajpath.2012.08.023; the authors of the referenced article and the planning committee members and staff have no
relevant financial relationships with commercial interests to disclose.]
a.
b.
c.
d.
Statins are primarily used to lower circulating cholesterol levels.
Statins protect against ischemic injury and stimulate angiogenesis in normocholesterolemic animals.
Simvastatin stimulates reparative neovascularization and improves recovery from limb ischemia in type 1
diabetic mice.
Simvastatin enhances vascular endothelial growth factor production and improves wound healing in an
experimental model of diabetes.
© The American Society for Investigative Pathology
ASIP Semiannual 2012/2 AJP CME Program in Pathogenesis
The American Journal of Pathology, Volume 181, Number 6, December 2012