A 61-Year-Old Man Comes to the Emergency Department Due to Fever

question 538

Multiple Choice

A 61-year-old man comes to the emergency department due to fever, chills, and a productive cough with thick, blood-tinged sputum for the past several days.  His temperature is 38.8 C (102 F) , blood pressure is 90/60 mm Hg, and pulse is 110/min.  On examination, the patient is lethargic and ill appearing.  Bronchial breath sounds and crackles are present in the right lung.  Blood and sputum cultures grow Klebsiella pneumoniae.  It is determined that the bacteria express a lipopolysaccharide on their outer membrane surface that stimulates toll-like receptors in the inflammatory cells.  This in turn leads to degradation of the IκB inhibitor protein, which normally binds to a latent transcription factor found in the cytoplasm.  Which of the following factors is most likely to be directly activated by the removal of this inhibitor protein?

• A)Granulocyte colony-stimulating factor
• B)Janus kinase 2
• C)Nuclear factor-kappa B
• D)Transforming growth factor-β
• E)Tumor necrosis factor-α

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