2. Inflammation Flashcards Preview

Pathology Clues > 2. Inflammation > Flashcards

Flashcards in 2. Inflammation Deck (63):
0

It is fundamentally a protective response, designed to eliminate initial cause of cell injury and the consequences of such injury:

Inflammation

1

What are the 2 types of inflammation and differentiate?

1. Acute inflammation - rapid in onset with short duration lasting for minutes to several hours or few days.

2. Chronic inflammation - longer in duration.

2

Differentiate acute inflammation from chronic inflammation according to morphologic or histologic features:

1. Acute inflammation - main characteristics are the exudation of fluis and plasma proteins and emigration of leukocytes, predominantly NEUTROPHILS
2. Chronic inflammation - presence of lymphocytes and macrophages, proliferation of blood vessels, fibrosis, and tissue necrosis

3

What are the general features of inflammation? (5 R's)

1. Recognition of injurious events
2. Recruitment of leukocytes
3. Removal of the agent
4. Regulation of response
5. Resolution (repair)

4

What are the 5 cardinal signs of inflammation?

1. Rubor - redness
2. Calor - heat
3. Tumor - swelling
4. Dolor - pain
5. Functio laesa - loss of function

5

It is transient and early response to injury that involves release of chemical mediators, causing stereotypic vessel and leukocyte responses:

Acute inflammation

6

What is the hallmark of acute inflammation?

Increase vascular permeability

7

What are the 3 major components of acute inflammation?

1. Vascular dilatation and increase blood flow (causing erythema and warmth)
2. Extravasation and deposition of plasma fluid and proteins (edema)
3. Leukocyte emigration and accumulation in the site of injury

8

What are the stimuli for acute inflammation?

1. Infection
2. Trauma
3. Physical and chemical agents
4. Tissue necrosis
5. Foreign bodies
6. Immune reactions (hypersensitivity rxns)

9

Transudate vs. exudate

Transudate- hypocellular, poor protein (albumin), SG of 1.012, causes increase hydrostatic pressure and decrease oncotic pressure

Exudate - highly cellular, rich in protein, SG of >1.012(1.020) and causes inflammation or infection

10

What are the vascular events in acute inflammation?

1. Vasoconstriction of arterioles
2. Vasodilation of arterioles
3. Increase permeability of venules
4. Swelling of tissue (edema)
5. Reduced blood flow

11

One of the earliest manifestation of acute inflammation:

Vasodilation

12

What are the 2 main mediators that induces vasodilation?

1. Histamine
2. Nitric oxide

13

What are the 4 cellular events involved in leukocyte extravasation with their corresponding mediatiors?

1. Rolling (vasculature/stroma: E-selectin, P-selectin) (leukocyte- sialyl lewis)
2. Tight bonding (ICAM) (LFA-1(integrin))
3. Diapedesis (PECAM-1) (PECAM-1)
4. Migration (bacterial products: CILK - C5a, IL-8, LT B4, Kallikren

14

What are the mediators for chemotaxis, leukocyte recruitment and activation?

1. TNF
2. IL-1
3. Chemokines
4. C3a
5. C5a
6. LT
7. B4

15

What are the mediators for fever?

1. IL-1
2. TNF
3. Prostaglandin

16

What are the mediators for pain?

1. Prostaglandin
2. Bradykinin

17

What are the mediators for tissue damage?

1. Lysosomal enzymes
2. ROS
3. NO

18

What are the 2 main acute phase reactants?

1. ESR
2 C-reactive protein

19

What conditions present with increased ESR?

1. Infections
2. Inflammation
3. Cancer
4. Pregnancy
5. SLE

20

What conditions present with decreased ESR?

1. Sickle cell anemia
2. Polycythemia
3. CHF

21

What are the morphologic hallmarks of Acute inflammation?

1. Dilation of small vessels
2. Slowing of blood flow
3. Accumulation of leukocytes and fluid in the extravascular tissue

22

What are the morphologic patterns in acute inflammation?

1. Serous
2. Fibrinous
3. Suppurative
4. Ulcerative
5. Pseudomembranous

23

A type of inflammation where there is Outpouring of a thin fluid (effusion) derived from the plasma or from the secretions of mesothelial cells:

Serous inflammation

24

Give some examples of serous infammation:

1. Pleural effusion
2. Pericardial effusion
3. Skin blisters

25

Which biochemical disorder in heme synthesis presents with skin blisters due to photosensitivity?

Porphyria

26

What is the most common variant of porphyria? What enzyme is deficient?

Porphyria cutanea tarda
Deficient enzyme: URO decarboxylase

27

What is the morphologic characteristic of Fibrinous inflammation:

Bread and butter appearance

28

Give an example of fibrinous inflammation:

Fibrinous pericarditis

29

Two weeks after sustaining a myocardial infarction, your patient presented with fever, pleuritic chest pain, and a pericardial effusion. What is most likely etiology?

Dressler's syndrome - fibrinous pericarditis post MI

30

Type of inflammation containing pus or abscess?

Suppurative infalmmation

31

Consists of neutrophils, liquefactive necrosis and edema

Pus or purulent exudate

32

Localized collections of purulent inflammatory tissue:

Abscess
Central region: necrotic wbc and tissue
Outer rim: neutrophils, connective tissue

33

Examples of suppurative inflammation:

1. Acute appendicitis
2. Skin abscess

34

It is a local defect, or excavation, of the surface of an organ; produced by sloughing of inflamed necrotic tissue:

Ulcer

35

Example of ulcerative inflammation:

Peptic ulcer disease

36

What are the most common complications of peptic ulcer disease?

1. Bleeding
2. Perforation
3. Obstruction

37

What blood vessels will be injured with perforation of gastric ulcer?

Left gastric artery

38

What blood vessels will be injured with perforation of duodenal ulcer?

Gastroduodenal artery

39

Type of inflammation with bacterial toxin-induced damage of mucosal lining:

Pseudomembranous inflammation

40

Morphologic characteristic of pseudomembranous inflammation:

Shaggy membrane of necrotic tissue

41

Give 3 examples of pseudomembranous inflammmation:

1. Diphtheria
2. Esophageal candidiasis
3. Pseudomembranous colitis

42

Which antibiotic is regarded as the most common cause of pseudomembranous colitis?

Clindamycin (ampicillin, 3rd gen cephalosporins)

43

What is the treatment of pseudomembranous colitis?

Stop offending antibiotic
Give metronidazole/vancomycin
Note: metronidazole (metallic taste and disulfiram like effect)
Vancomycin (red man syndrome)

44

Inflammation of prolonged duration (weeks or months) in which inflammation, tissue injury, and attempts at repair coexist, in varying combinations

Chronic inflammation

45

What are the 3 main causes of chronic inflammation?

1. Persistent infections (evoked as delayed type hypersensitivity or granulomatous reaction)
2. Autoimmunity
3. Prolonged exposure to potentially toxic agents

46

What are the cytokines involved in chronic inflammation?

1. IL-12 (principal source: Dendritic cells and macrophages)
2. IFN-y (principal source: T lymphocytes and NK cells)
3. IL-17 (principal source: T lymphocytes)

47

What is the principal action of IL-12?

Increase production of IFN-y

48

What is the principal action of INF-y?

Activation of macrophages (increase ability to kill microbes and tumor cells)

49

What is the principal action of IL-17?

Recruitment of neutrophils and monocytes

50

Morphologic characteristic of chronic inflammation:

1. Infiltration with mononuclear cells
2. Tissue deatruction
3. Healing by connective tissue replacement of damaged tissue (angiogenesis and fibrosis)

51

What is the dominant cellular player in chronic inflammation?

Macrophages

52

A type of inflammation with a distinctive pattern of chronic inflammatory reaction characterized by focal accumulations of activated macrophages, which often develop an epithelial-like appearance.

Granulomatous inflammation

53

A focus of chronic inflammation consisting of a microscopic aggregation of macrophages that are transformed into epithelial-like cells surrounded by a collar of mononuclear leukocytes, principally lymphocytes with occasional plasma cells:

Granuloma

54

Macrophages surrounded by a collar of mononuclear leukocytes:

Epitheloid macrophages

55

Epitherloid cells fused to form giant cells:

1. Langhans-type: in the periphery
2. Foreign body-type : haphazardly

56

Which DMARD drug may cause reactivation of latent tuberculous infection?

Influximab
tttt: methotrexate

57

What precautionary test should be done prior to starting treatment with Influximab?

PPD or tuberculin test

58

What are the two types of granuloma and differentiate each?

1. Foreign body granuloma -incited by relatively inert foreign bodies.
2. Immune granulomas - caused by insoluble particles, typically microbes, capable of inducing a cell mediated immine response

59

In TB, granuloma is referred to what? Classically characterized by the presence of central caseous necrosis:

Tubercle

60

Give 6 examples of infectious cause of granulomatous inflammation:

1. Tuberculosis
2. Leprosy
3. Systemic mycosis
4. Catscratch disease
5. Tertiary syphilis
6. LGV

61

Give examples of non-infectious causes of chronic granulomatous inflammation:

1. Sarcoidosis
2. Crohn's disease
3. Berylliosis

62

Pathologic consequences of inflammation?

1. Defective inflammation (increase susceptibility to infection and delayed wound healing)
2. Excessive inflammation (allergies, autoimmune disorders, atherosclerosis, alzheimer disease)