23 - Inflammation and Healing III - Chronic Inflammation

Question 1

Ways that chronic inflammation can arise 1) 2) a) b) c)

Answer 1

1) Can follow acute inflammation 2) Possible insidious onset from: a) Some infections b) Autoimmune diseases c) Repeated/prolonged exposure to potentially toxic agents (EG: asbestos)

Question 2

Examples of disease processes that involve chronic inflammation 1) 2) 3) 4)

Answer 2

1) Tuberculosis 2) Atherosclerosis 3) Viral hepatitis 4) Fibrosing lung diseases

Question 3

Macrophage appearance in histological stain

Answer 3

Single nucleus Nucleus is on one side of cell.

Question 4

Different appearances of macrophages 1) 2) 3)

Answer 4

1) If phagocytose fat, become ‘foamy cells’ 2) If phagocytose carbon, have dark pigment in cytoplasm (but not much inflammation) 3) If phagocytose blood, produce heamosiderin

Question 5

Disease where foamy cells are common

Answer 5

Atherosclerosis

Question 6

Key cells in diagnosing granulomatous inflammation

Answer 6

Epithelioid macrophages, giant cells

Question 7

Giant cells

Answer 7

Multinucleate macrophages. Very large

Question 8

Histological appearance of lymphocytes

Answer 8

Large nucleus, narrow ring of cytoplasm surrounding it

Question 9

Histological appearance of plasma cells 1) 2) 3) 4) 5)

Answer 9

1) Large nucleus on one side of cell. 2) Cell is ovular. 3) Pale area beside nucleus (paranuclear hof) 4) ‘Clockface chromatin’ 5) Purplish cytoplasm, as there is so much RNA in cytoplasm

Question 10

Paranuclear hof

Answer 10

In a plasma cell an area of slightly paler cytoplsm beside nucleus. Where Golgi apparatus is. Stains less intensely than surrounding cytoplasm

Question 11

Clockface chromatin

Answer 11

In a plasma cell. Chromatin is distributed around edge of plasma cell

Question 12

Eosinophil histological appearance

Answer 12

Bilobar nucleus

Question 13

Germinal centre histological appearance

Answer 13

Circles of slightly lighter material.

Question 14

Primary follicale

Answer 14

B cells haven’t been exposed to cognate antigen. In lymph nodes, GALT

Question 15

Secondary follicle

Answer 15

Activated B cells differentiating into plasma cells and memory cells

Question 16

Difference between granulomatous inflammation and a granuloma

Answer 16

A granuloma is an area of granulomatous inflammation with a clearly delineated boundary of fibrous tissue.

Question 17

Types of granulomatous inflammation

Answer 17

Immune and foreign body

Question 18

What does granulomatous inflammation develop in response to?

Answer 18

Certain persistent or non-degradable antigens

Question 19

Types of infections that area more likely to lead to granulomatous inflammation

Answer 19

Intracellular bacteria. Never viral.

Question 20

Histological appearance of necrosis

Answer 20

Very eosinophilic

Question 21

How can chronic rheumatic valve disease occur?

Answer 21

Strep infects airways, gets to heart. Fibrotic thickening of chordae tendinae occurs.

Question 22

Examples of disease in which granulomatous inflammation occurs 1) 2) 3) 4)

Answer 22

1) Infection (syphilis, TB, leprosy, fungal, parasitic) 2) Unknown aetiology (Crone’s, sarcoidosis) 3) Lymphomas 4) Deposition of irritants (sutures, uric acid crystals, keratin)

Question 23

Type of hypersensitivity that is granulomatous inflammation

Answer 23

Type IV hypersensitivity

Question 24

How does granulomatous inflammation start?

Answer 24

Macrophages detect antigen, release: IFNg - Macrophage activation IL-2 - Th1 activation

Question 25

Local effects of TNFa 1) a, b 2)

Answer 25

1) Inflammation a) Vascular effects - increased leukocyte adhesion molecules, IL-1, chemokine production, increased procoagulant, decreased anticoagulant activity) b) Leukocyte effects - Activation, production of cytokines 2) Repair - Fibroblast proliferation, collagen production

Question 26

Acute phase proteins produced by hepatocytes 1) 2) 3) 4) 5)

Answer 26

1) C-reactive protein (CRP) 2) Fibrinogen 3) Serum amyloid A protein 4) Complement factors 5) Hepcidin

Question 27

Erythrocyte sedimentation rate

Answer 27

Increased fibrinogen content leads to increased erythrocyte sedimentation. Test is placing RBCs in tube, see how quickly they sediment

Question 28

Effect of prolonged serum amyloid A protein

Answer 28

Secondary amyloidosis. Deposits of amyloid in organs can damage them (EGL kidneys)

Question 29

Effect of chronically elevated hepcidin

Answer 29

Reduces available iron for haemoglobin production. This can result in chronic anaemia

Question 30

Effects of excessive IL-1, IL-6 and TNFa levels

Answer 30

Systemic endothelial dilation, shock

Question 31

Cell type pointed to by arrow

Answer 31

Macrophages

Question 32

What does this picture show?

Answer 32

GRanulomatous inflammation, with giant cell around hair.

Question 33

Which cell type does this pictvure show?

Answer 33

Lymphocytes

Question 34

Cell types displayed in this picture

Answer 34

Plasma cells (black)

Eosinophils (orange)

Question 35

What are displayed in this picture?

Answer 35

Germinal centres

Question 36

Answer 36

Question 37

Answer 37