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USMLE Pathology > Acute Inflammation > Flashcards

Acute Inflammation Flashcards

1
Q

What are the primary cells in acute inflammation?

A

Neutrophils

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2
Q

What are the primary cells in chronic inflammation?

A

Lymphocytes

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3
Q

What are the 2 main causes of acute inflammation?

A
  • Infection
  • Tissue necrosis
    Goal is to eliminate pathogen or clear necrotic debris
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4
Q

What will a patients white count be after an MI?

A

Raised (predominantly neutrophils)

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5
Q

What does innate immunity include?

A
  • Epithelium
  • Mucus
  • Complement
  • Mast cells
  • Macrophages
  • Neutrophils
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6
Q

What are toll like receptors present (TLRs) on?

A

Innate immune system cells

- Macrophages and dendritic cells

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7
Q

What do TLRs recognise?

A

PAMP

- Pathogen associated molecular patterns

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8
Q

What does CD14 on macrophages recognise?

A

LPS (lipopolysaccharide) on the outer membrane of gram -ve bacteria
- A form of PAMP

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9
Q

TLR activation results in the upregulation of what?

A

NF-kB

  • Transcription factor
  • Molecular switch which turns of acute inflammatory response - multiple immune mediators turned on
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10
Q

What enzyme releases arachadonic acid from the phospholipid cell membrane?

A

Phospholipase A2

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11
Q

What enzymes act on Phospholipase A2?

A
  • Cyclooxygenase (COX)

- 5- Lipooxygenase

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12
Q

What does the cyclooxygenase pathway (from arachadonic acid) produce?

A

Prostaglandins (PG)

- PGI2, PGD2, PGE

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13
Q

What do PGI2, PGD2 and PGE3 mediate?

A

Vasodilation and increases vascular permeability

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14
Q

What prostaglandin mediates vasodilation, increases vascular permeability AND mediates fever and pain?

A

PGE2

- “E2 fEver”

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15
Q

What does 5-lipooxygenase produce?

A

Leukotrienes

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16
Q

What does LTB4 do?

A

Attracts and activates neutrophils

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17
Q

What do LTC4, LTD4 and LTE4 do?

A
  • Mediate vasoconstriction
  • Bronchospasm
  • Increase vascular permeability (contraction of pericytes)
18
Q

What are the 4 key mediators that attract and activate neutrophils?

A
  • LTB4
  • C5a
  • IL-8
  • Bacterial products
19
Q

What cells lie below endothelial cells and are located above the BM?

A

Pericytes

20
Q

What do pericytes do when contracted?

A

Opens up space between endothelial cells

- Allows leakage of fluid into interstitium

21
Q

What are mast cells activated by?

A
  • Tissue trauma
  • Complement proteins C3a and C5a
  • Cross-linking of cell-surface IgE by antigen
22
Q

Where are mast cells found?

A

Widely distributed throughout multiple connective tissues

23
Q

What do mast cells immediately release and what do these granules do?

A

Preformed histamine granules

- Mediates vasodilation of arterioles and increase vascular permeability (post-capillary venule)

24
Q

What is produced by mast cells in the delayed response?

A
  • Arachadonic acid metabolites

- Particularly leukotrienes

25
Q

What is the classical pathway?

A

C1 binds to IgG or IgM that is bound to antigen

26
Q

What is the alternative pathway?

A

Microbial products directly activate complement

27
Q

What is the mannose-binding lectin pathway?

A

MBL binds mannose on microorgansims and activates complement

28
Q

What are the convertases?

A

C3 convertase and C5 convertase

29
Q

What does C5b complex with to create?

A

C6 - C9

- To create the Membrane attack complex

30
Q

What do C3a and C5a trigger?

A

Mast cell degranulation

31
Q

What complement product acts as a chemotactic factor for neutrophils?

A

C5a

32
Q

What does C3b act as?

A

Opsonin for phagocytosis

33
Q

What is Hageman factor?
Where is it located?
What is it activated upon?

A
  • Inactive proinflammatory protein produced in liver

- Activated upon exposure to subendothelial or tissue collagen

34
Q

What can gram -ve organisms activate to cause DIC?

A

Hageman factor

35
Q

What does Hageman factor activate?

A
  • Coagulation and fibrinolytic systems
  • Complement
  • Kinin system - cleaves HMWK to bradykinin, which mediates vasodilation, increased vascular permeability and pain
36
Q

What are the 2 main substances which mediate pain?

A
  • PGE2
  • Bradykinin
    Sensitize sensory nerve endings
37
Q

What 3 substances cause vasodilation and relaxation of arteriolar SM (causing rubor and calor?

A
  • Histamine (primarily)
  • PGs
  • Bradykinin
38
Q

What does swelling in inflammation come from?

A

Leakage of fluid from postcapillary venules into interstitial space

39
Q

What 2 factors cause tumor?

A

Tissue damage and histamine

40
Q

How does fever occur?

A
  • Pyrogens cause macrophages to release IL-1 and TNF
  • Increase COX activity in perivascular cells of hypothalamus
  • Increased PGE2 raises temperature set point

USMLE Pathology (15 decks)

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