Acute Inflammation

Question 1

What are the clinical features of acute inflammation ?

Answer 1

RUBOR 
TUMOR
CALOR
DOLOR
LOSS OF FUNCTION

Question 2

What happens to the blood vessels in acute inflammation ?

Answer 2

1) transient vasoconstriction of arterioles - few seconds
2) vasodilation of arterioles
3) vasodilation of blood vessels
4) increased permeability
5) STASIS due to increased RBCs + increased viscosity of blood

Question 3

What cells is histamine released from?

Answer 3

Mast cell, basophils, platelets

Question 4

Which chemical mediator acts immediately in an acute inflammation response and how quickly ?

Answer 4

Histamine

Within 30 mins

Question 5

What does release of histamine do?

Answer 5

• vasodilation
• increased permeability
• Pain

Question 6

What is bradykinin and what does it do?

Answer 6

Inflammatory chemical mediator
Peptide
Causes vasodilation = reduced bp

Question 7

What response do leukotrienes evoke and which condition are leukotrienes particularly troublesome?

Answer 7

Bronchiole constriction

Asthma

Question 8

What are the two types of oedema?

Answer 8

Transudate

Exudate

Question 9

What is the difference between transudate oedema and exudate oedema ?

Answer 9

Exudate oedema = high protein content

Transudate oedema = low protein content

Question 10

Which type of oedema do you get in acute inflammation ?

Answer 10

Exudate

Question 11

What type of oedema would you expect in cardiac failure/ venous outflow obstruction

Answer 11

Transudate - oedema due to hydrostatic pressure imbalance

Question 12

What is polymorphonuclear leucocyte?

Answer 12

Neutrophil

Question 13

What is the primary type of white blood cell involved in acute inflammation?

Answer 13

Neutrophil

Question 14

How do neutrophils infiltrate into the tissue ?

Answer 14

Margination - line the endothelium
Rolling - roll along endothelium
Adhesion - stick to endothelium via receptors
Emigration - neutrophils enter blood vessel walls- (cause cells junctions to relax, digest the basement membrane & move in)

Question 15

Which important protein is found in exudate oedema ?

What is its role in acute inflammation ?

Answer 15

Fibrin

Keeps inflammation local and stops it spreading

Question 16

How do histamines and leukotrienes increase vascular permeability?

Answer 16

Cause endothelial contraction - resulting in gaps for protein containing fluid to leak out.

Question 17

How do cytokines IL-1 & TNF increase vascular permeability?

Answer 17

Cytoskeleton reorganisation

Question 18

What is transcytosis?

What causes this?

Answer 18

Fluid moving across wall of non leaky blood vessel

VEGF

Question 19

What is the commonest type of inflammatory cell?

Answer 19

Neutrophil

Question 20

How many lobes does a neutrophil have?

Answer 20

Multiple

Question 21

What are the 4 stages of neutrophil infiltration ?

Answer 21

Migration
Rolling
Adhesion - loose then tight
Emigration

Question 22

What causes migration of the neutrophils?

Answer 22

Stasis of the blood

Question 23

How do the neutrophils emigrate into the tissue?

Answer 23

• relaxation of the endothelial cell junctions

- digestion of the vascular basement membrane

Question 24

What is diapedesis?

Answer 24

Seen in inflammation - Passage of blood cells through intact capillary walls

Question 25

What are 3 chemotaxins ?

Answer 25

C5a LTB4 Bacterial peptides

Question 26

How do neutrophils move to site of injury ?

Answer 26

Chemotaxis

Question 27

What are the steps in chemotaxis ?

Answer 27

- receptor on neutrophils binds to ligand (chemotaxins) - causes rearrangement of cytoskeleton - + production of a pseudopod - attracts more neutrophils

Question 28

Once in the tissue what do neutrophils do?

Answer 28

Phagocytose

Question 29

Name 2 opsonins

Answer 29

Fc (fixed component on all antibodies) | C3b

Question 30

List 3 o2 independant killing mechanisms?

Answer 30

- lysozyme enzymes : eg hydrolases - defensins (cationic proteins) - BPI (bacterial permeability increasing protein

Question 31

What are 3 families of chemical mediators ?

Answer 31

Proteases Prostaglandins/leukotrienes Cytokines/chemokines

Question 32

The proteases involved in acute inflammation are found where? They are produced where?

Answer 32

Plasma Liver

Question 33

Where are plasma proteins produced?

Answer 33

Liver

Question 34

What are 3 proteases involved in acute inflammation ?

Answer 34

Kinins Complement Clotting factors

Question 35

What are the metabolites of arachidonic acid?

Answer 35

Prostaglandins | Leukotrienes

Question 36

Name 2 cytokines ?

Answer 36

Interleukin 1 | TNF alpha

Question 37

What are chemokines ?

Answer 37

Smaller cytokines (proteins)

Question 38

Which chemical mediators result in increased blood flow?

Answer 38

- histamine | - prostaglandins

Question 39

Which chemical mediators result in increased vascular permeability ?

Answer 39

Histamine | Leukotrienes

Question 40

Which chemical mediators result in neutrophil chemotaxis ?

Answer 40

C5a, BPI (BACTERIAL PEPTIDES), LTB4

Question 41

Which chemical mediators are responsible for phagocytosis ?

Answer 41

C3b

Question 42

What is the hallmark of acute inflammation?

Answer 42

- exudate of oedema fluid | - infiltration of inflammatory cells

Question 43

What is cardiac tamponade?

Answer 43

Compression of heart due to too much fluid in the pericardium

Question 44

What are local complications of acute inflammation?

Answer 44

- swelling - exudate - loss of fluid - pain - loss of function

Question 45

What are systemic effects of acute inflammation ?

Answer 45

``` Fever Leukocytosis Acute phase response Acute phase proteins Shock ```

Question 46

What are 5 acute phase proteins

Answer 46

``` CRP Alpha 1 antitrypsin Haptoglobin Fibrinogen Serum amyloid A protein ```

Question 47

Give some examples of the acute phase response ?

Answer 47

Loss of appetite Raised pulse rate Altered sleep pattern

Question 48

Give 2 examples of endogenous pyrogens?

Answer 48

IL-1 | TNF alpha

Question 49

WHAT IS SHOCK?

Answer 49

circulatory failure

Question 50

What 4 things can happen after development of acute inflammation ?

Answer 50

- resolution - abscess - chronic inflammation + fibrous repair - Death

Question 51

Name 2 inhibitors of acute inflammatory changes

Answer 51

Lipoxins | Endothelin

Question 52

Acute inflammation of meninges can lead too..

Answer 52

Swelling and compression of brain | Thrombosis and reduced cerebral perfusion

Question 53

Which organism causes lobar pneumonia ?

Answer 53

Streptococcus pneumoniae

Question 54

What are 5 clinical features of a patient with lobar pneumonia?

Answer 54

- fever - prostration - Hypoxaemia - Breathlessness - dry cough

Question 55

When examining the exudate of a patient with a skin blister would you expect to find inflammatory cells in there?

Answer 55

Very few

Question 56

What type of tissue does abscess occur in?

Answer 56

Solid

Question 57

In an abscess what type of necrosis is in the centre?

Answer 57

Liquefactive

Question 58

What type of problems can you get it exudate pours into serous cavities?

Answer 58

- ascites - pleural effusion - pericardial effusion

Question 59

which acute inflammatory condition is described as having a bread and butter appearance ?

Answer 59

Pericarditis