AED - Inflammation - Week 1

Question 1

List 8 causes of inflammation.

Answer 1

Hypoxia
Chemicals/drugs
Physical agents
Microbiological agents
Immunological agents
Genetic defects
Nutritional imbalances
Age

Question 2

List 4 classic signs of acute inflammation and what they cause.

Answer 2

Redness
Heat
Swelling
Pain
They cause loss of function

Question 3

What two cells are more involved in inflammation due to bacteria or toxins?

Answer 3

Neutrophils and pus

Question 4

What two cells are more involved in inflammation due immunological agents or hypersensitivity?

Answer 4

eosinophil and basophils

Question 5

What kind of response does physical trauma generate more (2)?

Answer 5

Oedema and haemorrhage

Question 6

What three cells are more involved in inflammation due viral infections?

Answer 6

Macrophages, NKT cells, T cells

Question 7

Why does chronic infammation tend to occur (2)?

Answer 7

Failure to remove injurous agent or by-products of inflammation

Question 8

What might be seen with chronic inflammation (2)?

Answer 8

Granuloma formation and giant multinucleated cells

Question 9

True or false

Chronic inflammation tends not to be very heterogenous

Answer 9

False

Question 10

The presence of what three cells is a usually a good indicator of chronic inflammation?

Answer 10

Lymphocytes, plasma cells and macrophages

Question 11

What occurs as a result of healing by repair?

Answer 11

Scar formation

Question 12

List 4 cells that are typical of early phase/acute ocular inflammation.

Answer 12

Mast cells
Basophils
Neutrophils
Eosinophils

Question 13

What condition are mast cells particularly prevalent in?

Answer 13

Allergy-driven hypersensitivity

Question 14

What are mast cells histologically similar to, and how can they be distinguished? What is their characteristic stain colour, and what appearance do they have?

Answer 14

Similar to basophils
-Mast cells lack bi-lobed nuclei
Characteristic blue stain
Granular appearance

Question 15

Which is more common in the eye, basophils or eosinophils?

Answer 15

Eosinophils

Question 16

Are basophils involved in acute allergy-driven conjunctivitis?

Answer 16

Yes

Question 17

What is the major cell type of inflammatory responses?

Answer 17

Neutrophils

Question 18

What cell is particularly prevalent in allergy-driven hypersensitivity and parasitic infections, aside from mast cells?

Answer 18

Eosinophils

Question 19

What nucleus shape do eosinophils have?

Answer 19

Bi-lobed

Question 20

What cell is the most prevalent in bacterial infections?

Answer 20

Neutrophils (PMN)

Question 21

List two regions of the eye mast cells are resident.

Answer 21

Choroid

Conjunctiva

Question 22

Anterior ischaemic optic neuropathy is a disorder of what?

Answer 22

Posterior ciliary artery

Question 23

Describe what occurs with anterior ischaemic optic neuropathy (2).

Answer 23

Acute oedematous reaction

Haemorrhage of papillary vessels

Question 24

Anterior ischaemic optic neuropathy causes significant loss of what cells? Which retinal layers thins?

Answer 24

Loss of RGCs

NFL thinning

Question 25

If acute inflammation occurs to the eye as a result of trauma, would you expect neutrophils following redness and oedema?

Answer 25

No, not at this stage, unless it becomes infected

Question 26

Describe how hypopyons form.

Answer 26

Neutrophil exudation from iris vessels

Question 27

What does chemical injury to the eye often induce?

Answer 27

Neutrophil infiltration

Question 28

What are fibrinous exudates (3), and what do they follow?

Answer 28

Comprised of fibrinogen, granulation tissue, and inflammatory cells, following acute inflammation

Question 29

What is direct toxic damage to the eye exacerbated by? What can this contribute to?

Answer 29

Proteases released by neutrophils | Can contribute to corneal perforation

Question 30

Distinguish between the true membrane and pseudomembrane in an eye with acute inflammation. What can this usually be caused by (3) and does it happen often?

Answer 30

Pseudomembrane is not firmly attached to the underlying epithelium, the true membrane is. It is rare, but usually caused by infection, chemical, or immunogenic agents.

Question 31

What can be seen in the initial stages of inflammatory response in anterior uveitis? What about the later stages?

Answer 31

Neutrophil exudation from uveal vessels | Later stages involve largely macrophage response

Question 32

How can the effects of anterior uveitis be experimented on?

Answer 32

Immunogenic experimental uveitis is secondary to systemic endotoxin - it runs a course similar to acute anterior uveitis.

Question 33

How can acute and chronic uveitis be differentiated based on cells present (2)?

Answer 33

Keratic precipitates differ in size and colour, reflecting different cell types

Question 34

What are keratic precipitates largely composed of in chronic (2) vs acute (1) anterior uveitis?

Answer 34

Acute - neutrophils | Chronic - macrophages and lymphocytes

Question 35

What does chronic non-granulomatous inflammation in the iris (anterior uveitis) lead to (3)? What are the keratic precipitates largely composed of (2)?

Answer 35

Ischaemia Atrophy of the iris stroma and dilator muscle Keratic precipitates composed of macrophages and neutrophils

Question 36

What is episcleritis and is it usually acute or chronic? Is it quickly self-limiting or not?

Answer 36

Inflammation of the episclera - relatively common | Usually acute and self-limiting

Question 37

What are some characteristics of episcleritis that are more consistent with a chronic condition? List them (4).

Answer 37

Redness Oedema Infiltrate of lymphocyte and plasma cells Spillover into the conjunctiva

Question 38

Define sarcoidosis.

Answer 38

Disease involving abnormal collections of inflammatory lumps known as granulomas

Question 39

List a distinctive histological feature of chronic granulomatous conjunctivitis. Which cells are present?

Answer 39

Subepithelial region - epitheloid cells and multinucleated / giant cells surround a fibrous wall of tissue. Lymphocytes are also present (T cells)

Question 40

What condition can chronic granulomatous inflammation be secondary to?

Answer 40

Blocked meibomian gland - chalazion

Question 41

How would a chalazion appear histologically? Explain the characteristic appearance and what initiated inflammation, as well as the cells that would be present (3).

Answer 41

A central clear area - which is dissolved lipid | This initiated inflammation, evident by the surrounding giant cells, lymphocytes, and plasma cells

Question 42

What is cobblestone papillae mediated by (the response and disease)?

Answer 42

Acute IgE mediated inflammatory response in vernal keratoconjunctivitis.

Question 43

What cells accumulate in cobblestone papillae, and what is it often indicative of?

Answer 43

Accumulations of euosinophils and some basophils (or possibly mast cells) Often indicative of an allergic response

Question 44

How do blood vessels appear in cobblestone papillae (3)?

Answer 44

Hard, flat-topped, central vessels

Question 45

Is vernal keratoconjunctivitis an acute or chronic response? Explain.

Answer 45

There is evidence of a mised response - lymphocytes can be found in conjunctival biopsies

Question 46

What happens to the cornea following radiation trauma (4)?

Answer 46

Local inflammation Signs of oedema Inflammatory cell infiltrate Fibroblast / myofibroblast activation

Question 47

What happens to the cornea after inflammation following radiation trauma (4).

Answer 47

Evidence of healing: - wedge of disorganised collagen - an acellular region of the stroma - regrowth of epithelium - no inflammatory cells present

Question 48

Are signs of inflammation always histologically acute or chronic?

Answer 48

No, it can be a mixture of both

Question 49

What is the purest example of the classic acute inflammatory response in the eye?

Answer 49

Bacterial keratitis