Chapter 3: Overview

Question 1

The typical inflammatory reaction develops through a series of sequential steps (the 5 Rs). What are these?

Answer 1

Recognition, recruitment, removal, regulation, and repair

Question 2

When pathogenic microbes invade tissues or tissue cells die, leukocytes are rapidly recruited. What is the order of leukocytes to arrive?

Answer 2

neutrophils, then later monocytes and lymphocytes

Question 3

What are the major participants in the inflammatory response?

Answer 3

blood vessels and leukocytes

Question 4

what are the vascular and cellular reactions of inflammation triggered by?

Answer 4

soluble factors that are produced by various cells

Question 5

What is the main cellular infiltrate for acute inflammation?

Answer 5

mainly neutrophils

Question 6

what is the main cellular infiltrate for chronic inflammation?

Answer 6

monocytes/macrophages and lymphocytes

Question 7

What are the 5 cardinal signs of inflammation?

Answer 7

Rubor, Calor, Dolor, Tumor, Loss of function

Question 8

What are 4 causes of inflammation?

Answer 8

Infection, tissue necrosis, foreign bodies, and immune reactions

Question 9

What are some examples of endogenous substances that can be harmful if they deposit in tissues?

Answer 9

urate crystals (gout), cholesterol crystals (in atherosclerosis) and lipids

Question 10

What is the initiating step in inflammatory reactions?

Answer 10

recognition of microbial components or substances released from damaged cells

Question 11

What is the best defined cellular receptor for microbes?

Answer 11

Toll-like receptors (TLRs)

Question 12

What is the best example of a cystolic receptor that senses cell damage?

Answer 12

NOD-like receptors (NLRs)

Question 13

What molecules do NLRs sense?

Answer 13

uric acid, ATP, and reduced intracellular K+ concentrations

Question 14

When NLRs sense damage to cells, what do they activate?

Answer 14

the inflammasome

Question 15

what does the inflammasome induce?

Answer 15

the production of the cytokine IL-1

Question 16

In addition to directly recognizing microbes, what else do many leukocytes express receptors for?

Answer 16

the Fc tails of antibodies and for complement proteins (these receptors recognize opsonized microbes)

Question 17

What circulating proteins are capable of recognizing microbes and products of cell damage and triggering inflammation?

Answer 17

mannose-binding lectin (MBL) and collectins

Question 18

What are the cytokine-induced systemic reactions collectively called?

Answer 18

acute-phase response

Question 19

What cytokines are important mediators of the acute-phase reaction?

Answer 19

TNF, IL-1, and IL-6

Question 20

The acute-phase response consists of several systemic clinical and pathological changes. What are these three things?

Answer 20

Fever, acute phase reactants, and Leukocytosis

Question 21

What 2 cytokines are endogenous pyrogens?

Answer 21

IL-1 and TNF

Question 22

how do IL-1 and TNF function as pyrogens?

Answer 22

when released, they upregulate cyclooxygenases, which is the enzyme that synthesizes prostaglandins

Question 23

What is the role of prostaglandins in regards to fevers?

Answer 23

prostaglandins (especially PGE2) stimulate the production of NTs by the hypothalamus that reset the body’s steady state temp to a high level by reducing heat loss (via vasoconstriction) and increasing heat generation

Question 24

What are three of the best known acute-phase reactants?

Answer 24

C-reactive protein (CRP), Fibrinogen, and Serum amyloid associated protein (AA)

Question 25

What is synthesis of CRP in the liver stimulated by?

Answer 25

cytokines- especially IL-6

Question 26

What is the role of CRP?

Answer 26

it acts as an opsonin and it aids in clearing necrotic debris

Question 27

What is the relationship between CRP and MIs?

Answer 27

elevated serum CRP has been proposed as a marker for increased risk of MIs in patients with CAD

Question 28

what is an established predictor of recurrent cardiovascular events?

Answer 28

hsCRP elevation

Question 29

What is the synthesis of fibrinogen in the liver stimulated by?

Answer 29

cytokines- especially IL-6

Question 30

What is the role of fibrinogen?

Answer 30

it binds to red cells and causes them to form stacks (rouleaux)

Question 31

What is the effect of rouleaux formation?

Answer 31

the red blood cells will sediment more rapidly than individual RBCs

Question 32

What is an example of a non-specific test for an inflammatory response?

Answer 32

Erythrocyte sedimentation rate- the faster the sedimentation rate the more likely inflammation is present

Question 33

What is the synthesis of serum amyloid associated protein in the liver stimulated by?

Answer 33

IL-1 and TNF

Question 34

What is the role of AA?

Answer 34

acts as an opsonin; helps in clearing necrotic cells

Question 35

What does prolonged production of SAA cause?

Answer 35

secondary amyloidosis

Question 36

Why does leukocytosis occur initially?

Answer 36

because of the accelerated release of cells from the bone marrow post mitotic reserve pool (caused by cytokines including TNF and IL-1)

Question 37

What do most bacterial infections cause an increase of?

Answer 37

neutriphils

Question 38

what do most viral infections, such as infectious mononucleosis, mumps, and German measles, cause an increase in?

Answer 38

the number of lymphocytes

Question 39

what do allergies and helminth infestations cause an increase in?

Answer 39

eosinophils

Question 40

What is associated with decreased number of circulating white blood cells?

Answer 40

this is called leukopenia; caused by certain infections like typhoid fever and infections caused by some viruses, rickettsiae, and certain protozoa

Question 41

What is the clinical triad known as septic shock?

Answer 41

High blood levels of cytokines cause various widespread clinical manifestations such as 1) DIC 2) hypotensive shock and 3) metabolic disturbances (including insulin resistance and hyperglycemia)