Chronic inflammation II

Question 1

What is granulomatous inflammation? What is it characterized by (cell types, appearance etc)?

Answer 1

Distinctive pattern of chronic inflammation characterized by aggregates of activated macrophages having a squamous (epithelioid) appearance

Question 2

What causes granulomatous inflammation as opposed to other forms of inflammation?

Answer 2

Isolation of indigestible substance

Question 3

What are the cells that mediate granulomatous inflammation?

Answer 3

Persistent T cell response with macrophage activation

Question 4

Insolubles substances produce what type of immune response?

Answer 4

Cell mediated response

Question 5

What is the prototypical Granuloma causing agent? Other notable ones?

Answer 5

TB/leprosy

Sarcoidosis
Fungal infx
Cat scratch fever

Question 6

What does a granuloma contain?

Answer 6

Aggregation of macrophages that are transformed into epithelioid cells, surrounded by a collar of mononuclear leukocytes (lymphocytes)

Question 7

What are Lanhans giant cells seen in?

Answer 7

Granulomas

Question 8

What is the difference between a granuloma and granulation tissue?

Answer 8

Granuloma = macrophages

Granulation tissue = Walled off via fibroblasts and capillaries

Question 9

What is granulation tissue?

Answer 9

Histological appearance of fibroblasts and a new, thin walled delicate capillaries in a loose ECM

Question 10

What is the name for the arrangement of giant cells when they are located at the periphery of a granuloma?

Answer 10

Langhans-type

Question 11

For what type of infection/stimulus are multinucleated giant cells arranged in a haphazard manner?

Answer 11

Foreign bodies

Question 12

When are foreign body granulomas formed?

Answer 12

When FBs are too large to be phagocytosed

Question 13

What is caseous necrosis?

Answer 13

Cheese-like tissue that forms around bacteria or FBs

Question 14

What is lymphangitis? How does this appear clinically?

Answer 14

Inflammation of lymphatic channels, leukocytes and cell debris

Appears as red streaks

Question 15

If an infection overwhelms a lymph node, what can happen?

Answer 15

Gains access to vascular circulation (bacteremia)

Question 16

What is SIRS?

Answer 16

Systemic inflammatory response system (acute phase response)

Question 17

What are the clinical symptoms of systemic inflammation?

Answer 17

Increased WBCs, cytokine release, fever

Question 18

What are the two major cytokines released in systemic inflammation? What about the one that bacteria have that causes systemic inflammation?

Answer 18

IL-1 and TNF-alpha

Bacteria have LPS

Question 19

How do IL-1 and TNF alpha promote fever?

Answer 19

stimulate PG synthesis (COX pathway converts AA to PG) in hypothalamic thermoregulatory center, resetting the body thermometer

Question 20

What are the three major acute phase proteins?

Answer 20

1. CRP
2. Fibrinogen
3. SAA (serum amyloid protein)

Question 21

Where are acute phase proteins synthesized? What is their function?

Answer 21

Liver

Functions as opsonizers

Question 22

Acute phase proteins can be upregulated by what proteins? (3)

Answer 22

1. IL-1
2. IL-6
3. TNFalpha

Question 23

What is a leukemoid reaction?

Answer 23

Extremely high WBC (over 40,000/microliter)

Question 24

What happens to band cell production in SIRS?

Answer 24

Increases since bone marrow cannot keep up with demand for WBCs

Question 25

What is lymphocytosis?

Answer 25

Increase in absolute number of lymphocytes; seen in viral infections (e.g. mononucleosis, mumps, etc)

Question 26

What is leukopenia? What is this seen in?

Answer 26

Lower WBCs Seen in overwhelming infections or debilitated hosts

Question 27

Why is sweating decreased in systemic inflammation?

Answer 27

Redirected blood flow from cutaneous to deep vascular tissue to minimize heat loss

Question 28

What bacterial chemical is prone to lead to sepsis?

Answer 28

LPS

Question 29

What is the triad for septic shock?

Answer 29

1. DIC 2. Hypoglycemia 3. CV failure

Question 30

What is the net result of sepsis?

Answer 30

Multisystem organ dysfunction

Question 31

What is defective inflammation?

Answer 31

Increased susceptibility to infections and delayed wound healing

Question 32

What is excessive inflammation caused by? (3)

Answer 32

Autoimmune disease CA atherosclerosis

Question 33

There is a strong relationship between chronic inflammation and what disease?

Answer 33

CA

Question 34

What is the etiological agent associated with gastritis? What type of CA does this predispose pts to?

Answer 34

H. Pylori | Gastric adenocarcinoma

Question 35

What is the etiological agent associated with Schistosomiasis? What type of CA does this predispose pts to?

Answer 35

Schistomes | Bladder, liver, and rectal CA

Question 36

What is the etiological agent associated with cholangitis? What type of CA does this predispose pts to?

Answer 36

Liver flukes | Cholangiocarcinoma/colon CA

Question 37

What is the etiological agent associated with cholecystitis? What type of CA does this predispose pts to?

Answer 37

Various bacteria/stones | gallbladder CA

Question 38

What is the etiological agent associated with hepatitis? What type of CA does this predispose pts to?

Answer 38

Hep B/C | Hepatocellular carcinoma

Question 39

What is the etiological agent associated with PID? What type of CA does this predispose pts to?

Answer 39

Gonorrhea/chlamydia/papilloma virus Ovarian/ cervical CA

Question 40

What is the etiological agent associated with osteomyelitis? What type of CA does this predispose pts to?

Answer 40

Various bacterial infx | Skin carcinoma

Question 41

How do granulomas appear?

Answer 41

Macrophages with Pale, pink, and granular cytoplasm

Question 42

What is reactive lymphadenitis?

Answer 42

Inflammation of a draining lymph node

Question 43

What is chromatolysis?

Answer 43

Process involving the cell body following injury, caused by increased protein synthesis in an attempt to repair

Question 44

What are the three characteristics of chromatolysis?

Answer 44

1. Round cellular swelling 2. Displacement of the nucleus to the periphery 3. Dispersion of Nissl substance

Question 45

Extravasation of WBC occurs where?

Answer 45

Post capillary venules

Question 46

What maintains a granuloma?

Answer 46

Th1 cells secreting IFN-gamma, and TNF-alpha from macrophages

Question 47

What are the cell types that surround a granuloma?

Answer 47

Macrophages surrounded by Th cells

Question 48

What is the MOA of ASA blocking fever?

Answer 48

Inhibits cyclooxygenase and thus prostaglandin synthesis in the hypothalamus.

Question 49

What is ESR and why is it measured in sepsis?

Answer 49

Rise in fibrinogen in sepsis = blood sticking together. ESR measures this.

Question 50

What is the cause of hypoglycemia in sepsis?

Answer 50

Liver damage decreases gluconeogenesis