Grouping II

Question 1

In essence, what is a granuloma?

Answer 1

A conjugation of epitheloid squamous like macrophages around an alien body, can also form in response to continual T cell activation to certain microbes and fungu. They are further surrounded by T cells and form a barrier.

Question 2

What cytokines activate macrophages into granuloma formation?
What do macrophages then produce to maintain the granuloma formation?

Answer 2

Cytokine IFNY from TH1 cell recruit macrophages for granuloma formation.

Macrophages then maintain the granuloma through secretion of TNFalpha.

Question 3

What effect could prescribing TNF-alpha inhibitors on a patient have if they also have TB?

Answer 3

TNF-Alpha inhibitors could cause the break down of granulomas protecting the patient from TB. This could be deadly for the pt and result in reactivation of a latent TB.

Question 4

Epitheloid cells can combine forming a structure known as what?

Answer 4

Langhans giant cell with a peripheral rim of lymphocytes.

Question 5

What does granulation tissue contain?

Answer 5

Granulation tissue is very different from granulomas and contains vasculature, fibrotic tissue and fibroblasts.
There may be a few scattered macrophages and other cells present as well.

Question 6

What morphilogical differences would allow you to differentiate between a langhans type granuloma and a Foreighn body-type granuloma?

Answer 6

Langhans-type granulomas will have peripheral arrangements.

Foreighn-body type granulomas will have a haphazard shape to them encasing typically a foreign body of sorts.

Question 7

What are endogenous pyogens?

Answer 7

Cytokines IL-1 and TNF induced by bacterial LPS causing acute systemic phase responses.

Question 8

How do endogenous pyogens work?

Answer 8

IL-1 and TNF increase COX PG synthesis in the hypothalmic thermoregulatory center in which PG stimulates neurons that will raise the body temperature.

Question 9

What are the three well known acute phase proteins?

Answer 9

CRP C-reactive protein
Fibrinogen
SAA (Serum amyloid A protein)
All of these are systematic responses.
Each of these are upregulated again by IL-1 and TNF (IL-6 as well/ Low yield)

Question 10

What is Leukocytosis?

Answer 10

An increase in total WBC from normal 4000-10000 cells/uL
to
15,000 cells/uL - 20,000 cells/uL

Question 11

What is the Leukemoid reaction?

Answer 11

This is an exremely high white cell count that reaches numbers similar to leukemia.
40,000 to 100,000 cells per uL

Question 12

What is a systemic “Shift to the Left” and when is it seen?

Answer 12

A shift to the left is seen in sever cases of bacterial infection in which band cells are seen as the body tries to pump out more neutrophils that it is able.

Question 13

What is Leukopenia and when is it seen?

Answer 13

Leukopenia is a decrease in the number of WBC and is most often seen in certain viral infections such as typhoid fever or in debilitated hosts with overwhelming infection.

Question 14

What is the clinical triad of bacterial sepsis?

Answer 14

Cardiovascular failure
Microthrombi (DIC)
Liver injury (hypoglycemia)
Net effect is organ failure leading to death.

Question 15

Compare and contrast the terms healing and repair.

Answer 15

Healing is regeneration of architecture and function of damaged tissue.

Repair of tissue is the regain of function but not the architecture.

Question 16

What are labile cells?

Give some examples

Answer 16

Labile cells are cells that are constantly being regenerated. Some examples would be:
Bone marrow
Epidermis
GI epithelium
Bronchial epithelium

Question 17

What are Stable cells, give some examples

Answer 17

These cell can regenerate but only do so during damage.
Examples would include:
The liver
Kidneys

Question 18

What are permanent cells? Give some examples.

Answer 18

These are cells that when damaged can only undergo repair and under no circumstances can undergoe regenerative healing and instead result in scarring.
Examples:
Myocardiocytes
Muscle cells
Brain

Question 19

The human adult wound healing process can be devided into three different phases.
Please list the phases.

Answer 19

Inflammatory (immediate)
Proliferation (2-3 days after wound)
Remodeling (1w after wound)

Question 20

What cells are involved in the inflammatory stage of wound healing?

Answer 20

Platelets
Neutrophils
Macrophages
Aid in clot formation, vessel permeabiliy, and debris clearing via macrophages/ neutrophils.

Question 21

What cells are involved in the proliferative stage of wound healing?

Answer 21

Fibroblasts
Myofibrils
Endothelial cells
Keratinocytes
Macrophages
Result in deposition of granulation tissue and collagn, angiogenesis, epithelial cell proliferation, disolution of clot, and wound contraction.

Question 22

What cells are involved in the remodeling phase of wound healing and what important occurance hapens here?

Answer 22

Fibroblasts in which type III collagen is replaced by the stronger type I collagen.

Question 23

What is the responsibility of PDGF?

Answer 23

Platelet derived growth factor can be released by macrophages or platelets and induces vascular remodeling with smooth muscle cell migration and fibroblast collagen formation.

Question 24

What is the responsibility of FGF?

Answer 24

Stimulates all aspects of angiogenesis.

Question 25

What is the responsibility of TGF-B

Answer 25

Angiogenesis, fibrosis, and cell cycle arrest.

Question 26

What is the responsibility of Metalloproteinases?

Answer 26

Tissue remodelling.

Question 27

What is the major regulatory molecule for angiogenesis?

Answer 27

VEGF resulting in endothelial cell prolferation and capillary budding.

Question 28

What is the major regulatory molecule for fibrogenesis?

Answer 28

TGF-Beta causing fibroblast activation and collagen deposition.

Question 29

Appearance of granulation tissue 3-5 days post injury is a sign of what?

Answer 29

It is a good sign of repair in which fibroblasts, fibrous material, and vasculature is moved into the wound location.

Question 30

What is healing by first intention?

Answer 30

This is the description of healing as a result of an incision in whcih the margins of the wound are directly lined up producing minimum granulation material.

Question 31

What is healing by second intention?

Answer 31

This is the case in which edges of a wound are not line up. In these cases there will be more granulation, with more epithelization and thus more fibrosis.
There is also a higher risk of contraction and conenctration of myofibroblasts in these cases.