Outcomes of Inflammation

Question 1

What is granulomatous inflammation? What cells are unique to a granuloma?

Answer 1

Morphological pattern of chronic inflammation with epitheloid cells (Macrophages), CD4+ lymphocytes, giant cells (fused macrophages), and fibroblasts

Question 2

What unique macrophage is present in granulomas caused by tuberculosis?

Answer 2

Langhan’s giant cells

Question 3

What is the name given to the initial “pre-scar” tissue seen in the early stages of healing by fibrosis?

Answer 3

Granulation tissue

Question 4

What cell type is important in wound contraction?

Answer 4

Myofibroblasts

Question 5

What is a primary wound healing response initiated in response to?

Answer 5

Stitches and surgical incisions

Question 6

What is a secondary wound healing response initiated in response to?

Answer 6

Open wounds and abrasions

Question 7

What are the four outcomes of acute inflammation?

Answer 7

Resolution, abcess/suppuration, fibrosis, becomes chronic inflammation

Question 8

What is the usual outcome in an acute pattern of inflammation?

Answer 8

Resolution

Question 9

What is an abscess made from?

Answer 9

Fibrin

Question 10

What is the duration marker for chronic inflammation?

Answer 10

Three weeks or greater (anything shorter is acute)

Question 11

What are the causes of chronic inflammation?

Answer 11

Persistent microbial infection, prolonged exposure to toxins, autoimmune diseases, cancers

Question 12

What hypersensitivity reactions cause chronic inflammation?

Answer 12

Type II and III

Question 13

What is the hallmark cell of granulomatous inflammation?

Answer 13

Epithelioid cell (activated macrophage)

Question 14

What pathologies and foreign objects can cause granulomatous inflammation?

Answer 14

Tuberculosis, histoplasmosis, sutures, asbestos, silica gel, Crohn’s disease, sarcoidosis, leprosy, syphilis

Question 15

What cells are present in a granuloma?

Answer 15

Epithelioid cells, giant cells, fibroblasts, CD4+ lymphocytes

Question 16

What is the number one disease presenting with caseous necrosis? What other fungal pathology can cause it?

Answer 16

1 = Tuberculosis; #2 = Histoplasmosis

Question 17

What are the outcomes involved in the wound healing repair process?

Answer 17

Total reconstruction by regeneration or resolution
Partial reconstruction
Universal repair tissue (fibrous scar)

Question 18

What are the four components of wound healing and repair?

Answer 18

Angiogenesis (proliferating endothelial cells)
Proliferating fibroblasts
Deposition of ECM
Remodeling of CT

Question 19

What is granulation tissue composed of?

Answer 19

Proliferating capillaries
Proliferating fibroblasts and myofibroblasts
Extracellular fluid
Macrophages

Question 20

What are the functions of granulation tissue?

Answer 20

Fill in tissue “gaps”
Remove dead cell debris
Aid in wound contraction
Formation of “pre-scar”

Question 21

What is universal repair tissue equivalent to?

Answer 21

Fibrous connective tissue scar

Question 22

What is the first type of collagen laid down in wound healing?

Answer 22

Type III collagen

Question 23

What is the function of a myofibroblast?

Answer 23

Wound contraction for primary and secondary union healing

Question 24

Granulation tissue is always (Acute/Chronic)?

Answer 24

Acute

Question 25

What immune response is granulation tissue associated with?

Answer 25

Innate immune response

Question 26

What are the steps of primary and secondary union and timeframes?

Answer 26

Blood clot fills incision (4-16 minutes) Neutrophils infiltrate (less than 24 hrs) Epithelium continuity is restored (less than 24 hrs) Macrophages infiltrate (Day 3) Granulation tissue fills incision (Days 5-7) Progressive Collagenization (Day 7) Remodeling (3 months)

Question 27

What is different about a secondary union wound healing process?

Answer 27

More granulation tissue Prolonged inflammatory response More debris and inflammatory exudate More scar tissue formation More myofibroblast activity

Question 28

What are local factors that influence wound healing?

Answer 28

Type, size, and location Vascular supply Infection Movement

Question 29

What are systemic factors that influence wound healing?

Answer 29

Circulatory status Infection Malnutrition

Question 30

What are examples of complications of normal wound healing?

Answer 30

Proud flesh, keloid, wound dehiscence, contracture

Question 31

Where are the highest amount of continuous capillaries located in the body which can be implicated in faster wound healing?

Answer 31

Face

Question 32

What is proud flesh?

Answer 32

Excessive granulation tissue

Question 33

What is a keloid?

Answer 33

Hypertrophic scar with excessive collagen deposition

Question 34

What is one way that a keloid commonly forms?

Answer 34

Piercings

Question 35

In what population is a keloid most common?

Answer 35

African American

Question 36

Diabetics have (Better/Worse) wound healing characteristics?

Answer 36

Worse

Question 37

What is wound dehiscence?

Answer 37

Mechanical stress resulting in the reopening of a scar or wound

Question 38

What is contracture?

Answer 38

Excessive wound contraction by myofibroblasts resulting in shortening of tendons

Question 39

What traumatic injury can result in excessive wound contracture?

Answer 39

3rd degree burns, Achilles rupture repair

Question 40

What are important characteristics/mechanisms regarding cauliflower ear?

Answer 40

- Inflammatory serous or purulent exudate due to traumatic injury resulting in injury to an arteriole - may also result in dystrophic calcification