Session 2 - Inflammation

Question 1

this is known as the body’s reaction to tissue injury or infection characterized by reddening, pain, swelling, and warmth.

Answer 1

inflammation

Question 2

what is the warmth that is associated with inflammation due to?

Answer 2

increased blood flow (and dilation) to the traumatized site

Question 3

symptoms of swelling, heat and pain resulting from dilation of the BV in the affected part is associated with what in terms of plasma and WBC?

Answer 3

loss of plasma and wbc into the tissues –> this is what causes the swelling

Question 4

how do wbc communicate with one another?

Answer 4

via cytokines

Question 5

what is the first initial process of inflammation? (in terms of the BV)

Answer 5

bref contraction of nearby arterioles - remember, this is followed by dilation which involves flushing of the capillaries with blood, from which plasma proteins and wbc pass into injured tissues causing swelling as they attack the cause of injury

Question 6

in terms of inflammation, amplification depends on what?

Answer 6

the extent of injury and the activation of mediators

Question 7

termination of the inflammatory response is mediated by what?

Answer 7

intrinsic anti-inflammatory mechanisms that limit tissue damage.

Question 8

T or R: the inflammatory process may stimulate nerves and cause pain

Answer 8

true

Question 9

what is the main wbc involved in ACUTE inflammation?

Answer 9

PMNs (polymorphonuclear neutrophils)

Question 10

what is the main wbc involved in CHRONIC inflammation?

Answer 10

lymphocytes and few macrophages

Question 11

what is the condition of increased blood flow to the tissues called?

Answer 11

hyperemia (remember, this is responsible for redness and warmth at sites of tissue injury).

Question 12

what is the real impetus for edema after inflammation? (think in terms of the cell)

Answer 12

increase in endothelial cell barrier permeability results in the edema

Question 13

how is the extravascular fluid cleared post inflammation?

Answer 13

cleared through the lymphatics

Question 14

this is known as the accumulation of fluid within the extravascular compartment and interstitial tissues

Answer 14

edema

Question 15

edema fluid with low protein content (specific gravity <1.015)

Answer 15

transudate

Question 16

which type of edema fluid tends to occur in noninflammatory conditions, where the the endothelial barrier remains intact and prevents loss of large molecules from the vasculature?

Answer 16

transudate

Question 17

edema fluid with high protein concentration which frequently contains inflammatory cells.

Answer 17

exudate

Question 18

which type of edema fluid is produced by mild injury such as sunburn or traumatic blisters?

Answer 18

exudate

Question 19

this type of exudate contains large amounts of fibrin as a result of activation of the coagulation system.

Answer 19

fibrinous exudate

Question 20

this type of exudate/effusion contains prominent cellular components (PMNs) and is frequently associated with pathological conditions such as pyogenic bacterial infections.

Answer 20

purulent

Question 21

T or F: vasoactive mediators originate from both plasma and cellular sources and are generated at sites of tissue injury

Answer 21

TRUE - remember, these bind to receptors and can cause v/d or v/c.

Question 22

in terms of the vascular response, proximal to capillaries, what happens to the arterioles?

Answer 22

v/d to increase BF

Question 23

in terms of the vascular response, distally, what happens to the venules?

Answer 23

v/c which increases capillary bed hydrostatic pressure potentiating edema formation

Question 24

with severe direct injury, what does the cell body form?

Answer 24

blebs

Question 25

is it the capillary or venous side (in terms of the microcirculatory environment) that interacts with clotting mechanisms and the overall inflammation process?

Answer 25

capillary venous side

Question 26

what are the 2 main sources of plasma-derived inflammatory mediators of increased vascular permeability?

Answer 26

Factor XII (Hangeman factor, which includes the clotting/fibrinolytic system and the Kallkerin-kinin system) and complement system (C3a, C5a)

Question 27

in terms of cell-derived sources of inflammatory mediators, they include: mast cells, inflammatory cells, and what two other sources?

Answer 27

platelets and endothelium; mast cells are associated with histamine; platelets with serotonin; inflammatory cells with leukotrienes, PAF and prostaglandins, and endothelium with nitric oxide, PAF, and prostaglandins

Question 28

what are the other two respective names for local and systemic mediators?

Answer 28

cell and plasma-derived

Question 29

what is the end point of the complement system?

Answer 29

formation of MAC (membrane attack complex)

Question 30

what makes the process of phagocytosis easier?

Answer 30

opsonins (esp C3b)

Question 31

what is the classic pathway activated by?

Answer 31

Ag-Ab complex -proteins includd c1 to c9

Question 32

in terms of arachidonic acid metabolism, the pathway that involves 5-lipoxygenase leads to what?

Answer 32

leukotrienes

Question 33

in terms of arachidonic acid metabolism, the pathway that involves cyclooxygenase leads to what? (it's a 2 tiered approach)

Answer 33

PGH2 and then Prostaglandins and thromboxanes.

Question 34

in terms of eicosanoids, phospholipases are inhibited by what?

Answer 34

steroids

Question 35

cyclooxygenase is inhibited by what?

Answer 35

COX1 an COX2 inhibitors

Question 36

what are two of the most common COX inhibitors

Answer 36

aspirin and indomethicin

Question 37

leukotrienes mainly cause v/c or v/d?

Answer 37

v/c and also bronchospasm; as a side note it also causes increased permeability

Question 38

prostacylins mainly cause v/d or v/c? how does it affect platelet aggregation?

Answer 38

v/d and also it inhibits platelet aggregation

Question 39

thromboxanes cause v/d or v/c? how does it affect platelet aggregation?

Answer 39

v/c and promotes plate aggregation

Question 40

in terms of leukocyte interaction with endothelial selections what is the interaction that involves the slowing of leukocytes in the BF?

Answer 40

tethering

Question 41

leukocytes moving along the vascular endothelial cell surface with saltatory movement is known was what?

Answer 41

rolling

Question 42

PMNS become activated by proximity to the endothelium and by inflammatory mediators. when this happens, they adhere strongly (firm adhesion) to intercellular adhesion molecules on the endothelium - what is this called?

Answer 42

leukocyte arrest

Question 43

in terms of leukocyte action in the inflammatory process, endothelial cells separate, and leukocytes do what?

Answer 43

transmigrate through the vessel wall, and under the influence of chemotactic factors, they migrate through extravascular tissue to the site of injury

Question 44

MAKE SURE YOU KNOW THE STEPS IN THE INFLAMMATORY PROCESS

Answer 44

KNOW THEM!! - Check packets

Question 45

what is known as directed cell migration?

Answer 45

chemotaxis - remember it is a combination of attractants, replants, and adhesion molecules

Question 46

what is one of the more important chemotactic factors?

Answer 46

C5a

Question 47

what are the 4 molecular families of adhesion molecules that are involved in leukocyte recruitment?

Answer 47

selectins, addressins, integrins, member of the immunoglobulin family

Question 48

T or F: blood leukocytes are recruited by chemoattractants released by endothelial cells; they then migrate from the endothelium toward the targeted tissue up a several chemoattractant gradients.

Answer 48

FALSE - all is correct except the leukocytes move DOWN the gradient

Question 49

when leukocytes transverse the endothelial barrier how do they move? (IOW, what is the term used to describe their migration?)

Answer 49

PARAcellular diapedesis (passing btwn adjacent endothelial cells)

Question 50

how do neutrophils migrate through endothelial cells? IOW, what is the term used to describe their migration?

Answer 50

TRANScellular diapedesis

Question 51

PMNs transverse thin regions of the endothelium called what?

Answer 51

fenestrae

Question 52

in the digestion phase of the intracellular events of inflammation, when the phagosome that contains the foreign material fuses with cytoplasmic lysosomes, what is it called?

Answer 52

phagolysosome (lysosomal enzymes are released into this)

Question 53

what are the four steps involved in the intracellular events of inflammation?

Answer 53

recognition, signally, internalization, and digestion

Question 54

this is known as a shift of water from the vascular space into another compartment, usually the interstitial compartment

Answer 54

edema

Question 55

occurs when there is venous pressure (hydrostatic edema) or low plasma osmotic pressure

Answer 55

low protein edema aka transudate

Question 56

a type of low protein edema; occurs when plasma albumin levels are abnormally low allowing water to escape from the vascular space into the interstitial space. also, this type of edema is typically associated with what disease process?

Answer 56

osmotic edema; liver disease (b/c remember, the liver is the primary producer of albumin)

Question 57

what is the term for generalized edema?

Answer 57

anasarca

Question 58

what type of edema is due to obstructed lymphatics?

Answer 58

lymphedema

Question 59

T or F: inflammatory cells have oxidative activity that leads to the production of several oxygen metabolites which are more reactive than oxygen itself. .

Answer 59

true. these contribute to killing of ingested bacteria

Question 60

T or F: Lysosomal acid hydrolases and specialized noncatalytic proteins unique to inflammatory cells are examples of nonoxidative bacterial killing

Answer 60

true

Question 61

T or F: since neutrophils have a short life-span, acute inflammatory rns are usually self-limited.

Answer 61

TRUE - typically followed by restoration of normal tissue architecture and function (resolution)

Question 62

this is the term to describe what happens if a tissue is irreversibly injured

Answer 62

scar

Question 63

if the area of acute inflammation is walled off by inflammatory cells and fibrosis, PMN products destroy the tissue and form this.

Answer 63

abscess

Question 64

localized acute inflammation and chronic inflammation may cause secondary inflammation of lymphatic channels and nodes. the lymphs will show hyperplasia

Answer 64

lymphadenitis

Question 65

this is the term used to describe the failure to eliminate a pathological insult or inability to trigger resolution to inury.

Answer 65

persistent inflammation

Question 66

when inflammatory cells persist, how does the stroma react?

Answer 66

it becomes hyperplastic --> if it continues it can lead to tissue destruction and may lead to organ dysfunction

Question 67

regarding the events of chronic inflammation: these are the microbial products or injury, and initiate the response

Answer 67

specific tirggers

Question 68

regarding the events of chronic inflammation: direct recruitment, activation, and interaction of inflammatory cells are done by which player?

Answer 68

chemical mediators

Question 69

once there is stromal cell activation and extracellular matrix what is happening in the inflammatory process?

Answer 69

remodeling.

Question 70

T or F: chronic inflammation is synonymous with chronic infection

Answer 70

FALSE; it can be associated with such things as cancer, and trauma.

Question 71

this is a protective response to chronic infection.

Answer 71

granulomatous inflammation

Question 72

what are the principal cells involved in granulomatous inflammation?

Answer 72

macrophages and lymphocytes

Question 73

under certain conditions, local injury may result in prominent systemic effects. what is the most serious of these possible effects ?

Answer 73

systemic inflammatory response syndrome

Question 74

what is systemic inflammatory response syndrome characterized by? (3 main things)

Answer 74

leukocytosis, fever and shock

Question 75

what is the clinical hallmark of inflammation?

Answer 75

fever