SYSTEMIC RESPONSE TO INJURY

Question 1

occurs as a
consequence of the local or systemic release of
“damage-associated” molecules to mobilize the
necessary resources required for the restoration
of homeostasis

Answer 1

inflammatory response

Question 2

Traumatic injury activates the innate immune
system to produce a __________ in an attempt to limit damage
and to restore homeostasis.

Answer 2

systemic inflammatory

response (SIR)

Question 3

2 GENERAL RESPONSES (CELLULAR INJURY)

Answer 3

acute proinflammatory response

anti-inflammatory response

Question 4

Systemic inflammatory response (SIRs)
is achieved clinically by two or more of
the following criteria:

Answer 4

■ If you have hypothermia or
hyperthermia
■ Tachycardia or Tachypnea
■ Abnormal WBC count

Question 5

Endogenous molecules that are produced as
a consequence of tissue damage or cellular
stress

Answer 5

DAMAGE- ASSOCIATED MOLECULAR PATTERNS

(DAMPS) OR ALARMINS

Question 6

DAMPS interact with immune and
non immune cell receptors to initiate a
“______” systemic inflammatory response
following severe traumatic injury.

Answer 6

Sterile

Question 7

In many cases, DAMP molecules are sensed by
______, which
are the same receptors that cells use to sense
invading pathogens.

Answer 7

pattern recognition receptors (PRRs)

Question 8

Identifiable source of microbial insult

Answer 8

Infection

Question 9

In SIRS, 2 or more of the following criteria are met:

Temperature:____
Heart rate:_______
Respiratory rate:____
PaCO2:_____

Answer 9

1. ≥38c (100.4F) or ≤36C (96.8F)
2. ≥90 beats per minute
3. ≥20 breaths per minute
4. ≤32 mmHg

Question 10

Identifiable source of infection + SIRS

Answer 10

Sepsis

Question 11

Sepsis + organ dysfunction

Answer 11

Severe sepsis

Question 12

Sepsis + Cardiovascular collapse

Answer 12

Septic shock

Question 13

Released passively from damaged or necrotic
cells and is detected rapidly in the circulation
within 30 minutes post injury.

Answer 13

HIGH-MOBILITY GROUP PROTEIN B1

Question 14

In particular, HMGB1 binding to TLR24 triggers
the proinflammatory cytokine release that
mediates____

Answer 14

“sickness behavior”

Question 15

activation of TLRs mainly occurs in ____

Answer 15

myeloid

cells

Question 16

Acute Lung Injury (ALI) is caused by ____ in

Traumatic Brain Injury (TBI)

Answer 16

HMGB1

Question 17

can act as
DAMPs by triggering an inflammatory response
to necrosis and cellular stress.

Answer 17

Mitochondrial proteins and/or DNA

Question 18

Leaked from damaged mitochondria, leads both
to inflammasome activation and activation of the
_______

Answer 18

stimulator of interferon gene pathway (STING)

Question 19

Function as molecular chaperones to monitor
and maintain appropriate protein folding,
physiological seen in our cytoplasm which
discard improperly folded proteins

Answer 19

HEAT-SHOCK PROTEINS

Question 20

Surface and cytoplasmic receptors that sense
DAMPS and mediate the innate immune
response

Answer 20

PATTERN RECOGNITION RECEPTORS (PRRS)

Question 21

Classes of receptors that are important for
sensing damaged cells and cell debris / DAMPs
which are the same receptors that cells use to
sense invading pathogens

Answer 21

PATTERN RECOGNITION RECEPTORS (PRRS)

Question 22

molecularly diverse group of molecules that
share a conserved mode of action defined by
complement activation, agglutination and
neutralization, and opsonization

Answer 22

SOLUBLE PATTERN RECOGNITION MOLECULES: THE

PENTRAXINS

Question 23

short pentraxin; first PRM to be

identified

Answer 23

C-REACTIVE PROTEIN (CRP

Question 24

has 51% sequence similarity to human
CRP, also contains the pentraxin
molecular signature

Answer 24

SERUM AMYLOID PROTEIN (SAP)

Question 25

A long pentraxin family member, in the “sterile” inflammatory response associated with cellular stress

Answer 25

PENTRAXIN 3 (PTX3)

Question 26

CNS receives information with regard to injury-induced inflammation via _____ as well as direct neural projections that transmit information to regulatory areas in the brain

Answer 26

soluble | mediators

Question 27

NEUROENDOCRINE RESPONSE TO INJURY

Answer 27

● Hypothalamic-Pituitary-Adrenal Axis | ● Sympathetic nervous system

Question 28

HYPOTHALAMIC- PITUITARY- ADRENAL AXIS (pathway)

Answer 28

Injury → Circulating cytokines or direct neural input via vagal fibers → hypothalamus → corticotropin-releasing hormone (CRH) release → anterior pituitary → ACTH release → zona fasciculata of the adrenal glands → glucocorticoids release

Question 29

Major glucocorticoid in humans, with | anti-inflammatory actions

Answer 29

CORTISOL

Question 30

atrophic adrenal glands | caused by exogenous steroid administration

Answer 30

Adrenal insufficiency

Question 31

exaggerated proinflammatory response associated with a blunted adrenocortical response

Answer 31

Critical illness-related corticosteroid | insufficiency (CIRCI)

Question 32

Counteract the anti-inflammatory activity of | glucocorticoids

Answer 32

MACROPHAGE MIGRATION INHIBITORY FACTOR

Question 33

Expressed by the pituitary gland that has both | metabolic and immune-modulatory effect

Answer 33

GROWTH HORMONE

Question 34

Insulin enhances enhanced hepatic synthesis of | ________

Answer 34

insulin-like growth factor-1 (IGF-1)

Question 35

Anabolic growth factor that is known to improve the metabolic rate, gut mucosal function, and protein loss after traumatic injury

Answer 35

INSULIN-LIKE GROWTH FACTOR-1 (IGF-1)

Question 36

T or F IGF-1 is decreased in critical illness, leading to a catabolic state

Answer 36

True

Question 37

appetite stimulant that is secreted by the | stomach

Answer 37

GHRELIN

Question 38

Ghrelin is a natural ligand for _____

Answer 38

``` GH-secretagogue receptor 1a (GHS-R1a) ```

Question 39

T or F low ghrelin levels were a positive predictor of ICU-survival in septic patients

Answer 39

False

Question 40

are hallmarks of injury and critical illness due to the catabolic effects of circulating mediators, including catecholamines, cortisol, glucagon, and growth hormone.

Answer 40

Hyperglycemia and insulin resistance

Question 41

A mineralocorticoid released by the zona | glomerulosa of the adrenal cortex

Answer 41

ALDOSTERONE

Question 42

T or F Aldosterone also gives positive feedback to anti-inflammatory effects by inducing pro-inflammatory cytokines.

Answer 42

False | -negative feedback

Question 43

are small molecules that are highly reactive due to the presence of unpaired outer orbit electrons

Answer 43

Reactive oxygen and nitrogen species (ROS, | RNS, respectively)

Question 44

Reactive oxygen and nitrogen species (ROS, | RNS, respectively)-These are commonly known as ____

Answer 44

Free radicals

Question 45

a way of disposing of damaged organelles and debris aggregates, ROS

Answer 45

AUTOPHAGY

Question 46

Autophagy is stimulated by Th1 cytokines with activation of TLR in macrophages but is inhibited by________

Answer 46

Th2 cytokines

Question 47

Mechanism for clearing senescent or dysfunctional cells without promoting an inflammatory response

Answer 47

APOPTOSIS

Question 48

the side effects of too much cortisol and growth hormone

Answer 48

insulin resistance and hyperglycemia

Question 49

Aldosterone reduces expression of the insulin-sensitizing factors which contribute to ________________

Answer 49

insulin resistance

Question 50

ROS has also been shown to have important roles as signaling messengers, particularly in the immune system through their ability to modulate________

Answer 50

cysteine residues by oxidation

Question 51

Provides negative feedback for ROS synthesis

Answer 51

Pyruvate kinase

Question 52

Important proteins involved in the unfolded protein response are:

Answer 52

IRE1, PERK, ATF6

Question 53

Neutrophil apoptosis is inhibited by _______

Answer 53

Inflammatory products

Question 54

Is activated through the binding of death receptors, which leads to the recruitment of Fas-associated death domain protein and subsequent activation of capsase 3

Answer 54

Extrinsic pathway

Question 55

proceeds through protein mediators that influence mitochondrial membrane permeability

Answer 55

Intrinsic pathway (Increased membrane permeability leads to the release of mitochondrial cytochrome c, which ultimately activates caspase 3 an thus induces apoptosis)

Question 56

Difference between apoptosis and necroptosis

Answer 56

Necroptosis- nucleus of the cell remains intact

Question 57

Form of regulated cell death that is dependent on the activity of the proinflammatory caspase enzyme associated with inflammasome

Answer 57

Pyroptosis