Unit 3 - Acute Inflammation Flashcards
(185 cards)
1
Q
The response of living tissue to injury. Involves a well-organized cascade of fluidic and cellular changes:
A
Inflammation
2
Q
What is the primarily delivery system for inflammatory components?
A
blood
3
Q
mediated by prostaglandins that are increased in the hypothalamus
A
fever
4
Q
Which prostaglandins produce fevers?
A
TNF, IL-1, IL-6
5
Q
What increases cyclooxygenases that convert AA to prostaglandins (PGE2)
A
Cytokines
6
Q
How do NSAIDs reduce fever?
A
by inhibiting prostaglandin synthesis
7
Q
Stimultes acute phase protein production by the liver:
A
IL-1, IL-6
8
Q
List the three common acute phase proteins:
A
- C-reactive protein
- SAA
- Fibrinogen
9
Q
Predominance of mononuclear cells is characteristic of:
A
chronic inflammation
10
Q
What are the primary mononuclear cells?
A
macrophages, lymphocytes, plasma cells
11
Q
The inner wall of an abscess is granulation tissue, called a:
A
pyogenic membrane
12
Q
Standardized reaction, Early response; Hours to days:
A
acute
13
Q
Alteration of an inflammatory; weeks to years:
A
chronic
14
Q
What are the goals of acute inflammation?
A
- dilute toxins
- isolate
- eliminate
- repair
15
Q
Increased _______ often indicates a bacterial infection:
A
neutrophils
16
Q
Increased ______ are associated with viral infections:
A
lymphocytes
17
Q
an abnormally high number of circulating white blood cells:
A
leukocytosis
18
Q
What part of the brain coordinates a fever?
A
hypothalamus
19
Q
5 Cardinal Signs of Inflammation:
A
Heat, redness, swelling, pain, loss of function
20
Q
What is the stimulus that triggers inflammation?
A
tissue injury
21
Q
List three exogenous stimulants of inflammation:
A
microbes, foreign bodies, and injury (chemical, thermal, heat, ischemia)
22
Q
List the 2 endogenous inflammation stimulants:
A
hypersensitivity, autoreactive
23
Q
Inflammation activates the:
A
innate immune response
24
Q
What is the cellular phase of acute inflammation?
A
leukocyte emigration
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What is the fluidic phase of acute inflammation?
microvascular exudation of electrolutes, fluid, and plasma proteins
26
How does the body recognize invaders/foreign material?
- cellular receptors
- cellular sensors
- circulating proteins
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Where are some of the cellular receptors located on immune cells?
- PM (extracellular)
- cytosol (intracellular)
- endosome (ingested)
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Each TLR recognizes:
a different set of microbial molecules
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TLR-4 recognizes:
LPS
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PAMPs associated with:
microbial structures
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DAMPs associated with:
released from necrotic cells
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Which cytosolic receptors recognize a diverse set of molecules and active the inflammasome?
- bacterial products
- crystals
- K+ efflux
- reactive O2 species
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Inflammasomes induce the production of:
IL-1
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IL-1 recruits:
leukocytes
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Receptors located on the plasma membrane that detect fungal glycans and elicit inflammation to fungi:
C-type lectin receptors
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receptors that recognize antibodies and complement proteins:
Fc (recognize opsonized material)
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circulating proteins that react against microbes and produces mediators of inflammation:
complement
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substances that initiate and regulate inflammatory reactions:
mediators of inflammation
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What are some ways inflammatory mediators are kept in check?
- short half-lives
- enzymatically destroyed
- scavenged by antioxidants
40
One mediator can stimulate the release of:
other mediators
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What organ constantly secretes inflammatory mediators from plasma proteins?
liver
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What cell types produce histamine?
mast cells, basophils, and platelets
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What is the function of histamine?
vasodilation
| increased vascular permeability
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What cell types produce serotonin?
mast cells, platelets
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What is the function of serotonin?
similar to histamine
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List the synthesized mediators (3):
- cytokines
- chemokines
- arachidonic acid metabolites
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Which cells are the primary activators of cytokines?
macrophages, lymphocytes, dendritic cells
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Which cytokines are responsible for acute inflammation?
TNF, IL-1, IL-6
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What is the function of cytokines?
regulate immune and inflammatory reactions
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4 main functions of cytokines?
1. endothelial activation
2. leukocyte recruitment
3. leukocyte activation
4. systemic acute phase response
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cytokines that promote leukocyte chemotaxis and migration:
chemokines
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secreted by activated macrophages, endothelial cells, and others
IL-8
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Which interleukin causes the chemotaxis of neutrophils?
IL-8
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What are the lipid mediators produced from arachidonic acid present in membrane phospholipids?
prostaglandins, leukotrienes
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Prostaglandin function:
vasodilation
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leukotriene function:
vasoconstriction, increased vascular permeability, chemotaxis/leukocyte adhesion
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Thromboxane function:
vasoconstriction
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Collection of soluble proteins and membrane receptors that function in host defense; circulate as inactive form in plasma
complement system
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deposition of the MAC results in:
cell lysis
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Which complement cleavage products stimulate inflammation via histamine release?
C3a and C5a
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Which complement cleavage product is chemotactic for leukocytes?
C5a
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Which complement cleavage product is useful for opsonization/phagocytosis?
C3b
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Activates the intrinsic coagulation AND catalyzes the formation of kallikrein:
factor 12
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Functions of bradykinin:
- increased vasc. permeability
- vasodilation
- pain
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What is the function of kallikrein?
plasminogen --> plasmin
| cleaves C3
66
Synthesized by endothelial cells and macrophages:
nitric oxide
67
3 functions of nitric oxide:
- vasodilation
- inhibits platelet aggregation and adhesion
- oxidizes lipids
68
Platelet activating factor functions in:
vasoconstriction and bronchoconstriction
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Which principal mediators are responsible for vasodilation?
histamine
| prostaglandins
70
Which principal mediators are responsible for increased vascular permeability?
- histamine
- serotonin
- C3a, C5a
- leukotrienes
71
Which principal mediators are responsible for chemotaxis, leukocyte recruitment, and activation?
- TNF
- IL-1
- IL-8 (neutrophil chemotaxis)
- Chemokines
- C3a, C5a
- Leukotrines
72
Which principal mediators are responsible for fever?
- IL-1
- TNF
- Prostaglandins
73
Which principal mediators are responsible for pain?
- prostaglandins
| - bradykinins
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Which principal mediators are responsible for tissue damage?
- lysosomal enzymes of leukocytes
| - reactive oxygen species
75
Which phase of acute inflammation functions in dilution and localization of the stimulus?
fluidic phase
76
Sequence of vascular events of the fluidic phase:
1. increased blood flow
| 2. increased permeability of capillaries and postcapillary venules
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Why does increased vascular permeability mainly occur in venules?
high density of histamine receptors
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What allows for the retraction of endothelial cells?
actin/myosin
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results from increased vascular permeability
serous fluid
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suggests that the injury is rather mild or peracute
serous fluid
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clear watery fluid with low concentration of plasma protein and no/low # of leukocytes
serous fluid
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What are some likely times you will see serous fluid?
mild skin injury, allergy (runny nose), serosal surfaces
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What does the histology of serous fluid typically look like?
affected tissues are spread apart by watery fluid
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Dehydration of serous exudate released from injured vessels:
serous crust
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termed used to describe a PATTERN of acute inflmmation:
fibrinous inflmmation
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Exudate that has leakage of large molecular weight proteins (fibrinogen) that then polymerize to form fibrin:
fibrinous inflammation
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Accumulation of fluid with a high concentration of plasma protein:
exudate
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Where is fibrinous exudate most commonly seen?
in serous membranes of body cavity (pleura, pericardium, peritoneum, synovial membrane)
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What is the gross appearance of fibrinous exudate?
- surface tissue is often hyperemic
- early - surface may be granular and dull
- surface covered with fibrin
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Fibrinous exudate on histopath often involves:
- eosinophilic proteinaceous material - often fibrillary
| - rapidly infiltrated by neutrophils
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If extensive, fibroblasts may migrate in and begin organizing exudate leading to fibrinous adhesions:
fibrinous inflammation
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Delivers leukocutes to the site in order to kill and/or digest the stimulus (neutrophils and macrophages)
cellular phase
93
What are the steps of the cellular phase (4)?
1. Margination
2. Rolling
3. Adhesion to endothelium
4. Migration
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Which cytokines enhance expression of rolling and adhesion?
TNF, IL-1
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Exongenous products that induce chemotaxis:
- bacterial products
| - some lipids
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Endogenous products:
- IL-8
- complement
- arachidonic acid
97
Monocytes/macrophages are seen how many hours after injury?
24-48
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Neutrophils are seen how many hours after injury?
6-24
99
The first cells to arrive depends on the:
stimulus
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Neutrophils are the first cells to arrive in a:
bacterial infection
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Lymphocytes and plasma cells are the first to arrive in:
hypersensitivity reactions
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Eosinophils are the first to arrive in:
allergic reactions
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Lymphocytes are the first to arrive in:
viral infections
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Which type of inflammation involves a response consisting of an accumulation of fluid with high concentrations of plasma proteins and high number of neutrophils?
purulent inflammation
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Which term is often used synonymously with purulent but often implies that a larger amount of pus is present?
suppurative
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an accumulation of dead neutrophils
pus
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If the purulent exudate is white, it means:
neutrophils are predominant component
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If the purulent exudate is yellow:
there is lots of necrotic debris
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What are the three types of consistencies associated with purulent inflammation?
1. watery
2. creamy
3. firm
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When purulent inflammation is mixed with fibrin:
fibrinopurulent
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on microscopic examination, you will see large numbers of neutrophils, many degenerate neutrophils and mixed with necrotic cellular debris, tissue debris, plasma proteins, and fibrin:
purulent inflammation
112
If purulent inflammation progresses to chronic inflammation it becomes:
an abscess
113
Mediated by prostaglandins that are increased in the hypothalamus:
fever
114
Which cytokines mediate fever?
TNF, IL-1, IL-6
115
Increase production of leukocytes by the bone marrow:
TNF, IL-1, IL-6
116
stimulate acute phase protein production by the liver:
IL-1, IL-6
117
What are the acute phase proteins? (3)
- c-reactive protein
- SAA
- fibrinogen
118
Cytokines and acute phase proteins affect (3):
heart rate, blood pressure, body temp
119
clinically significant form of bacteremia complicated by toxemia, fever, malaise, and often shock:
septicemia
120
Septicemia gross findings:
fluid in body cavity, pulmonary edema, petechial hemorrhages, congestion of the liver and intestine
121
Septicemia histologic findings:
acute necrosis of renal tubules, centrolobular hepatocytes, and cardiac myocytes
122
What is the major interleukin that recruits neutrophils?
IL-8
123
How long do neutrophils live in the tissue?
1-2 days
124
How long do neutrophils live in circulation?
24 hours
125
List the 2 main functions of neutrophils:
- phagocytosis
| - release of granular contents
126
What's different about cow neutrophils?
cytoplasm is more eosinophilic
127
What are two other names for neutrophils?
myeloid cells
| PMNs
128
What are the important granules released by neutrophils?
- myeloperoxidase
| - lysozyme
129
converts hydrogen peroxide (and chloride anions) to hypochlorous acid (toxic to microbes)
myeloperoxidase
130
form pores in membranes
defensins
131
enzymes released by neutrophils cause liquefaction of the exudate and:
accumulation of pus
132
Reptiles and birds have reduced concentration of the enzymes released by neutrophils and thus:
cannot liquefy the exudate (and a caseous material forms)
133
extracellular fibrillary networks that provide a high concentration of antimicrobial substances
NETs
134
What are NETs composed of?
meshwork of nuclear chromatin
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How long do eosinophils live in circulation?
12 hours
136
How long do eosinophils live in the tissue?
1 week
137
What are eosinophils attracted by?
histamine, eosinophil chemoattractant factor A
138
When do eosinophils enter lesions?
during the transition from acute to chronic
139
Gives the muscle a tan-green tinge:
large numbers of eosinophils in the CT of muscles
140
Found in all supporting tissues:
mast cells/basophils
141
How long do mast cells live?
4-12 weeks
142
Have the ability to replicate in tissues:
mast cells
143
Which type of cell is distributed in skin, GI, and around blood vessels?
mast cells
144
Mast cells express high affinity for which immunoglobulin?
IgE
145
Which stain type is used to see the metachromatic granules of mast cells?
Giemsa
146
In circulation, monocytes are:
short lived
147
In tissues, macrophages are _____-____ are retained the ability to proliferate:
long-lived
148
What are the three functions of monocytes/macrophages?
- phagocytosis
- antigen presentation
- immune modulation
149
Macrophages of the liver:
Kupffer cells
150
Macrophages of the CNS:
microglia
151
Macrophages of the lungs:
alveolar macrophages
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Macrophages of the skin:
Langerhans cells
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Macrophages of the bone:
osteoclasts
154
Which cell type arrives as a second wave after neutrophils - 12-48 hours - and takes over?
macrophages
155
What do platelets arise from?
megakaryocyte fragmentation in marrow
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Which preformed substance do platelets carry?
histamine
157
Offending agent is quickly eliminated, little tissue is damaged:
complete resolution
158
agent persists, particularly one that is strongly chemotactic for neutrophils:
abscess
159
With substantial parenchymal injury and loss, granulation tissue fills in the defects:
healing by fibrosis
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- hyperemia is typical, often with protein rich fluid exudate
- neutrophils are the predominant leukocyte
acute
161
- characterized by fibrous and vascular proliferation
- reduced hyperemia
- parenchymal proliferation
- few to no neutrophils
chronic
162
What are some chronic modifiers?
- granulomatous (lots of macrophages)
- lymphocytic
- lymphoplasmocytic
- fibrosing
- proliferative
163
What are some causes of serous inflammation?
- early reaction to many inciting causes
- trauma to joints
- burns
164
What is the function of a serous exudate?
dilution of offending agent
165
Exudate of accumulation of serum-like fluid
serous inflammation
166
Secretion of large amounts of mucus that occurs only in mucous membranes:
catarrhal inflammation
167
What can cause catarrhal inflammation?
- mild irritants
| - mild/early inflammation
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What is the gross appearance of catarrhal inflammation?
clear film
169
What is the microscopic appearance of catarrhal inflammation?
- pale blue strands of mucus
| - may be mixed with inflammatory cells
170
Exudate containing a large amount of fibrin:
fibrinous exudate
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What is the gross appearance of fibrinous exudate?
dull granular to thick sheets
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What is the microscopic appearance of fibrinous exudate?
fibrillar eosinophilic material
173
Exudate containing large numbers of neutrophils, necroptic tissue cells, fibrin, and necrotic inflammatory cells:
suppurative/purulent exudates
174
collection of pus with a fibrous capsule:
abscess
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Which type of exudate reflects severe vascular injury, arises quickly, and is often fatal?
hemorrhagic exudate
176
Hemorrhagic exudate often involves:
mucosal surfaces
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Hemorrhagic exudate gross appearance:
deep red and pink to red-tinged fluid is present
178
Which type of exudate can accompany many disease processes?
hemorrhagic
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suggests severe destruction of host tissue (recruits inflammation, calls in fibrins):
necrotizing
180
a covering of a mucosal surface by a coagulum of fibrin, mucus, necrotic cells, and leukocytes:
pseudomembranes
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How can you tell if a pseudomembrane is present?
when the exudate is peeled away, leaves an ulcerated mucosal surfacce
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Inflammation of the kidney due to a bacterial infection:
pyelonephritis
183
An infection in any part of the urinary system, the kidneys, bladder, or urethra:
cystitis
184
What is the pathogenesis for the lay-down of fibrin on an organ?
acute inflammation, leakage of protein --> deposition of fibrin
185
If you see whispy material on histo, what most likely are you seeing?
fibrin
