05b: Chronic and Granulomatous Inflammation

Question 1

Chronic inflammation lasts how long?

Answer 1

More than a few days

Question 2

List the typical causes of chronic inflammation

Answer 2

1. Prolonged exposure to injury/irritant
2. Immune-mediated diseases
3. Persistent infections

Question 3

T/F: All major cells present in acute inflammation are also present in chronic inflammation.

Answer 3

False - all except neutrophils

Question 4

T/F: All major cells present in chronic inflammation are also present in acute inflammation.

Answer 4

False - all except fibroblasts

Question 5

M1 (X)-activated macrophages are important in (Y).

Answer 5

X = classically
Y = acute inflammation

Question 6

M2 (X)-activated macrophages are important in (Y).

Answer 6

X = alternatively
Y = wound healing

Question 7

(M1/M2) macrophages produce ROS and lysosomal enzymes.

Answer 7

M1

Question 8

(M1/M2) macrophages produce IL-10 and TGF-beta.

Answer 8

M2

Question 9

(M1/M2) macrophages produce NO and chemokines.

Answer 9

M1

Question 10

(M1/M2) macrophages produce IL-1, 12, and 23.

Answer 10

M1

Question 11

Top layer of skin ulcer is comprised of:

Answer 11

Fibrinopurulent exudate (fibrin and neutrophils)

Question 12

Middle layer of skin ulcer is comprised of:

Answer 12

Granulation tissue (cap network embedded in loos matrix of fibroconnective tissue)

Question 13

Deep/bottom layer of skin ulcer is comprised of:

Answer 13

Scar tissue

Question 14

(Top/middle/bottom) layer of skin ulcer contains inflammatory cells.

Answer 14

Middle (granulation tissue)

Question 15

Autoimmune diseases: abundant inflammatory cross-talk between which two main cells?

Answer 15

Macrophages and T-cells

Question 16

Chronic inflammation: Macrophages produce (X) and present antigen to activate T cells as well as to promote (Y) processes.

Answer 16

X = cytokines (i.e. IL-12, TNF)
Y = leukocyte recruitment, inflammation

Question 17

Chronic inflammation: Activated T-cells produce (X) to further activate macrophages as well as to promote (Y) processes.

Answer 17

X = cytokines (i.e. TNF, IL-17, IFN-gamma)
Y = leukocyte recruitment, inflammation

Question 18

(X) leukocytes are most closely identified with asthmatic response.

Answer 18

X = eosinophils

Question 19

Acute phase proteins are elevated in (acute/chronic) inflammation.

Answer 19

Both! rapidly increase during acute phase and stay chronically elevated unless inflammation subsides

Question 20

Acute phase proteins are present in (X) and synthesized primarily by (Y).

Answer 20

X = blood
Y = hepatocytes

Question 21

Which clinical methods most often used to measure acute phase reactants/proteins?

Answer 21

1. CRP (C-reactive protein)

2. ESR (erythrocyte sedimentation rate)

Question 22

(X) inhibitors dramatically improve outcomes in chronic inflammatory conditions. List the two methods of inhibition used.

Answer 22

X = TNF

1. Ab to TNF
2. TNF soluble receptors

Question 23

(X) cytokine stimulates (Y) to synthesize acute phase reactants. Which cells produce this?

Answer 23

X = IL-6
Y = liver

Macrophages, T-cells, Fibroblasts, Endothelial cells

Question 24

C-reactive protein increases by factor of (X) during inflammation.

Answer 24

X = 5-500

Question 25

T/F: Plasma levels of cytokines are used clinically to monitor chronic inflammation.

Answer 25

False - too short of half-life and low conc in plasma

Question 26

At minimum, a granuloma is defined as:

Answer 26

Aggregation of macrophages (arranged concentrically)

Question 27

Granuloma usually arranged in which shape?

Answer 27

Concentrically around pathogen or irritant

Question 28

Granuloma: (X) cells surrounded by collar of (Y) cells.

Answer 28

``` X = epithelioid macrophages Y = lymphocytes ```

Question 29

Purpose of granulomas:

Answer 29

Attempt by host to contain and eliminate an insult too great for one cell alone

Question 30

List some causes (and examples) of granulomas.

Answer 30

1. Bacterial (esp myobacteria) infections (TB, Leprosy) 2. Fungal/parasitic infections 3. Foreign body 4. Idiopathic (Sarcoidosis, Crohn's Disease)

Question 31

Distinctive feature of granuloma is presence of (X) cells with abundant (basophilic/eosinophilic) cytoplasm. What are these cells derived from?

Answer 31

X = multi-nucleated giant Eosinophilic Fusion of individual macrophages

Question 32

Chronic granulomatous disease is a result of (X) enzyme (excess/deficiency/mutation). What's the function of (X)?

Answer 32

X = NADPH Oxidase Deficiency Generates ROS

Question 33

Growth factors typically act through which receptor type?

Answer 33

RTKs