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Tobias Sec I-III Sample Questions > 1. Inflammatory Response > Flashcards

1. Inflammatory Response Flashcards

1
Q

Which of the following is false?

a. The classic signs of acute inflammation are calor, dolor, rubor, and tumor
b. Vasodilation is caused by catecholamines, serotonin, and bradykinins
c. Permeability occurs after vasodilation
d. Permeability is mediated by histamine and serotonin

A

b. Vasodilation is caused by catecholamines, serotonin, and bradykinins?
False – Vasoconstriction

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2
Q

Which of the following is false?

a. Vasoconstriction leads to stasis which allows for increased contact time
b. Transmigration is facilitated by PECAMs
c. Margination is mediated by cytokines on endothelial cells
d. Neutrophils are the first migratory cells to arrive in acute inflammation

A

c. Margination is mediated by …

glycoproteins called selectins on the endothelial cells.

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3
Q

1) PAMPS and DAMPS have affinity to what receptor?
a) Nuclear factor keppa B
b) Toll like receptor
c) Complement protein C3b
d) CXCL8

A

b) Toll like receptor

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4
Q

2) What is the major receptor for lipopolysaccharide?
a) TLR1
b) TLR2
c) TLR3
​d) TLR4

A

TLR4

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5
Q 
What is false regarding histamine? 
 ​a) arteriolar vasoconstriction 
 b) Increased venule permeability 
 c) constriction of large arteries 
 d) chemotaxis
A

a) arteriolar vasoconstriction

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6
Q

1.Which of the following is true regarding chemokines?
a.Chemokines act in chronic inflammation
b.There are five families of chemokines that are categorized according to
where the cysteine residue lies
c.The two most common chemokines are the C and CXC
d.The chemoattractant in most mammals is IL-8 which is also referred
to as CXCL8

A

a.Chemokines act in ACUTE inflammation
b.There are 4 families of chemokines that are categorized according to
where the cysteine residue lies
c.The two most common chemokines are the CC and
CXC)

TRUE: The chemoattractant in most mammals is IL-8 which is also referred
to as CXCL8

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7
Q

Which of the following is false regarding Interleukin-10?
a.It is an anti-inflammatory cytokine produced by CD4+ Th2 cells,
monocytes, and B-cells
b.It promotes the production of TNF-alpha, IL-1, IL-6, and IL-8 while
suppressing degradation of messenger RNAs
c.IL-10 promotes shedding of TNF receptors into systemic circulation
d.IL10 deficiencies are reported in chronic inflammatory, autoimmune
diseases and after transplants

A

b.

It SUPPRESSES TNF-alpha, IL-1, IL-6, and IL-8 while
promoting degradation of messenger RNAs

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8
Q

Which of the following is true regarding prostaglandins?
a.COX-1 is induced by trauma, growth factors, proinflammatory cytokines
b.They cause vasoconstriction and aide in decreasing pain and fever during
inflammation
c.COX-2 is a constitutively expressed enzyme noted to play a role in
homeostasis
d.COX-2 selective agents are a good choice in dogs due to their decreased incidence of gastric ulceration

A

ANSWER
d.COX-2 selective agents are a good choice in dogs due to their
decreased incidence of gastric ulceration

a.COX-2 is induced by trauma, growth factors, proinflammatory cytokines
b. they induce vasodilation and contribute to causing
pain and fever)
c.COX-1 is a constitutively expressed enzyme noted to play a role in
homeostasis

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9
Q

Which is true?
a.Carbon monoxide decreases with inflammation.
b.Carbon monoxide upregulates proinflammatory cytokines
c.Carbon monoxide decreases the expression of IL-10
d.Carbon monoxide decreases the expression of surface adhesion
molecules on endothelial cells and neutrophils

A

d.Carbon monoxide decreases the expression of surface adhesion
molecules on endothelial cells and neutrophils

a. Carbon monoxide increases with inflammation.
b. Carbon monoxide DOWNregulates proinflammatory cytokines
c. Carbon monoxide INCREASES the expression of IL-10

FYI - (CO is antiinflam, apoptotic, and cytoprotective)

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10
Q

Which is true about hydrogen sulfide?

a. Increases inflammation.
b. Induces smooth m. relaxation and vasodilation
c. Enhances leukocyte recruitment.
d. NSAIDs cause it to increase.

A

b.Induces smooth m. relaxation and vasodilation

Primarily antiinflammatory
Blockade of hydrogen sulfide-producing enzymes enhances leukocyte recruitment.
d.NSAIDs suppress cystathionine gama-lase which reduces levels

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11
Q

What is not a hallmark of an acute phase reaction?

a. Fever
b. Leukopenia
c. Hypoalbuminemia
d. Increase of C-reactive protein

A

b.Leukopenia (leukocytosis).

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12
Q

Which is true?
a. Negative acute phase proteins decrease in concentration by at least
25% during the inflam response
b. Positive acute phase proteins decrease in concentration by at least 10%
during an inflammatory response
c. Positive acute phase proteins increase within a few hows of inflam, peak
within 12-14 hours, and decrease as inflammation persists.
d. C-reactive protein is the major acute phase protein in rodents.

A

a.Negative acute phase proteins decrease in concentration by at least
25% during the inflam response

b. Positive APP inc. 25%
c. Positive APP increase within a few hows of inflam, peak within 24-48 hours, remain throughout with inflam
d. in rodents. (serum amyloid P)

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13
Q

Which statement regarding Bradykinin is incorrect?
a.Kinins are formed when kallikreins cleave kininogens, which are originally
produced in the liver.
b.A self perpetuating cascade of activation and stimulation of factor XII links the kinin system to the coagulation system when prekallikrein and cofactor
high-molecular-weight kininogen contact a negatively charged surface.
c.Kinase inactivates bradykinin
d.Bradykinin reacts with two receptors,​ B1​ which is produced de novo in many pathologic conditions and​ B2​, which is ubiquitous and constitutively expressed

A

d.Bradykinin reacts with two receptors,​ B2 which is produced de novo in many pathologic conditions and​ B1​, which is ubiquitous and constitutively expressed

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14
Q

Which of the following is not a function of bradykinin?
a. Inhibits​ the migration of polymorphonuclear leukocytes
b.Venous dilation through local nitric oxide release
c.Stimulates cytokine synthesis
d.Mediates tissue plasminogen activator release and endothelial prostacyclin
synthesis

A

a. FACILITATES the migration of polymorphonuclear leukocytes

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15
Q

How does substance P promote transmission of pain and pro-inflammatory signals?

a. Inhibits​ the release of prostaglandins
b. Binds to G-coupled receptors designated NK-Rs (neurokinin receptors)
c. Activates the alternative complement cascade
d. Only causes vasodilation by inducing NO production

A

b.Binds to G-coupled receptors designated NK-Rs (neurokinin receptors)

a.INDUCES the release of prostaglandins
c.​fOREIGN MICROBES activate the
alternative pathway of complement activation
Causes vasodilation by inducing NO production (ALSO ​binds to NK1-R
directly on endothelial cells)

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16
Q

Which statement is incorrect about granulomatous inflammation.

a. It is a type of ​acute​ inflammation
b. Function is to sequester an inciting agent
c. Aggregation of macrophages, epitheliod cells, and multinucleated giant cells
d. Suture can cause a granulomatous reaction

A

a.It is a type of CHRONIC inflammation

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17
Q

Which is true?

a. Pathogen-associated molecular patterns (PAMP) are intracellular chaperones that normally regulate proper protein folding.
b. Danger-associated molecular patterns (DAMP) are endogenous molecules such as fibrinogen, which alert the body to cellular damage initiated by infectious or noninfectious agents
c. Lipopolysaccharide is a DAMP
d. Heat shock proteins are highly conserved microbial molecules, recognized as foreign to the host

A

b. DAMPs = are endogenous molecules such as fibrinogen, which alert the body to cellular damage initiated by infectious or noninfectious agents

heat-shock proteins are intracellular chaperones that normally regulate proper protein folding.
Lipopolysaccharide is a PAMP
PAMPs are highly conserved microbial molecules, recognized as foreign to the host.

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18
Q

Which is true?

a. Toll-like receptors are proteins that initiate intracellular signaling cascades, which, in general, activate nuclear factor (NF)-κB and result in altered gene transcription.
b. Toll-like receptors are type 3 transmembrane proteins
c. TLR3 is a major receptor for lipopolysaccharide (endotoxin)
d. Toll-like receptors are DAMPs

A

a. TLRs are proteins that initiate intracellular signaling cascades, which, in general, activate nuclear factor (NF)-κB and result in altered gene transcription.
Toll-like receptors are Type I
major receptor for LPS =TLR4
Toll-like receptors are = Pattern recognition receptors - they bind DAMPs/PAMPs

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19
Q

Which is false?
Tachykinins are neuropeptides released from peripheral neurons after stimulation or trauma of sensory nerves.
Substance P is a tachykinin
Substance P inhibits transmission of pain signals
Substance P is pro-inflammatory overall

A

Substance PROMOTES transmission of pain signals)

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20
Q

Which is true?
The acute vascular response is primarily mediated by two vasoactive substances, tachykinin and serotonin.
Serotonin is also called 5-hydroxytryptamine
The term vasoactive amine refers to a very diverse group of small, soluble proteins that act as intercellular messengers during a number of physiologic processes.
Proinflammatory cytokines are TNF-α, IL-1β, IL-10

A

Serotonin is also called 5-HT

The acute vascular response is primarily mediated by two vasoactive substances, (histamine and serotonin)
The term CYTOKINE refers to a very diverse group of small, soluble proteins that act as intercellular messengers
Proinflammatory cytokines are TNF-α, IL-1β, IL-6 is pro not IL-10

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21
Q

Which of the following statements is true?

a. IL-ra is an anti-inflammatory cytokine that competes with IL-1 for receptor sites
b. IL-8/CXCL8 attracts macrophages promoting transition to chronic phase
c. IL-10 helps initiate hepatic synthesis of acute phase proteins and proliferation of lymphocytes
d. IL-6 inhibits the translocation of NFkB and promoting degredation of messenger RNA, down regulates production of Th-1 cytokines, and promotes shedding of TNF receptors into systemic circulation

A

A is correct

IL-8/CXCL8 neutrophil chemoattractant
IL-6 helps initiate hepatic synthesis of acute phase proteins and proliferation of lymphocytes
IL-10 inhibits the translocation of NFkB and promoting degredation of messenger RNA, downregulates productino of Th-1 cytokines, and promotes shedding of TNF receptors into systemic circulation

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22
Q

Which of the following is true?
Leukotrienes such as LTB4 provoke vasodilation and decreased venule permeability
Lipoxins are targeted by acetominophen to inhibit leukotriene-induced neutrophil chemotaxis
Hydrogen peroxide is a free radical
Platelet-activating factor increases eiconsanoid production, increases surface integrins on neutrophils and causes platelet aggregation and degranulation

A

D. is correct

LTB4 = potent chemotactic agent
Peptidoleukotrienes (LTC4, LTD4, LTE4) provoke vasoconstriction, bronchoconstriction and increased venule permeability
Aspirin increase production of some lipoxins which attenuates effects of leukotrienes
Hydrogen peroxide is a Non-free radical but easily destabilized

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23
Q

TxA2, PGF2a, PGD2, PGE2, PGI2(prostacyclin)

Endothelial cells, platlets/macrophages, endometrial cells, many cell types, mast cells

A 
TxA2=platlets/macrophages
PGF2a= endometrial cells
PGD2= mast cells 
PGE2= many cell types
PGI2(prostacyclin)= Endothelial cells
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24
Q 
Prolonged Ischemia results in the productions of which reactive oxygen species
Hypoxanthine
Myeloperoxidase
Superoxide
Hydrogen peroxide
A

Hypoxanthine

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25
Q

Which of the following is false regarding nitric oxide?
A Nitric oxide is synthesized from the amino acid L-arginine by nitric oxide synthase
B Two forms of nitric oxidase synthase are known
C The main physiologic function of nitric oxide is vasodilation by diffusing into smooth muscle cells
D Common anti-inflammatory drugs including cyclosporine and glucocorticoids inhibit nitric oxide expression

A

B. 3 forms of nitric oxidase synthase are known

endothelial derived
neuronal derived
inducible nitric oxide synthase

26
Q 
Negative acute phase proteins decrease in concentration by at least what percent during an inflammatory response
15%
25%
40%
50%
A

25%

27
Q

Which of the following is true in regards to serum Amyloid A?
A. Serum amyloid A is produced by macrophages, epithelial cells and hepatocytes
B. Majority of the isoforms found in blood become components of low-density lipoproteins
C. Concentrations can increase 100-fold during an inflammatory condition but magnitude is both species and disease dependent
D. Free serum amyloid A stimulates the production of proinflammatory cytokines (TNF-a, IL-1b, IL-8) from leukocytes, particularly macrophages

A

C. is correct

SAA from ENDOTHELIAL cells, macrophages and hepatocytes

become compnents of HIGH-density lipoproteins

proinflammatory –> NEUTROPHILS

28
Q

Name the 3 ways the complement cascade is activated and what do all 3 pathways have in common

A

Classic pathway
Alternative pathway
Lectin pathway

All 3 pathways convert C3 into C3a and C3b

29
Q

True or false: overproduction of the complement factors during conditions of sepsis can induce a wide variety of tissue damage leading to multiple organ failure

A

TRUE

30
Q

Name the effector functions of the complement pathway
C5a, C3a: ___________
C3b: ___________
MAC: ___________

A

C5a, C3a: inflammation
C3b: phagocytosis
MAC: lysis of microbe

31
Q

What parameters are included as characteristics of SIRS in humans?

A 
Body temperature
Heart rate
Blood pressure
Respiration
Leukocyte counts
32
Q

Granulomatous inflammation is a specialized type of chronic inflammation in which macrophages, epithelioid cells, and multinucleated giant cells aggregate into a well-demarcated lesion.

A

TRUE

33
Q

Which one is false?

  1. Prolonged, uncontrolled inflammation may have detrimental effects including excessive pain, immunosuppression, organ dysfunction, and death
  2. Vasoconstriction is induced by vascular smooth muscle changes mediated by nitric oxide, histamine, leukotrienes, prostaglandins, and complement factors
  3. The acute vascular response includes vasodilation, increased permeability, stasis, and leukocyte extravasation
  4. During leukocyte extravasation, leukocytes are initially slowed down by weak, transient interactions between the glycoprotein cell adhesion molecules called selectins on the endothelial cells; leukocyte adhesion to the vascular wall then occurs through high affinity bonds formed by integrins on the leukocyte surface; Once adhered, leukocytes migrate out of the vessel via diapedesis.
  5. Neutrophils are the first migratory cells to arrive and take a predominant role in acute inflammation, with peak populations present during the first 24 to 48 hours
A

FALSE:
2. Vasoconstriction is induced by vascular smooth muscle changes mediated by nitric oxide, histamine, leukotrienes, prostaglandins, and complement factors

(vasodilation)

34
Q

Which one is NOT a classic macroscopic sign of acute inflammation?

  1. Rubor (redness, erythema)
  2. Calor (heat)
  3. Dolor (pain)
  4. Fluor (secretion/discharge)
  5. Tumor (swelling, edema)
  6. Loss of function
A

FALSE:

4. Fluor (secretion/discharge)

35
Q

Macrophage polarization refers to the ability of macrophages to assume two distinct functional phenotypes: M1 and M2. Which type (M1, M2, or both) do the following:

Produce proinflammatory cytokines (IL-1β, IL-6, and TNF-α) and prostaglandins, enhancing the inflammatory response.

A

M1

36
Q

Macrophage polarization refers to the ability of macrophages to assume two distinct functional phenotypes: M1 and M2. Which type (M1, M2, or both) do the following:

Aid in wound repair and healing by secreting growth factors like PDGF or TGF-β, which stimulate fibroblasts to produce collagen, further dampening the inflammatory response.

A

M2

37
Q

Macrophage polarization refers to the ability of macrophages to assume two distinct functional phenotypes: M1 and M2. Which type (M1, M2, or both) do the following:

Secrete enzymes like collagenases and elastases to dissolve the extracellular matrix, facilitating phagocytosis and remodeling, respectively.

A

M1 & M2

38
Q

Which type of WBC can extravasate in response to chemotaxins, including cytokines, fibronectin, elastin, complement factors (C3a, C5a), thrombin, and growth factors (e.g., platelet-derived growth factor [PDGF], transforming growth factor-beta [TGF-β]), constitute one of the main cell types in inflammatory conditions, and serve as short-lived effector cells that promote vascular regrowth in tissues.

  1. Neutrophil
  2. Monocyte (specifically monocyte-derived macrophages that form to help the tissue-resident macrophages)
  3. Lymphocyte
  4. Mast cell
A
  1. Monocyte (specifically monocyte-derived macrophages that form to help the tissue-resident macrophages)
39
Q

What is the difference between pathogen associated molecular pathogens (PAMPS) and danger associated molecular pathogens (DAMPS)?

A

PAMPS: highly conserved microbial molecules, recognized as foreign by the host. Includes LPS, lipotechoic acid, peptidoglycan and microbial oligonucleoetodes.

DAMPS: endogenous molecules such as fibrinogen, which alert the body to cellular damage initiated by infectious or non-infectious agents.

Both PAMPS and DAMPS signal the immune system by interacting with cell surface receptors

40
Q

Name the two major vasoactive amines in inflammation.

A

Histamine

Serotonin

41
Q

What are cytokines?

A

Diverse group small soluble proteins that act as intercellular messengers during physiologic processes.

42
Q

Name the major pro and anti-inflammatory cytokines:

A

Pro-inflammatory cytokines (e.g. TNF-a, IL-1b, IL-6 ) increase innate immune response.

Anti-inflammatory cytokines (e.g. IL-10, IL-1ra) attenuate the responses.

43
Q

What is the role of TNF-a in inflammation?

A

Initiates production of pro-inflammatory cytokines (i.e. IL-6), reactive O2 intermediates, chemotaxins & endothelial adhesion molecules à invasion of cells at site of inflammation
IL-1 works in similar fashion to TNF.

44
Q

What is the role of IL-6 in inflammation?

A

Initiation of hepatic synthesis of APPs and influences the proliferation of lymphocytes.
Increases in plasma proportionately with duration and severity of the condition.

45
Q

What are chemokines? Which is the most well known?

A

Chemotactic cytokines responsible for attraction of cells across concentration gradient.
Il-8 (CXCL8)

46
Q

What is the role of IL-10 in inflammation?

A

Depresses production of TNF-a, IL-1, IL-6 & Il-8, by inhibiting translocation of nuclear factor kB (NF-kB) and promoting degradation of mRNA.

Downregulates Th-1 cytokines, promotes shedding of TNF ® into systemic circulation and inhibits Ag presentation by macrophages and dendritic cells.

47
Q

What are Eicosanoids? What is their precursor?

A

Lipid mediators that are rapidly created from membrane phospholipids and exert effects locally.
Their precursor is the fatty acid, arachidonic acid.

48
Q

What is the prostaglandin that is the precursor for all others?

  1. PGH2
  2. PGI2
  3. PGD2
  4. PGE2
A
  1. PGH2
49
Q

Which of the following statements about leukotrienes is false?

  1. They are produced in the lipoxygenase pathway
  2. They are secreted by leukocytes, platelets, and endothelial cells
  3. They are less potently vasoactive than histamine
  4. Peptidoleukotrienes provoke vasoconstriction and bronchoconstriction
A

FALSE:
3. They are less potently vasoactive than histamine

(more)

50
Q

Elevation of reactive oxygen species has been associated with:

  1. Improved surgical outcomes due to prevention of abdominal adhesions, improved wound healing, and decreased scarring
  2. Decreased likelihood of specific disease patterns such as pancreatitis
  3. Peroxidation of membrane phospholipids which govern cell permeability and the activity of various cellular proteins
  4. Tissue damage in small amounts
  5. Cardiovascular burst which helps defend against bacterial invaders
A
  1. Peroxidation of membrane phospholipids which govern cell permeability and the activity of various cellular proteins
51
Q

The roles of nitric oxide are all of the following except:

  1. Anti-inflammatory
  2. Pro-inflammatory
  3. Vasodilation
  4. Increased platelet aggregation and leukocyte adhesion
A

FALSE:

4. Increased platelet aggregation and leukocyte adhesion

52
Q

An acute phase reaction is characterized by all except:

  1. Decreased C-reactive protein
  2. Leukocytosis
  3. Hypoalbuminemia
  4. Fever
A

Decreased C-reactive protein

53
Q

Which of the following statements about positive acute phase proteins is false?

  1. Show an increase in plasma concentration by at least 75% during an inflammatory response
  2. Levels increase within a few hours and peak within 24-48 hours, remaining elevated as long as the stimuli persists
  3. Can be used as a prognostic marker for early identification of inflammation and prediction of outcome
  4. Plays a role in minimizing tissue damage and enhancing the repair process after infection, trauma, or stress
A

FALSE:

1. Show an increase in plasma concentration by at least 75% during an inflammatory response

54
Q

Which of the following is not true about C-reactive protein?

  1. Has both pro- and anti-inflammatory actions
  2. Can be useful in predicting pyometra in dogs, but not responsive in cats
  3. Binds bacteria to promote activation of complement
  4. Promotes neutrophils and down regulates macrophages
A

FALSE:
4. Promotes neutrophils and down regulates macrophages

(it down regulates neuts and up regulates macrophages)

55
Q

Which of the following is not true?

  1. Serum amyloid A is a positive acute phase protein and is pro-inflammatory
  2. Serum Amyloid P is the major acute phase protein in cats
  3. Serum Amyloid P is similar to C-reactive protein and is also in the pentraxin family.
  4. Serum Amyloid P binds bacteria, apoptotic cells and DNA which increases complement deposition and thus increases phagocytosis
A

FALSE:
2. Serum Amyloid P is the major acute phase protein in cats

(Serum Amyloid P is the major acute phase protein in rodents)

56
Q

Which of the following is NOT true about complement?

  1. Complement has 3 activation pathways, all that cleave C3 into C3a and C3b
  2. Complement inserts into the lipid bilayer of the target cell membrane and creates channels, leading to dysregulation of cellular homeostasis and eventual lysis.
  3. C5 down regulates and controls the effects
  4. There are complex interactions between the complement and the coagulation cascade
A

FALSE:
3. C5 down regulates and controls the effects

(C5 activates generation of reactive oxygen species, aiding in killing bacteria)

57
Q

Which is NOT true about the intrinsic vs extrinsic coagulation cascade?

  1. The intrinsic and extrinsic pathways are completely separate and have no overlap
  2. Intrinsic pathway is activated when factor XII contacts a negatively charged surface.
  3. Extrinsic pathway is initiated by the activation of Factor VII by Tissue Factor
  4. Both pathways join to convert fibrinogen into fibrin and subsequent clot formation
A

FALSE:
1. The intrinsic and extrinsic pathways are completely separate and have no overlap

(The intrinsic and extrinsic pathways join to convert fibrinogen to fibrin)

58
Q

Which one of the following is NOT true?

  1. Inflammation impairs fibrinolysis and affects the anticoagulation factors
  2. Coagulation promotes anti-inflammatory effects
  3. Sepsis and DIC lead to reduced levels of antithrombin III, leading to hyper coagulation initially
  4. Activated protein C limits clotting by inactivating coag factors Va and VIIa
A

FALSE:
2. Coagulation promotes anti-inflammatory effects

(coag promotes PRO inflammatory effects)

59
Q

Which of the following is FALSE about substance P?

  1. Substance P promotes transmission of pain and pro-inflammatory signals
  2. Substance P binds to NK1-R which initiates local vasodilation and increases venule permeability
  3. Substance P is produced only by leukocytes
  4. Substance P is a Tachykinin
A

FALSE:
3. Substance P is produced only by leukocytes

(SubP is produced by leukocytes as well as prominent neurons)

60
Q

What is FALSE about chronic inflammation?

  1. Fibroblasts play a significant role by producing chemokines and chemoattractants
  2. Chronic inflammation is due to macrophages
  3. Chronic inflammation is characterized by monocytes, angiogenesis, and progressive tissue fibrosis.
  4. Granulomas are a type of chronic infections
A

FALSE:
2. Chronic inflammation is due to macrophages

(just false)

Tobias Sec I-III Sample Questions (18 decks)

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