1.2.3 Arthritis and Systemic Inflammation

Question 1

Which of the following substances are most likely to be recognized by toll-like receptors?

A. Antibodies

B. C5a

C. Chemokines

D. HIV gag peptide

E. Lipopolysaccharide

Answer 1

E. LPS

Question 2

Which of the following molecules is an acute phase reactant?

A. Antibody

B. C-reactive protein

C. IFN-I

D. NKG2D

E. TLR5

Answer 2

B. C-reactive protein

(Acute phase reactants are produced in the liver)

Question 3

What does ESR stand for? What does it measure?

Answer 3

Eryrthrocyte sedimentation rate; Rate at which RBCs settle in a westergren tube (rate increased by acute phase reactants)

Question 4

What does CRP stand for?

Answer 4

C-reactive protein

Question 5

CRP and ESR are both tested to do the presence of what?

Answer 5

Inflammation

Question 6

Compare the sensitivity/specificity of CRP and ESR in low-grade inflammation.

Answer 6

ESR: More specific, less sensitive

CRP: More sensitive, less specific

Question 7

Which test is susceptible to alterations in the size/shape/# of RBCs?

Answer 7

ESR

Question 8

Describe when in the inflammation process would ESR or CRP be the test of choice.

Answer 8

CRP: up to 7 days

ESR: after 7 days

Question 9

Release of which of the following molecules is most directly responsible for the continued low blood pressure?

A. ICAM-1

B. IFN-I

C. IL-1

D. IL-12

E. TNFα

Answer 9

E. TNFα

(IL-1, according to Dr. Yankee, is mainly involved in traveling to the brain and affecting temperature regulation)

Question 10

In the example of the elderly woman with a hip replacement, what is the pathway of progression of her infection throughout her body?

Answer 10

Cold -> Lungs -> Systemic -> Hip

Question 11

What types of signals are recognized by PRRs?

Answer 11

PAMPs and DAMPs

Question 12

What are some examples of cells that contain PRRs?

Answer 12

Neutrophils, Macrophages, and Dendritic Cells

Question 13

What is the specialty of macrophages (me)?

Answer 13

Cytokine production - danger signaling

Question 14

What are some of the cytokines produced by macrophages?

Answer 14

IL-1, TNF-alpha, IL-6

Question 15

What are two of the effects of TNF-alpha and IL-6?

Answer 15

Vasodilation (endothelial cells) and stimulation of liver to produce acute phase reactants.

Question 16

What the 4 clinical manifestations of SIRS (systematic inflammatory response syndrome)?

Answer 16

Temp under 36 C or fever above 38 C

HR: over 90 beats/min

RR over 20 or aterial CO₂ tension less than 32mm Hg

Abnormal WBC (high or low)

[Can be infectious or non-infectious in origin]

Question 17

What is sepsis?

Answer 17

Systematic response to infection; It has all the same clinical manifestations as SIRS along with documented/presumed infection, associated w/ organ dysfunction, hypoperfusion or hypotension

Question 18

What is septic shock?

Answer 18

Sepsis-induced hypotension

Persistent hypotension and perfusion abnormalities despite adequate fluid resuscitation, caused by high levels of TNF-alpha