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342 - Pathologic Basis of Disease > 3 - Acute Inflammation > Flashcards

3 - Acute Inflammation Flashcards

1
Q

True or false. Inflammation is not necessarily associated with infection.

A

True.

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2
Q

The three very broad functions of inflammation are listed below in alphabetical order. Place them in chronologic order from earliest to latest.

(a) Initiate the process of repair and healing, eventually returning the tissue to normal structure and function.
(b) Kill/eliminate the initial cause of injury (e.g., microbes, foreign material, thermal, radiation).
(c) Phagocytose and remove any cellular debris resulting from the injury.

A

(b) Kill … –> (c) Phagocytose … –> (a) Initiate repair …

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3
Q

Which two white blood cell types are the “first responders” during acute inflammation?

A

Neutrophils and monocytes/macrophages

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4
Q

True or false: Fibrosis is excessive production of fibrin in tissues

A

False.

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5
Q

Inflammation in which the predominant cells are macrophages is called:

(a) granulocytic
(b) granulomatous
(c) histiocytic
(d) macrophagic
(e) monocytic
(f) suppurative

A

BOTH (b) granulomatous AND (c) histiocytic. “Granulomatous” is more commonly used.

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6
Q

Describe the gross appearance of fibrin on peritoneal, pleural or pericardial surfaces (actually, anywhere).

A

Fibrin forms soft, rubbery and sticky yellow strands or plaques that are easily peeled from surfaces.

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7
Q

There are two pools of mature neutrophils available to swing into action during acute inflammation: the marginal pool and the storage pool.

When both these pools are mobilized the resulting increase in blood neutrophils is called a __________. [Fill in the blank]

A

Neutrophilia

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8
Q

Which of the following is/are associated with an EXUDATE?

(a) Clear to pale yellow
(b) Few or no leukocytes
(c) High protein content
(d) Increased numbers of leukocytes
(e) Low protein content
(f) Often results from heart failure and venous congestion, hypoproteinemia, liver failure etc.
(g) Turbid
(h) Usually associated with inflammation

A

(c) High protein content
(d) Increased numbers of leukocytes
(g) Turbid
(h) Usually associated with inflammation

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9
Q

True or false: The presence of fibrin indicates chronic inflammation

A

False.

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10
Q

True or false. Inflammation is always associated with infection.

A

False.

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11
Q

What is the term for a decreased number of mature neutrophils in blood?

A

Neutropenia

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12
Q

Fill in the blank. Abscesses tend to form in the presence of ____(a)____ when ____(b)_____ have failed.

A

(a) pyogenic (= pus-forming) bacteria
(b) attempts at eliminating the inciting cause through acute inflammation

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13
Q

Inflammation in which the predominant cells are neutrophils is called:

(a) granulocytic
(b) granulomatous
(c) histiocytic
(d) monocytic
(e) neutrophilic
(f) suppurative

A

BOTH (e) neutrophilic AND (f) suppurative. “Suppurative” is more commonly used.

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14
Q

Describe the gross appearance of fibrous tissue on peritoneal, pleural or pericardial surfaces (actually, anywhere).

A

Fibrous tissue forms dense, strong, white connections between structures. Remember that this is type 1 collagen, the same material in fascia, tendons, aponeuroses, ligaments etc.

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15
Q

Which (abscess or granuloma) is more likely to form in the presence of bacteria that are resistant to degradation (e.g., Mycobacteria)?

A

Granuloma

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16
Q

What are the three very broad functions of inflammation?

A
  1. Kill/eliminate the initial cause of injury (e.g., microbes, foreign material, thermal, radiation).
  2. Phagocytose and remove any cellular debris resulting from the injury.
  3. Initiate the process of repair and healing, eventually returning the tissue to normal structure and function.
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17
Q

Fill in the blank. Once a monocyte leaves circulation and enters the tissues it changes name to a ________ .

A

Macrophage

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18
Q

There are two pools of mature neutrophils available to swing into action during acute inflammation.

What are these two pools’ names, and where are they located?

A

One is the MARGINATING POOL already in circulation.

The other is the STORAGE POOL in the bone marrow.

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19
Q

Explain, in vascular terms, the redness and heat that form 2 of the 5 cardinal signs of inflammation.

A

Arteriolar vasodilation in response to chemical signals emanating from an area of inflammation leads to hyperemia and congestion of downstream capillary beds. Since blood is warm and red, so are areas of hyperemia!

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20
Q

What are the five cardinal signs of inflammation? In English is fine.

A

Redness, swelling, heat, pain, and loss of function

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21
Q

True or false: The presence of fibrin indicates acute inflammation

A

True.

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22
Q

Which of the following is/are associated with a TRANSUDATE?

(a) Clear to pale yellow
(b) Few or no leukocytes
(c) High protein content
(d) Increased numbers of leukocytes
(e) Low protein content
(f) Often results from heart failure and venous congestion, hypoproteinemia, liver failure etc.
(g) Turbid
(h) Usually associated with inflammation

A

(a) Clear to pale yellow
(b) Few or no leukocytes
(e) Low protein content
(f) Often results from heart failure and venous congestion, hypoproteinemia, liver failure etc.

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23
Q

Abscesses tend to have three layers, listed below. Place them in order from PERIPHERAL to CENTRAL.

(a) Collagen layer
(b) Liquid layer of live and dead neutrophils and necrocellular debris (this combination = pus)
(c) Variable layer of macrophages and lymphocytes

A

(a) collagen capsule –> (c) macrophages and lymphocytes –> (b) pus

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24
Q

Which cell type makes fibrous tissue?

A

Fibrous tissue = dense collagen strands, so it’s made by fibroblasts

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25
Q

True or false: Fibroblasts make fibrin

A

False.

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26
Q

What is the name for the blood-circulating forms of macrophages?

A

Monocytes. Once a monocyte leaves circulation and enters the tissues it changes name to a macrophage.

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27
Q

You remove the rib cage from a sheep that was euthanized for pneumonia. The parietal and visceral pleurae are attached by rubbery, tan-yellow mats of tenacious goo that is easily peeled from pleural surfaces. What is the adherent material, and how do you interpret this?

A

This is FIBRIN, and it indicates acute (rather than chronic) inflammation.

Remember: FIBRINOGEN is a plasma protein made by the liver. Its production by the liver is increased in response to acute inflammation anywhere in the body. When the plasma protein fibrinogen leaks from blood vessels during acute inflammation and polymerizes into a rubbery, sticky mat this material is called FIBRIN. The point of fibrinogen, therefore, is to give rise to fibrin. The point of fibrin is to confine pathogens and injurious agents at sites of inflammation and stop them spreading into healthy tissue.

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28
Q

Which cell type makes fibrin?

A

Kind of a trick question. Fibrin forms when the plasma protein fibrinogen leaks from blood vessels during acute inflammation and polymerizes into a rubbery, sticky material called fibrin. Fibrinogen, a plasma protein, is made by the hepatocytes of the liver.

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29
Q

Fill in the blank. Abscesses are composed largely of dead and dying ________.

A

Neutrophils

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30
Q

Two white blood cell types are the ““first responders”” during acute inflammation. Which of these two is best described by the following?

Big, round, bean-shaped nucleus, bubbly cytoplasm

A

Macrophage/monocyte

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31
Q

True or false: Fibroblasts make fibrinogen

A

False.

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32
Q

What is the point of fibrinogen, and where does it come from?

A

FIBRINOGEN is a plasma protein made by the liver. Its production by the liver is increased in response to acute inflammation anywhere in the body. When the plasma protein fibrinogen leaks from blood vessels during acute inflammation and polymerizes into a rubbery, sticky mat this material is called FIBRIN. The point of fibrinogen, therefore, is to give rise to fibrin. The point of fibrin is to confine pathogens and injurious agents at sites of inflammation and stop them spreading into healthy tissue.

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33
Q

How do the cells of the innate immune system “find” their way to sites of inflammation after exiting the blood stream?

A

They (neutrophils and macrophages) follow chemical signalling molecules (chemoattractants) along a directional concentration gradient that is strongest closest to the source of inflammation/injury and weakest at the periphery.

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34
Q

During inflammation macrophages have two jobs. What are they?

A

(1) Phagocytosis of dead cells and debris
(2) Coordination of repair, once job 1 is underway or complete

35
Q

True or false: Fibroblasts do NOT make fibrin

A

True.

36
Q

You remove the rib cage from a sheep that was euthanized for pneumonia. The parietal and visceral pleurae are attached by strong white strands and bands that need to be cut with a knife to free the lungs. What is the attaching material, and how do you interpret this?

A

This is COLLAGEN, and it indicates chronic (rather than acute) inflammation.

37
Q

What are three reasons that neutrophils are the leukocytes (white blood cells) that respond first and fastest to inflammation?

A

They:
(a) are already the most numerous leukocyte in the blood
(b) respond faster to chemical signals than other leukocytes
(c) attach to endothelium better than other leukocytes so are more efficient at leaving vessels

38
Q

What is the collective term for plasma proteins synthesized in the liver whose concentrations increase (or decrease) by 25% or more during inflammation?

A

Acute phase proteins

39
Q

What are acute phase proteins?

A

They are plasma proteins synthesized in the liver whose concentrations increase (or decrease) by 25% or more during inflammation.

40
Q

Acute inflammation progresses through three phases. These are listed below in alphabetical order. Place them in chronologic order from earliest to latest.

(a) Cellular
(b) Fluidic
(c) Reparative

A

(b) Fluidic –> (a) Cellular –> (c) Reparative

41
Q

True or false: The presence of fibrosis indicates chronic inflammation

A

True.

42
Q

Acute inflammation essentially begins with microvessels adjacent to a site of injury becoming leaky. This results from recognition of biologic molecules attached to or released from (a) microbes or (b) damaged cells.

What are the molecules attached to or released from MICROBES called? [They are recognized by pattern recognition receptors on many different types of body cells.]

A

Pathogen-associated molecular patterns (PAMPs)

43
Q

Fill in the blank. Granulomas tend to form in the presence of ____(a)____ or ____(b)_____ when ____(c)_____ have failed.

A

(a) bacteria that are resistant to degradation (e.g., Mycobacteria)
(b) foreign materials that are resistant to degradation
(c) attempts at eliminating the inciting cause through acute inflammation

44
Q

True or false: Fibroblasts do NOT make fibrinogen

A

True.

45
Q

True or false: Fibrosis is essentially the same as scarring

A

True.

46
Q

Granulomas tend to have four layers, listed below. Place them in order from CENTRAL to PERIPHERAL.

(a) Collagen layer
(c) Semiliquid or caseous layer of foreign material or resistant bacteria
(b) Layer of macrophages and multinucleate giant cells
(d) Variable layer of lymphocytes

A

(c) foreign material or resistant bacteria –> (b) macrophages –> (d) lymphocytes –> (a) collagen capsule

47
Q

Acute inflammation essentially begins with microvessels adjacent to a site of injury becoming leaky. This results from recognition of biologic molecules attached to or released from (a) microbes or (b) damaged cells.

What are the molecules attached to or released from DAMAGED CELLS called? [They are recognized by pattern recognition receptors on many different types of body cells.]

A

Damage-associated molecular patterns (DAMPs)

48
Q

Which cell type makes fibrinogen?

A

Hepatocyte (NOT fibroblast)

49
Q

How long do neutrophils live?

A

Less than a day

50
Q

Granulomas tend to have four layers, listed below. Place them in order from PERIPHERAL to CENTRAL .

(a) Collagen layer
(c) Semiliquid or caseous layer of foreign material or resistant bacteria
(b) Layer of macrophages and multinucleate giant cells
(d) Variable layer of lymphocytes

A

(a) collagen capsule –> (d) lymphocytes –> (b) macrophages –> (c) foreign material or resistant bacteria

51
Q

True or false: inflammation is an inherently harmful process

A

Very, very false. Inflammation is generally beneficial in that it (1) eliminates the initial cause of injury and removes tissue debris and (2) initiates the processes of healing and repair. Without inflammation, infections would go unchecked and wounds would never heal.

52
Q

True or false: The presence of fibrosis indicates acute inflammation

A

False.

53
Q

Abscesses tend to have three layers, listed below. Place them in order from CENTRAL to PERIPHERAL.

(a) Collagen layer
(b) Liquid layer of live and dead neutrophils and necrocellular debris (this combination = pus)
(c) Variable layer of macrophages and lymphocytes

A

(b) pus –> (c) macrophages and lymphocytes –> (a) collagen capsule

54
Q

During acute inflammation it is important that endothelial cells and neutrophils come into contact and interact.

Why?

A

So that neutrophils can slow down and adhere to the endothelial lining in microvessels near sites of inflammation in preparation for extravasation (squeezing between endothelial cells to exit vessels).

55
Q

When mature neutrophils are used up (e.g., during an overwhelming infection), immature neutrophils are released from the marrow.

What is the descriptive term for this in terms of bloodwork?

A

A left shift

56
Q

Name the system that results in the generation of numerous biologically active molecules, which have effects that are proinflammatory, chemotactic, opsonizing, antigen solubilizing, antibody inducing, permeability enhancing, and microbicidal (cell lysis) and usually beneficial to the animal.

A

The complement system

57
Q

Fill in the blank. Macrophages and dendritic cells are collectively known as __________.

A

Histiocytes. [FYI Dendritic cells are antigen-presenting cells.

All dendritic cells are part of the adaptive immune response and act as potent antigen-presenting cells. By presenting antigens to naive T-cells in lymph nodes, dendritic cells initiate an immune response. Unfortunately, dendritic cells frequently give rise to a complex set of histiocytic neoplasms, mainly in dogs and especially in certain breeds like the Bernese mountain dog.]

58
Q

Explain, in vascular terms, the swelling that is one of the 5 cardinal signs of inflammation.

A

Increased permeability of the microvasculature results from retraction of endothelial cells in response to chemical signals emanating from an area of inflammation. Hydrostatic blood pressure then forces plasma fluid and proteins through this leaky endothelial lining and into the interstitium (causing tissue swelling). In addition, the accumulation of leaked plasma proteins increases the osmotic pull of the interstitium, resulting in further fluid accumulation (causing even more tissue swelling).

59
Q

Acute inflammation progresses through three phases: fluidic, then cellular then reparative.

In the fluidic phase, what is the purpose of fluid leakage from microvessels into the interstitium?

A

To dilute, surround (i.e., isolate) and contain (i.e., trap) the stimulus and damage, thereby limiting the extent of involvement of adjacent normal cells and tissue.

60
Q

Which (abscess or granuloma) is more likely to form in the presence of pyogenic bacteria like Trueperella pyogenes?

A

Abscess

61
Q

What is responsible for the redness and heat at sites of inflammation?

A

Increased blood delivery secondary to arteriolar dilation (i.e., hyperemia)

62
Q

Which (abscess or granuloma) is more likely to form in the presence of foreign materials that are resistant to degradation?

A

Granuloma

63
Q

Inflammation in which the predominant cells are macrophages is called:

(a) granulocytic
(b) granulomatous
(c) histiocytic
(d) macrophagic
(e) monocytic
(f) suppurative

A

BOTH (b) granulomatous AND (c) histiocytic. “Granulomatous” is more commonly used.

64
Q

What does the presence of fibrous adhesions on peritoneal, pleural or pericardial surfaces (actually, anywhere) indicate?

A

It indicates that a chronic inflammatory process is taking place or has resolved, leaving scarring.

65
Q

During inflammation macrophages have two jobs, listed below. Which comes FIRST?

(a) Coordination of repair
(b) Phagocytosis of dead cells and debris

A

(b) Phagocytosis of dead cells and debris

66
Q

True or false: Fibrosis is NOT excessive production of fibrin in tissues

A

True.

67
Q

When mature neutrophils are used up (e.g., during an overwhelming infection), immature neutrophils are released from the marrow.

What are these immature neutrophils called, and why?

A

Band neutrophils. Their nuclei are plump and sausage-shaped (“bands”) instead of looking like the segmented “balloon animals” of mature neutrophils.

68
Q

What is the point of fibrin and where does it come from?

A

FIBRINOGEN is a plasma protein made by the liver. Its production by the liver is increased in response to acute inflammation anywhere in the body. When the plasma protein fibrinogen leaks from blood vessels during acute inflammation and polymerizes into a rubbery, sticky mat this material is called FIBRIN. The point of fibrinogen, therefore, is to give rise to fibrin. The point of fibrin is to confine pathogens and injurious agents at sites of inflammation and stop them spreading into healthy tissue.

69
Q

Many body cell types have receptors that sense the presence of (a) microbes or (b) products released from damaged cells.

What are these receptors called?

A

Pattern recognition receptors. They are called pattern recognition receptors because they recognize molecular patterns that are common to many microbes or to damaged cells.

70
Q

During inflammation macrophages have two jobs, listed below. Which comes SECOND?

(a) Coordination of repair
(b) Phagocytosis of dead cells and debris

A

(a) Coordination of repair

71
Q

What does the term neutropenia mean?

A

A decreased number of mature neutrophils in blood

72
Q

What does the presence of fibrin on peritoneal, pleural or pericardial surfaces (actually, anywhere) indicate?

A

It indicates that an acute inflammatory process is taking place.

73
Q

Which of the following are the three biggest players in acute inflammation?

(a) Adaptive immune response
(b) B lymphocytes
(c) Chemical mediators/signals
(d) Collagen fibres
(e) Endothelial cells
(f) Hypercoagulability
(g) Lymphatic vessels
(h) Neutrophils & macrophages
(i) Plasma oncotic pressure
(j) Red blood cells (erythrocytes)

A

(c) Chemical mediators/signals
(e) Endothelial cells
(h) Neutrophils & macrophages

74
Q

Sites of inflammation are red and warm because of increased blood content. Is this a result of (a) congestion or (b) hyperemia?

A

(b) Hyperemia: increased blood delivery secondary to arteriolar dilation (i.e., hyperemia). This is normal and beneficial during inflammation.

75
Q

Two white blood cell types are the ““first responders”” during acute inflammation. Which of these two is best described by the following?

Pale cytoplasm, pale granules, segmented “balloon animal” nucleus

A

Neutrophil

76
Q

Two white blood cell types are considered the “first responders” during acute inflammation.

Which one predominates SECOND at sites of inflammation, and for what approximate time period?

A

Monocytes/macrophages. Day 2.
(Monocytes/macrophages predominate at sites of inflammation in after 24-48 hours of inflammation)

77
Q

How are monocytes and macrophages different?

A

They’re not, really. Monocytes are just the blood-circulating form of macrophages. Once a monocyte leaves circulation and enters the tissues it changes name to a macrophage.

78
Q

True or false: The liver makes collagen

A

False.

79
Q

As part of leaving the bloodstream to migrate to sites of tissue inflammation neutrophils undertake the following four steps. Put them in sequence from earliest to latest.

(a) Adhesion
(b) Extravasation
(c) Margination
(d) Rolling

A

c-d-a-b

(c) Margination –> (d) Rolling –> (a) Adhesion –> (b) Extravasation

80
Q

During acute inflammation it is important that endothelial cells and neutrophils come into contact and interact.

What are three ways that this is achieved?

A
  1. Blood flow slows due to vasodilation of the microvasculature. This allows neutrophils to slow down and move to the periphery of the bloodstream, where they will contact the endothelial lining.
  2. Endothelial cells become activated, expressing molecules and receptors that make them ““sticky”” to any passing neutrophils.
  3. Endothelial cell retraction allows fluid to leave the bloodstream, concentrating the blood. This makes its flow sluggish and gives even more opportunity for neutrophils and endothelium to interact.
81
Q

Two white blood cell types are considered the “first responders” during acute inflammation.

Which one predominates FIRST at sites of inflammation, and for what approximate time period?

A

Neutrophils. Day 1.
(Neutrophils predominate at sites of inflammation in the first 6-24 hours of inflammation)

82
Q

Acute inflammation progresses through three phases: fluidic, then cellular then reparative.

In the cellular phase, which two white blood cell types are the earliest to migrate from the bloodstream to sites of inflammation?

A

Neutrophils and monocytes/macrophages

83
Q

True or false: The liver does NOT make collagen

A

True.

342 - Pathologic Basis of Disease (14 decks)

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