7. healing

Question 1

chronic inflammation mediated by

Answer 1

Mediated by macrophages, lymphocytes, and plasma cells

Question 2

chronic inflammation characterized by three simultaneously ongoing components

Answer 2

It is characterized by three simultaneously ongoing components, in varying combinations:
1. Active inflammation
2. Tissue destruction
3. Attempts at repair

Question 3

macrophages activated by

Answer 3

classical by microbial products
alternative by il13 and il4

Question 4

Granulomatous inflammation

Answer 4

Characterized by granuloma, which is a microscopic aggregation of epithelioid histiocytes (activated macrophages), usually surrounded by giant cells, a rim of lymphocytes and plasma cells

Question 5

Type of granuloma

Answer 5

Noncaseating granulomas
caseating

Question 6

Noncaseating granulomas

Answer 6

lack central necrosis.
Common etiologies include
reaction to foreign material,
sarcoidosis,
beryllium exposure,
Crohn disease,
Leprosy and
at scratch disease

Question 7

Caseating granulomas

Answer 7

exhibit central necrosis and are characteristic of
tuberculosis,
fungal infections and
Syphilis gumma

Question 7

Infectious granulomas

Answer 7

Bacterial: tuberculosis, leprosy, syphilis, cat scratch disease and lymphogranuloma venerum(Chlamydia)

Fungal: histoplasmosis, cryptococcosis, coccidiodomycosis, blastomycosis

Helminthic: schistosomiasis

Protozoal: leishmaniasis, toxoplasmosis

Question 8

Noninfectious or immune granulomas

Answer 8

Usually are noncaseating granulomas
Sarcoidosis, primary biliary cirrhosis and hypersensitivity pneumonitis

Question 9

Types of Multinucleate giant cells

Answer 9

langhans - nuclei around periphery of cell
- in TB

foreign body type - nuclei scattered around

Question 9

Morphologic features of chronic inflammation

Answer 9

Chronic abscess e.g. Empyema
Sinus e.g. Tuberculous lymphadenitis
Fistula e.g. Fistula in ano
Ulcer e.g. skin or gastric peptic ulcer
Fibrosis e.g. urethral or esophageal stricture

Question 10

termination of acute inflammatory response

Answer 10

neutrophils short half life

stop signals switch pro to anti inflammatory

macrophages release anti inflammatory cytokines TGF-B and il-10

neural impulse cholinergic

Neutrophils synthesize precursors of active lipoxins and pass these to platelets, where they are converted to mature lipoxins.

Question 11

Tissue Repair

Answer 11

refers to the restoration of tissue architecture and function after an injury

Question 12

tissue repair consists of two processes

Answer 12

• tissue regeneration and
• fibrous organization (scar formation)

Question 13

Liver regeneration by

Answer 13

TNF and IL-6 G0 to G1

HGF and EGF progression through the rest of the cell cycle

FGF and TGF-α are mitogenic for hepatocytes

Question 14

Key Players in Healing and Repair

Answer 14

1. Cells – Macrophages, lymphocytes, platelets, endothelial cells, fibroblasts etc.
2. Cytokines, Growth factors, Enzymes
3. Extracellular matrix: Structural proteins (eg. collagens), Adhesive glycoproteins (eg. cadherins) Proteoglycans and Hyaluronan

Question 15

ECM Exists in Two Different Forms

Answer 15

1. Interstitial matrix
2. Basement membrane

Question 16

…………..are found in the granulation tissue and are important for the contraction of wounds and the prevention of dehiscence

Answer 16

Myofibroblasts

Question 17

functions of growth factors 3

Answer 17

1. Cell cycle activation (by direct stimulation or removal of blocks that inhibit cell cycle)
2. Prevention of apoptosis
3. Enhanced synthesis of cellular proteins

Question 18

Phases of healing

Answer 18

1 the inflammatory phase;
2 the proliferative phase;
3 the remodeling phase (maturing phase).

Question 19

Granulation tissue

Answer 19

replace lost tissue and template for scar production

Question 20

The process of healing through granulation tissue formation is called

Answer 20

organization

Question 21

Fetal cutaneous wounds heal without scar why?

Answer 21

TGF β isoforms (non-fibrogenic),
lack of osteopontin, &
the absence of a TH2 response

Question 22

Primary union and secondary union

Answer 22

Primary union(healing by first intention) is seen in incised wounds with opposed edges (clean and uninfected wound).
Secondary union(healing by secondary intention) is seen in open wounds with separated edges, extensiveloss of cells and large defects.

Question 22

Regaining Wound Strength is result of

Answer 22

Is a result of type III collagen is replaced by type I collagen,
excess collagen synthesis,
cross-linking of collagen and
↑↑ fiber size

Question 23

There are three main steps in bone repair

Answer 23

• Procallus (soft tissue callus) formation
  
  • Osseous callus formation
    
    • Remodelling

Question 24

Healing of muscle

Answer 24

if muscle sheath intact - heals
eg zenker in typhoid

if muscle muscle sheath not intact - scar
eg volkman ischemic contraction

Question 27

Cardiac muscle healing

Answer 27

: Replaced by the permanent scar tissue

Question 31

cns healing

Answer 31

Neuroglial cells only show proliferation called gliosis.

Question 32

pns healing

Answer 32

Proliferation of Schwann cells and fibrils from distal ends is seen in response to injury.
1 mm per day

Question 33

Painful nodule “pseudotumor” results from

Answer 33

a failure of the outgrowing axons to find their distal

Question 34

Factors that retard wound healing

Answer 34

local and systemic factors

Question 35

local and systemic factors

Answer 35

Local; Decreased blood supply, Denervation, Local infection, Foreign body, Mechanical stress, Large amounts of haemorrhage and necrosis

Systemic; Old age, Malnutrition, Anemia, Obesity, Drugs (steroids), Systemic infection, Genetic disorders, eg, Marfan syndrome and Ehlers–Danlos disease, Diabetes mellitus, Uremia and Vitamin and trace metal (zinc and copper) deficiency

Question 36

Abnormality in Wound Healing

Answer 36

Deficient scar formation
Excessive formation of the repair components and contraction
Atrophic /hypotrophic scar (sunken)
Implantation cyst
Pigment changes: depigmented (vitiligo) /hyperpigmented