ACUTE & CHRONIC INFLAMMATION - 2

Question 1

Why is an increase in fibrinogen associated with an increase in ESR during inflammation?

Answer 1

Fibrinogen is positively charged.

An increase in fibrinogen during inflammation –>decreased negative charge–>Increased RBC sedimentation –>elevated ESR

Question 2

Major Mediator responsible for acute phase response

Answer 2

IL-6

Question 3

List the Acute phase reactants that are upregulated during inflammation

Answer 3

Ferritin

Fibrinogen

Serum amyloid A (SAA)

Hepidin

C reactive protein (CRP)

Mnemonic: More FFiSH in the C

Question 4

Which granuloma is a result of the mechanism described below:

Immune granuloma/ Foreign body granuloma?

Persistent T cell mediated immune response

Answer 4

Immune granuloma

Question 5

Describe the appearance of necrosis in a granuloma

Answer 5

amorphous, structureless, eosinophilic, granular debris, with complete loss of cellular details

Question 6

See attached image. Acute inflammation or chronic inflammation?

Answer 6

Chronic Inflammation

• Greater decrease in serum albumin occurs with CI than with AI
• Increase in γ-globulins

Question 7

Give an example of lymphoid organogenesis

Answer 7

synovium of patients with long-standing rheumatoid arthritis

Question 8

List the acute phase reactants that are downregulated during inflammation

Answer 8

Albumin

Transferrin

Transthyretin

Question 9

What type of granuloma is this?

Answer 9

Foreign body granuloma

(note the foreign body material and the foreign body giant cells)

Question 10

Which type of granuloma is generally indicative of a non-infectious etiology: necrotizing or non-necrotizing?

Answer 10

Non- necrotizing granulomas

Question 11

Mediator responsible for resetting of the temperature set point in the hypothalamus

Answer 11

PGE₂

Question 12

Benefits of fever

Answer 12

i. may induce heat shock proteins that enhance lymphocyte responses to microbial antigens.
ii. ODC shifts to right
iii. hostile environment for bacterial and viral reproduction

Question 13

See the attached image.

What is the most likley etiology?

Answer 13

Tuberculosis

(note central necrosis and multinucleate Langhans giant cells)

Question 14

a focus of chronic inflammation consisting of a microscopic aggregation of macrophages that are transformed into epithelium-like cells, surrounded by a collar of mononuclear leukocytes, principally lymphocytes and occasionally plasma cells

Answer 14

Granuloma

Question 15

List 4 causes of necrotizing granulomas

Answer 15

1. Tuberculosis
2. Systemic fungal infections - Histoplasma, Aspergillus fumigatus
3. Syphilis
4. Vasculitis - Wegner’s granulomatosis, Churg-Strauss
5. Rheumatoid nodule

Question 16

The acute phase reactant that decreases iron reabsorption and macrophage release of iron required for bacteria reproduction

Answer 16

Hepcidin

Question 17

List 4 causes of a non necrotizing granuloma

Answer 17

1. Sarcoidosis
2. Crohn’s disease
3. Drug reactions
4. Hypersensitivity pneumonitis

Question 18

a. How are epithelioid cells formed?
b. Describe their morphology.

Answer 18

a. They represent activated macrophages
b. pink granular cytoplasm with indistinct cell boundaries

Question 19

See attached image. Acute inflammation or chronic inflammation?

Answer 19

Acute Inflammation

• Slight decrease in serum albumin
• Normal γ-globulin peak

Question 20

Name the cytokine that is a powerful activator of macrophages via the classical pathway

Answer 20

Interferon-gamma