Chapter 9 Flashcards
Neutrophil
Primary phagocyte that arrives early at the site of inflammation, usually within 90 minutes of injury
Granulocyte
Identified by distinctive cytoplasmic granules
Resist staining
What are the cardinal signs of inflammation that appear at the site of injury?
A) Rubor, tumor, calor, and dolor, and functio laesa
B) Complement, TNF-α, vascular endothelial growth factor, and neutrophils
C) Fever, cytokines, exudation of fluid, and plasma components
D) Lymphocytes, macrophages, blood vessel proliferation, and tissue necrosis
A) Rubor, tumor, calor, and dolar, and functio laesa
What is the primary characteristic that distinguishes acute inflammation from chronic inflammation?
A) Presence of lymphocytes and macrophages
B) Duration of a few minutes to several days
C) Exudation of fluid and plasma components
D) Association with fibrosis and tissue necrosis
B) Duration of a few minutes to several days
What are the systemic manifestations that may occur during acute inflammation and are collectively known as the acute-phase response?
A) Fever and tissue necrosis
B) Exudation of fluid and plasma components
C) Lymphocytes and macrophages
D) Rubor and calor
A) Fever and tissue necrosis
What roles do endothelial cells play in the inflammatory response?
A) Synthesis of hematopoietic colony-stimulating factors
B) Regulation of blood flow through vasodilators and vasoconstrictors
C) Maintenance of vessel patency through antiplatelet and antithrombotic agents
D) Expression of cell adhesion molecules and receptors for leukocyte extravasation
D) Expression of cell adhesion molecules and receptors for leukocyte extravasation
Which function is NOT typically associated with endothelial cells in the context of the inflammatory response?
A) Synthesis of hematopoietic colony-stimulating factors
B) Maintenance of vessel patency through antiplatelet and antithrombotic agents
C) Regulation of blood flow through vasodilators and vasoconstrictors
D) Participation in the repair process through growth factors that stimulate angiogenesis
A) Synthesis of hematopoietic colony-stimulating factors
What is a key characteristic of circulating endothelial cells in individuals with systemic lupus erythematosus (SLE)?
A) Synthesis of antiplatelet agents
B) Regulation of blood flow
C) Expression of adhesion molecules for leukocyte extravasation
D) Indication of vascular dysfunction even in the absence of cardiovascular disease
D) Indication of vascular dysfunction even in the absence of cardiovascular disease
Which sequence of events characterizes the vascular phase of acute inflammation?
A) Vasodilation, increase in capillary permeability, protein-rich exudate, and tissue edema
B) Vasoconstriction, reduction in capillary pressure, and protein outflow
C) Stagnation of blood flow, clotting, and reduction in interstitial osmotic pressure
D) Arteriolar constriction, venular vasodilation, and protein synthesis
A) Vasodilation, increase in capillary permeability, protein-rich exudate, and tissue edema
What is the correct sequence of events during the cellular phase of acute inflammation involving leukocytes?
A) Endothelial activation, chemotaxis, adhesion and margination, transmigration
B) Transmigration, adhesion and margination, endothelial activation, chemotaxis
C) Adhesion and margination, chemotaxis, endothelial activation, transmigration
D) Chemotaxis, endothelial activation, adhesion and margination, transmigration
A) Endothelial activation, chemotaxis, adhesion and margination, transmigration
Which major components are involved in the two stages of acute inflammation, namely the vascular and cellular stages?
A) Fibrous proteins, elastin, and proteoglycans
B) Endothelial cells, connective tissue cells, and components of the extracellular matrix
C) White blood cells, red blood cells, and platelets
D) Mast cells, fibroblasts, and tissue macrophages
B) Endothelial cells, connective tissue cells, and components of the extracellular matrix
What role do activated platelets play in inflammation?
A) They regulate vascular permeability
B) They release over 300 proteins, including inflammatory mediators
C) They enhance chemotactic properties of endothelial cells
D) They participate in primary hemostasis
B) They release over 300 proteins, including inflammatory mediators
Which cells have a single kidney-shaped nucleus and are released from the bone marrow to act as macrophages?
A) Neutrophils
B) Monocytes
C) Granulocytes
D) Eosinophils
B) Monocytes
What term is used to describe the immature forms of neutrophils with a horseshoe shape of their nuclei, often released from the bone marrow during excessive demand for phagocytes?
A) Segmented neutrophils
B) Eosinophils
C) Basophils
D) Bands
D) Bands
What role do monocytes and macrophages play in inflammation?
A) They release vasoactive mediators and promote tissue regeneration
B) They are involved in primary hemostasis
C) They are responsible for the synthesis of inflammatory cytokines
D) They have a horseshoe-shaped nucleus and are released during excessive demand for phagocytes
A) They release vasoactive mediators and promote tissue regeneration
Leukocytosis
Increase in circulating white blood cells
Frequently elevated with bacterial infections and tissue injury
10,000-20,000 cells/uL
Bands
Immature forms of neutrophils released from bone marrow
Nuclei horseshoe shaped
Circulating monocytes
Single kidney-shaped nucleus and are the largest circulating leukocytes
Constitute 3-8% of the WBC count
Released from the bone marrow to act as macrophages
Mononuclear cells
Arrive at the inflammatory site shortly after the neutrophils and perform their phagocytic functions for several days
What distinguishes the lifespan of macrophages from that of neutrophils in the context of inflammation?
A) Macrophages have a shorter lifespan than neutrophils.
B) Neutrophils have a longer lifespan than macrophages.
C) Both macrophages and neutrophils have similar lifespans.
D) Macrophages have a longer lifespan than neutrophils.
D) Macrophages have a longer lifespan than neutrophils
What is a key function of monocytes and macrophages in chronic inflammation?
A) Release of histamine
B) Production of antibodies
C) Phagocytosis and walling off foreign material
D) Synthesis of vasoactive mediators
C) Phagocytosis and walling off foreign material
Important cells in inflammation associated with immediate hypersensitivity reactions and allergic disorders
Eosinophils, basophils, and mast cells
Eosinophils
Circulate in the blood and are recruited to tissues, similar to neutrophils
Increase in the blood during allergic reactions and parasitic infections
Stain red with the acid dye eosin, contain a protein that is highly toxic to large parasitic worms that cannot be phagocytized
Basophils
Blood granulocytes with structural and functional similarities to mast cells of the connective tissue. They are derived from bone marrow progenitors and circulate in blood. Stain blue with basic dye, contain histamine and other bioactive mediators of inflammation
Bind to antibody IgE which triggers release of histamine and vasoactive agents from the basophil granules
Mast cells
Derive from the same hematopoietic stem cells as basophils but do not develop until they leave the circulation and lodge in tissues sites.
Activation results in release of performed contents of their granules, synthesis of lipid mediators derived from cell membrane precursors, and stimulation of cytokine and chemokine synthesis by other inflammatory cells such as monocytes and macrophages
Which of the following is a key function of eosinophils?
A) Release of histamine
B) Phagocytosis of microbes
C) Control of chemical mediators in allergic reactions
D) Staining blue with a basic dye
C) Control of chemical mediators in allergic reactions
Which cell type circulates in the blood and plays a key role in IgE-triggered reactions and helminth infections?
A) Neutrophils
B) Basophils
C) Eosinophils
D) Monocytes
B) Basophils
Which cell type, derived from the same hematopoietic stem cells as basophils, does not develop until it leaves the circulation and lodges in tissue sites?
A) Eosinophils
B) Mast cells
C) Neutrophils
D) Monocytes
B) Mast Cells
Vasodilation is induced by the action of several mediators
Histamine and Nitric Oxide
Which of the following is a consequence of vasodilation during inflammation?
A) Temporary constriction of arterioles
B) Increased intracapillary osmotic pressure
C) Opening of capillary beds and congestion
D) Decreased redness and warmth in the affected area
C) Opening of capillary beds and congestion
What is the role of increased permeability of the microvasculature during inflammation?
A) Reducing blood constituents in the affected area
B) Decreasing intracapillary osmotic pressure
C) Preventing clotting of blood at the site of injury
D) Allowing the outpouring of protein-rich fluid into extravascular spaces
D) Allowing the outpouring of protein-rich fluid into extravascular spaces
What mediators induce vasodilation, one of the earliest manifestations of inflammation?
A) Prostaglandins and leukotrienes
B) Histamine and nitric oxide (NO)
C) Platelet-activating factor (PAF) and cytokines
D) Complement factors and growth factors
B) Histamine and Nitric oxide
What is the most common mechanism of vascular leakage in acute inflammation?
A) Constriction of endothelial cells
B) Formation of endothelial gaps in venules
C) Stimulation of intercellular junctions
D) Inhibition of chemical mediator binding
B) Formation of endothelial gaps in venules
This is elicited by histamine, bradykinin LT, and many other classes of chemical mediators
Immediate transient response
Occurs with minor injury
Develops rapidly after injury and is usually reversible and of short duration
Leaves capillaries and arterioles unaffected
Immediate sustained response
Occurs with more serious types of injuries and continues for several days
Affects arterioles, capillaries, and venules and is generally due to the direct damage of endothelium
Delayed hemodynamic response
Increased permeability occurs in the venules and capillaries
Delayed response usually caused by radiation, such as sunburn.
What is the correct sequence of events in the cellular response to inflammation?
A) Activation and phagocytosis, margination and adhesion, transmigration, chemotaxis
B) Margination and adhesion, transmigration, activation and phagocytosis, chemotaxis
C) Transmigration, chemotaxis, margination and adhesion, activation and phagocytosis
D) Chemotaxis, activation and phagocytosis, transmigration, margination and
B) Margination and adhesion, transmigration, activation and phagocytosis, chemotaxis
Margination
Leukocytes slow their migration, adhere tightly to the endothelium, and begin to move along the periphery of the blood vessels
What is the role of cytokines in the interaction between blood leukocytes and endothelial cells during inflammation?
A) Inducing chemotaxis
B) Stimulating pseudopodia formation
C) Expressing cell adhesion molecules
D) Mediating transmigration
C) Expressing cell adhesion molecules
Chemotaxis
Dynamic and energy-directed process of directed cell migration
Chemokines
Important subgroup of chemotactic cytokines
Small proteins that direct trafficking of leukocytes during the early stages of inflammation or injury
What is the role of chemokines in the directed movement of leukocytes during the early stages of inflammation?
A) Inducing vasodilation
B) Guiding leukocytes through tissues
C) Promoting clotting of blood
D) Mediating phagocytosis
B_ Guiding leukocytes through tissues
3 Distinct steps in phagocytosis
1) Recognition an adherence
2) Engulfment
3) Intracellular killing
Opsonization
The coating of an antigen with antibody or complement to enhance binding
What is the term for the process initiated by the recognition and binding of particles by specific receptors on the surface of phagocytic cells?
A) Phagosome formation
B) Intracellular killing
C) Opsonization
D) Endocytosis
C) Opsonization
What is the term for the process in which microbes are bound directly to the membrane of phagocytic cells by receptors such as toll-like and mannose receptors?
A) Opsonization
B) Engulfment
C) Recognition and adherence
D) Intracellular killing
C) Recognition and adherence
Histamine
Present in preformed stores in cells
First mediators to be released during an acute inflammatory reaction
What is the principal mediator of the immediate transient phase of increased vascular permeability in the acute inflammatory response?
A) Leukotrienes
B) Prostaglandins
C) Histamine
D) Platelet-activating factor (PAF)
C) Histamine
Which receptors does histamine bind to on endothelial cells, contributing to the increased vascular permeability in the immediate transient phase of acute inflammatory response?
A) Toll-like receptors
B) Histamine type 1 (H1) receptors
C) Mannose receptors
D) Leukotriene receptors
B) Histamine type 1 (H1) receptors
Slow-reacting substance of anaphylaxis (SRS-A)
Cause slow and sustained constriction of the bronchioles and are important inflammatory mediators in bronchial asthma and anaphylaxis
How does the consumption of omega-3 polyunsaturated fatty acids, such as eicosapentaenoic acid and docosahexaenoic acid found in fish oil, affect the production of inflammatory mediators derived from arachidonic acid?
A) Increases production of arachidonic acid–derived inflammatory mediators
B) Has no effect on the production of inflammatory mediators
C) Partially replaces arachidonic acid with eicosapentaenoic acid, leading to decreased production of inflammatory mediators
D) Enhances the synthesis of prostaglandins and leukotrienes
C) Partially replaces arachidonic acid with eicosapentaenoic acid, leading to decreased production of inflammatory mediators
Platelet-Activating Factor
Generated from a complex lipid stored in cell membranes
Affects a variety of cell types and includes platelet aggregation
Activated neutrophils and is a potent eosinophil chemoattractant
What is the effect of platelet-activating factor (PAF) on neutrophils?
A) Inhibition of neutrophil activation
B) Induction of eosinophil chemoattraction
C) Prevention of platelet aggregation
D) Suppression of bronchospasm
B) Induction of eosinophil chemoattraction
Clotting system
Contributes to the vascular phase of inflammation, mainly through fibrinopeptides that are formed during the final steps of the clotting process
Protease-activated receptors
Provides the final link between the coagulation system and inflammation
How does the clotting system contribute to the vascular phase of inflammation?
A) By degrading complement proteins
B) Through the formation of fibrinopeptides
C) By increasing vascular permeability
D) By activating the kinin system
B) Through the formation of fibrinopeptides
Which receptor, when engaged by proteases like thrombin, triggers several responses that induce inflammation, including the production of chemokines, expression of endothelial adhesion molecules, induction of prostaglandin synthesis, and production of platelet-activating factor (PAF)?
A) Protease-activated receptor 1 (PAR-1)
B) Thromboxane receptor
C) Bradykinin receptor
D) Complement receptor
A) Protease-activated receptor 1 (PAR-1)
Two major cytokines that mediate inflammation
TNF-a and IL-1
Cause generalized vasodilation, increased vascular permeability, intravascular fluid loss, myocardial depression, an circulatory shock
CHemokines
Family of small proteins that act to recruit and direct the migration of immune and inflammatory cells
How do chemokines generate a chemotactic gradient?
A) By binding to plasma proteins
B) By binding to proteoglycans on the surface of endothelial cells or in the extracellular matrix (ECM)
C) By forming complexes with clotting factors
D) By activating the complement system
B) By binding to proteoglycans on the surface if endothelial cells or in the extracellular matrix (ECM)
Bacterial infections cause an increase in
Neutrophils
Parasitic and allergic responses cause an increase in
Eosinophilia
Viral infections produce
A decrease in neutrophils and an increase in lymphocyteser
ous exudates
Watery fluids low in protein content that result from plasma entering the imflammatory site
Hemorrhagic Exudate
Occurs when there is severe tissue injury that damages blood vessels or when there is significant leakage of red blood cells from the capillaries
Fibrinous exudates
Contain large amounts of fibrinogen and form a thick sticky meshwork, much like the fibers of a blood clot
Membranous or pseudomembranous Exudate
Develop on mucous membrane surfaces and are composed of necrotic cells enmeshed in a fibrinopurulent exudate
Purulent (suppurative exudate)
Contains pus which is composed of degraded white blood cells, proteins, and tissue debris
Ulceration
Refers to a site of inflammation where an epithelial surface has become necrotic and eroded, often with associated sub epithelial inflammation
May occur as a result of a traumatic injury to the epithelial surface or because of vascular compromise
Characteristics of chronic inflammation
-Infiltration by mononuclear cells (macrophages) and lymphocytes
-proliferation of fibroblasts instead of exudates
Nonspecific Chronic inflammation
Involves a diffuse accumulation of macrophages and lymphocytes a the site of injury. Macrophages infiltrate inflamed site accumulate leading to fibroblast proliferation with subsequent scar formation.
What is a characteristic feature of nonspecific chronic inflammation?
A) Rapid resolution of inflammation
B) Diffuse accumulation of neutrophils at the site of injury
C) Scar formation and fibroblast proliferation
D) Predominance of eosinophils in the inflamed site
C) Scar formation and fibroblast proliferation
Granulomatous Inflammation
Associated with foreign bodies such as splinters, sutures, silica, and asbestos and with microorganisms that cause TB, syphilis, sarcoidosis, deep fungal infections, and brucellosis
Which cytokines are particularly involved in the initiation of the acute-phase response, leading to changes such as fever, increased numbers of circulating neutrophils, and skeletal muscle catabolism?
A) Interleukin-2 (IL-2) and tumor necrosis factor-β (TNF-β)
B) Interleukin-6 (IL-6), interleukin-1 (IL-1), and tumor necrosis factor-α (TNF-α)
C) Interleukin-4 (IL-4) and interleukin-10 (IL-10)
D) Interferon-γ (IFN-γ) and interleukin-12 (IL-12)
B) Interleukin-6 (IL-6), interleukin-1 (IL-1), and tumor necrosis factor-a (TNF-a)
Acute Phase Response
Begins within hours or days of the inflammation or infection
includes changes in the concentrations of plasma proteins, skeletal muscle catabolism, negative nitrogen balance, elevated erythrocyte sedimentation rate, and increased number of leukocytes
Most obvious sign of the acute-phase response
Fever
In severe bacterial infections (sepsis), what can the uncontrolled inflammatory response with the production and release of large quantities of inflammatory cytokines lead to?
A) Decreased vascular permeability
B) Skeletal muscle anabolism
C) Circulatory shock and systemic inflammatory response syndrome (SIRS)
D) Elevated erythrocyte sedimentation rate (ESR)
C) Circulatory shock and systemic inflammatory response syndrome (SIRS)
From a nursing perspective, what manifestations may a nurse observe in a patient experiencing the acute-phase response?
A) Increased appetite and activity levels
B) Hyperactivity and insomnia
C) Anorexia, somnolence, and malaise
D) Improved wound healing
C) Anorexia, somnolence, and malaise
C-reactive protein (CRP)
Acute-phase protein and an important inflammatory biomarker in various clinical conditions such as acute MI, malignancies, and autoimmune disorders, and surgical interventions
What is the function of C-reactive protein (CRP) during the acute-phase response?
A) Inhibition of inflammatory cytokines
B) Binding to microorganisms to target them for destruction
C) Promotion of erythrocyte formation
D) Prevention of clot formation
B) Binding to microorganisms to target them for destruction
Parenchymal tissues
Contain the functioning cells of an organ or body part
e.g. hepatocytes, renal tubular cells
Stromal Tissues
Consist of the supporting connective tissues, blood vessels, ECM, and nerve fibers
Labile cells
Continue to divide and replicate throughout life, replacing cells that are continually being destroyed.
Epithelial cells of the skin, oral cavity, vagina, and cervix
Stable Cells
Normally stop diving when growth ceases
Parenchymal cells of the liver, kidney, smooth muscle cells, and vascular endothelial cellsP
Permanent or Fixed Cells
Cannot undergo mitotic division
Include nerve cells, skeletal cells, and cardiac muscle cells.
Do not normally regenerate, once destroyed, they are replaced with fibrous scar tissue that lacks the functional characteristics of the destroyed tissue
