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House AMP > Chronic Inflammation > Flashcards

Chronic Inflammation Flashcards

1
Q

Chronic inflammation is a response of prolonged duration (weeks or months) in which ______,______, and ______ coexist, in varying combinations.

A

inflammation, tissue injury and attempts at repair

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2
Q

Chronic inflammation may follow:

_________, or
_____________

A

acute inflammation

may begin insidiously, as a low-grade, smoldering response.

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3
Q

causes of chronic inflammation

•_______ infections by microorganisms that are difficult to eradicate, such as ______ and certain viruses, fungi, and parasites.

These organisms often evoke an immune reaction called ____________
•The inflammatory response sometimes takes a specific pattern called a ________ reaction.

A

Persistent; mycobacteria

delayed-type hypersensitivity

granulomatous

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4
Q

Causes of chronic inflammation

• In other cases, an unresolved ______ may evolve into chronic inflammation,

A

acute inflammation

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5
Q

Causes of chronic inflammation

______ evoke a self- perpetuating immune reaction that results in chronic tissue damage and inflammation; examples of such diseases are rheumatoid arthritis and multiple sclerosis.

A

Autoantigens

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6
Q

Causes of Chronic inflammation

______ exposure to potentially toxic agents, either exogenous or endogenous.
• Silica is an __genous nondegradable inanimate material that, when inhaled for prolonged periods, results in an inflammatory ___ disease called ____

• Atherosclerosis is thought to be a (acute or chronic?) inflammatory process of the arterial wall induced partly by excessive production and tissue deposition of endogenous cholesterol and other lipids.

A

Prolonged

Exo; lung

silicosis

Chronic

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7
Q

MORPHOLOGICAL FEATURES

• Chronic inflammation is characterized by:

Infiltration with mononuclear cells, which include _______,_____,______

Tissue destruction, induced by the __________ or _______
Attempts at healing by ________ replacement of damaged tissue accomplished by ________ and, in particular, _______

A

macrophages, lymphocytes, and plasma cells

persistent offending agent or by the inflammatory cells

connective tissue; angiogenesis

Fibrosis

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8
Q

angiogenesis is the proliferation of __________

A

small blood vessels

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9
Q

Macrophages

• The half-life of blood monocytes is about ______, whereas the life span of tissue macrophages is several __________

A

1 day

months or years.

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10
Q

In inflammatory reactions, monocytes begin to emigrate into extravascular tissues quite (early or late?) , and within _________ they may constitute the predominant cell type.

A

Early

48 hours

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11
Q

Extravasation of monocytes is governed by different factors to those that are involved in neutrophil emigration.

T/F

A

F

the same

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12
Q

There are two major pathways of macrophage activation, called _____ and _______

A

classical and alternative.

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13
Q

Classical macrophage activation may be induced by:
 _______ products such as _______, which engage TLRs and
other sensors;
 by _____ cell–derived signals, importantly the __________ , in immune responses;
 by ______ substances including crystals and particulate matter.

A

Microbial; endotoxin

T ; cytokine IFN-γ

foreign

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14
Q

Classically activated (also called ___) macrophages produce _____ and ____ and upregulate lysosomal enzymes.

A

M1

NO and ROS

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15
Q

Alternative macrophage activation is induced by ________, such as _____ and ____, produced by _______ and other cells.

A

cytokines other than IFN-γ

IL-4 and IL-13

T lymphocytes

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16
Q

Alternative macrophages are actively microbicidal and the cytokines may actually inhibit the classical activation pathway;

T/F

A

F

They are not

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17
Q

Alternative macrophages’ cytokines may actually inhibit the classical activation pathway of macrophages

T/F

A

T

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18
Q

The products of activated macrophages

 eliminate injurious agents such as microbes,
 initiate _______
 also responsible for much of the ________ in ______________ inflammation .

A

the process of repair

tissue injury

chronic inflammation

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19
Q

Macrophages secrete mediators of inflammation, such as ________ and ______

A

cytokines (TNF, IL-1, chemokines, and others) and eicosanoids.

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20
Q

Macrophages display antigens to T lymphocytes and respond to signals from T cells

T/F

A

T

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21
Q

Role of Lymphocytes

•_____ and other environmental antigens activate T and B lymphocytes.
• These cells are often present in chronic inflammation and when activated, the inflammation tends to be _____ and _____
• Some of the strongest chronic inflammatory reactions, such as _______ inflammation are dependent on lymphocyte responses.
• Lymphocytes may be the dominant population in the chronic inflammation seen in _______ and other _____ diseases.
• Antigen-stimulated (effector and memory) T and B lymphocytes use various adhesion molecule pairs (selectins, integrins and their ligands) and chemokines to migrate into inflammatory sites.
• Cytokines from activated ______, mainly _____,____, and chemokines, promote leukocyte recruitment.

A

Microbes

persistent and severe.

granulomatous

autoimmune; hypersensitivity

Macrophages; TNF, IL-1

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22
Q

____+ T lymphocytes promote inflammation and influence the nature of the inflammatory reaction through _____ production.

A

CD4

cytokine

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23
Q

There are three subsets of CD4+ T cells that secrete different types of cytokines and elicit different types of inflammation.

• TH1 cells produce the cytokine ______, which _____________________
• TH2 cells secrete _____,——,____, which recruit and activate ______ and are responsible for the _____ pathway of macrophage activation.
• TH17 cells secrete ____ and other cytokines, which induce the secretion of _______ responsible for recruiting _______ and _______ into the reaction.

A

IFN-γ; activates macrophages by the classical pathway.

IL-4, IL-5, and IL-13; eosinophils; alternative

IL-17; chemokines

neutrophils (and monocytes)

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24
Q

Both TH__ and TH___ cells are involved in defense against many types of bacteria and viruses and in autoimmune diseases.

TH__ cells are important in defense against helminthic parasites and in allergic inflammation.

A

1; 17

2

25
Q

Activated B lymphocytes and antibody-producing plasma cells are often present at sites of chronic inflammation.

T/F

A

T

26
Q

In some chronic inflammatory reactions, the accumulated ______, _______ cells, and _____ cells cluster together to form ______ tissues resembling ________ and are called ___________

A

lymphocytes; antigen-presenting

plasma

lymphoid

Lymph nodes

tertiary lymphoid organs

27
Q

tertiary lymphoid organs is type of lymphoid organogenesis that is often seen in the ______ of patients with long- standing ______ and in the thyroid in __________.

A

synovium; rheumatoid arthritis

Hashimoto thyroiditis

28
Q

Other cell types may be prominent in chronic inflammation induced by particular stimuli.

• Eosinophils are abundant in immune reactions mediated by ____ and in ____ infections. Their recruitment is driven by adhesion molecules similar to those used by neutrophils, and by specific chemokines (e.g., ____) derived from leukocytes and epithelial cells.

Eosinophils have granules that contain major basic protein, a highly ____ protein that is toxic to _____

A

IgE; parasitic; eotaxin

cationic

parasites

29
Q

Mast cells are widely distributed in connective tissues and participate in __________ inflammatory reactions.

A

both acute and chronic

30
Q

Mast cells express on their surface the receptor (FceRI) that binds the ____ portion of _____ antibody.

A

Fc; IgE

31
Q

In immediate hypersensitivity reactions, ____ antibodies bound to the cells’ ___ receptors specifically recognize antigen, and the cells ______ and release mediators, such as histamine and prostaglandins.

This type of response occurs during _____ reactions to foods, insect venom, or drugs, sometimes with catastrophic results (e.g.,_________).

A

IgE

Fc; degranulate

allergic

anaphylactic shock

32
Q

Neutrophils are characteristic of acute inflammation, but many forms of chronic inflammation, lasting for months, continue to show large numbers of neutrophils, induced either by persistent microbes or foreign bodies.

T/F

A

T

33
Q

Granulomatous inflammation is a form of chronic inflammation characterized by collections of _______, often with ______, and sometimes associated with _______

A

activated macrophages

T lymphocytes

central necrosis.

34
Q

Granuloma formation is an attempt to _________________

A

contain an offending agent that is difficult to eradicate.

35
Q

In granuloma formation, The activated macrophages may develop ____ and begin to resemble ________ cells, and are called ______ cells.

Some activated macrophages may ______, forming ________ cells.

A

abundant cytoplasm

epithelial ; epithelioid

fuse; multinucleate giant

36
Q

There are two types of granulomas:
•________ granulomas
•________ granulomas

A

Foreign body

immune

37
Q

Foreign body granulomas - are incited by relatively _________, in the absence of ________________ responses.

A

inert foreign bodies

T cell–mediated immune

38
Q

Typically, foreign body granulomas form around materials such as talc (associated with _______), ______ , or other fibers that are large enough to preclude phagocytosis by a macrophage

A

intravenous drug abuse

sutures

39
Q

In foreign body granulomas

The foreign material when viewed with polarized light appears ______ at the _______

A

refractile; center of granuloma.

40
Q

Immune granulomas are caused by a variety of agents that induces a ______ response.

• In such responses, ______ activate T cells to produce cytokines, such as IL-__, which activates other T cells, perpetuating the response, and _____ which activates the macrophages.

A

persistent T cell–mediated immune

macrophages

2

IFN-γ,

41
Q

MORPHOLOGY of granulomas
• Activated macrophages in granulomas have ____ colored granular cytoplasm with indistinct ______ and are called _____ cells.

A

pink; cell boundaries

epithelioid bby

42
Q

MORPHOLOGY of granulomas

• The aggregates of epithelioid macrophages are surrounded by a _____
• Older granulomas may have a rim of ___________
• Frequently, but not invariably, _______ cells 40 to 50 μm in diameter are found in granulomas; these are called _______ cells.

A

collar of lymphocytes.

fibroblasts and connective tissue.

multinucleated giant;

43
Q

In granulomas associated with certain infectious organisms (most classically Mycobacterium tuberculosis), a combination of ____ and _____- mediated injury leads to a _____ zone of necrosis.
• Grossly, granular, cheesy appearance called _______ necrosis is seen.

A

Hypoxia; free radical

central

caseous

44
Q

In Granulomatous inflammation,

Microscopically, this necrotic material appears as (granular or amorphous?) , structureless, ____philic, granular debris, with complete loss of _____

A

Amorphous

eosino

cellular details.

45
Q

The granulomas in Crohn disease, sarcoidosis, and foreign body reactions do not have necrotic centers and are said to be _________.

A

noncaseating

46
Q

Granulomas is usually accompanied by ________

A

fibrosis

47
Q

Granulomas are encountered in certain specific pathologic
states;

• ________ responses to certain microbes (e.g., M.tuberculosis, Treponema pallidum, or fungi),
• Granulomas may also develop in some ______-mediated inflammatory diseases, notably ______ disease,
• In a disease of unknown etiology called _____.

A

Persistent T-cell

immune

Crohn

sarcoidosis

48
Q

Causes of sarcoidosis?

A

Unknown

49
Q

Tuberculosis is the prototype of a granulomatous disease caused by infection and should always be excluded.
• In this disease the granuloma is referred to as a ______.

A

tubercle

50
Q

Systemic Effects of Inflammation
• Inflammation, even if it is localized, is associated with cytokine-induced systemic reacti ons that are collectively called the __________

A

acute-phase response.

51
Q

The cytokines TNF, IL-1, and IL-6 are important mediators of the acute-phase reaction; other cytokines, notably type I interferons, also contribute to the reaction.

T/F

A

T

52
Q

• The acute-phase response consists of several clinical and pathologic changes:

• Fever, characterized by an elevation of body temperature, usually by —“ to ___ C, is one of the most prominent manifestations of the acute-phase response, especially when inflammation is associated with infection.

A

1° to 4°C

53
Q

Bacterial products, such as LPS (called ___genous _____), stimulate leukocytes to release cytokines such as IL-1 and TNF (called ____genous _____) that increase the enzymes (________) that convert AA into prostaglandins.
• In the hypothalamus, the prostaglandins, especially PG___, stimulate the production of neurotransmitters that reset the temperature set point at a higher level.

A

Exo; pyrogens

Endo; pyrogens

cyclooxygenase

E2

54
Q

NSAIDs, including _____, reduce fever by _____

A

aspirin

inhibiting prostaglandin synthesis.

55
Q

Acute-phase proteins are plasma proteins, mostly synthesized in the liver

• Three of the best-known of these proteins are __________,_______, and _______

A

C-reactive protein (CRP), fibrinogen, and serum amyloid A (SAA) protein.

56
Q

Leukocytosis is a common feature of inflammatory reactions, especially those induced by _____ infections.
• The leukocyte count usually climbs to ________ or ———— cells/mL, but sometimes it may reach extraordinarily high levels of ______ to _______ cells/mL.

A

bacterial

15,000 or 20,000

40,000 to 100,000

57
Q

These extreme elevations of leukocytes are referred to as ______ reactions, because ______________________

A

leukemoid

they are similar to the white cell counts observed in leukemia and have to be distinguished from leukemia.

58
Q

• In severe bacterial infections (sepsis), clinical manifestation may include;
• ————————————,
•_________, and
• metabolic disturbances including ___________ and ________.
• This clinical triad is known as __

A

disseminated intravascular coagulation

Hypotensive shock

insulin resistance and hyperglycemia

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