chronic inflammation

Question 1

true or false:
1.chronic inflammation is for prolonged period of time and delayed response
2.its the result from imbalance between progressive tissue damage caused by persistent damaging stimulus and attempted eradication of the damaging agent followed by tissue repair
3. chronic inflammation begins insidiously aka ab initial and it preceded by acute inflammation , stimulus can either persists or recurs

Answer 1

• true
• false , balance
• true

Question 2

the cells involved in chronic inflammatory are

Answer 2

macrophages and lymphocytes

Question 3

the chronic inflammation following acute inflammation is the:
1. progression of —-
2. organisation of an —- aka progression of acute osteomyelitis to chronic ostemolytis
3. presence of —- materials as wood implanted into wound and surgical sutures
4. recurrent episode of —– as chronic cholecystitis

Answer 3

• acute inflammation
• abscess
• indigestible
• acute inflammation

Question 4

chronic inflammation : ab initio includes:
1. persistent —— as:
2. prolonged exposure to —-
3. —— diseases as:
4. diseases of —–

Answer 4

1- persistent infection as:
▪ Mycobacterium tuberculosis
▪ Treponema pallidum
▪ Fungi
2. toxic agents as : silica or asbestos
3. autoimmune as SLE and rheaumatoid arthritis
4. unknown aetiology as: inflammatory bowel disease

Question 5

features of chronic inflammation includes :

Answer 5

1. monuclear cells as macophaes plasma cells and lymphocytes
2. tissue destruction
3. reapir granulation tissue as angioagenisis and fibrosis

Question 6

macrophages are derived from —- and ▪ Kupffer cells (liver)
▪ Sinus histiocytes (spleen and lymph nodes)
▪ Alveolar macrophages (lung)
▪ Micoglia (CNS)
▪ Osteoclasts (bone)
are all known to be —-

Answer 6

• blood monocytes
• tissue macrophages

Question 7

the main effector cells in chronic inflammation —- and are extravasion of —– aka adhesion molecules and chemical mediators and they transform into —–

Answer 7

• macrophages
• monocytes
• larger macrophages

Question 8

role of macrophages :
1. they are activated by:
2. involved in —- and are —- presenting
3. releases —– mediators influencing initiating the proegression of inflammation which leads to :
- tissue destruction
- vascular proliferation ( angiogenesis ) and fibrosis

Answer 8

• activated by cytokines and bacterial endotoxins
• phagosytosis and are antigen presenting
• inflammatory

Question 9

products released by macrophages include:

Answer 9

• Tissue destruction
  ▪ Proteases and other enzymes
  ▪ AA metabolites
  ▪ Toxic oxygen metabolites
  ▪ NO
  ▪ Coagulation factors
  ▪ Neutrophil chemotactic factors
• Vascular proliferation and fibrosis
  ▪ GFs
  ▪ Cytokines
  ▪ Remodelling collagenase and metalloproteinase

Question 10

1.t lymphocytes are produced in — 2.maturation occurs in —- Ala TCR rearrangement.
3.the activation of the T cells requires binding of ——
4. t lymphocytes release —-

Answer 10

• bone marrow
• thymus
• AG/MCH
• lymphokines

Question 11

—- are MHC class II
—– are MHC class I

Answer 11

• CD4
• CD8

Question 12

true or false:
T cells regulate macrophages activation in recruitment w lymphokines

Answer 12

true

Question 13

b cells are produced in —- and are activated by —- these cells derived from the b cells have encountered —– and are differentiated into —- producing cells and are rich in —- in order to make —-

Answer 13

• bone marrow
• plasma cells
• antigen
• antibody
• rough er
• antibodies

Question 14

estinophils are common in many —- inflammatory reactions and are effective killers of —- .
they mediate tissue damage , MBP aka toxic to parasites and are phagocytic

Answer 14

• allergic
• parasites

Question 15

true or false:
1.NK and other lymphocyte subtypes help eliminate
viruses and bacteria

Answer 15

true

Question 16

—- are the least common type of leukocytes in the blood as they migrate into the tissue and become —- , both —– and —- have cell surface — for —- and when stimulated masked cells can release inflammatory mediators including acids mucopolysaccharides, heparin, proteinases

Answer 16

• basophil
• mast cells
• mast cells and basophils
• receptors
• IgE

Question 17

—- are derived from bone marrow progenitors and they circulate in the blood , immature precursors , settle in tissue where they differentiate .
- involved in antigen presenting
- are primary cell types that stimulate naive T cells to imitate immune response
- antigens bind to —— and —– and then present antigens to —- and activates them

Answer 17

• dendritic cells
• MHC class 2 and dendritic cells
• lymphocytes

Question 18

1.—- is a specific form of chronic inflammation where its caused from aggregation of macrophages have enlarged , epithelium like appearance called ——
2. —– nodular collection of epitheliod macrophages surrounded by a rim of lymphocytes
3. —- large cells w a multiple nuclei aka fusion of macrophages

Answer 18

• granulomatous inflammation
• epitheliod macrophages
• granuloma ( aka cluster of wbc )
• giant cells

Question 19

granulomatous inflammation is seen in response to —- irritating agent which is — digested and/or which imitates a — mediated response aka which are:
it aims to —– or —- damaging agents

Answer 19

• persistent
• poorly
• cell mediated response
• which are: substance resist to lysosomal degradation and substances that induce a T cell hypersensitivity
• aims to control or remove
  ( check slide 24 )

Question 20

causes of granuloma inflammation:

Answer 20

1. bacteria:
   ▪ Tuberculosis
   ▪ Leprosy
   ▪ Cat scratch
   disease
   2.parasites:
   ▪ Schistosomiasis
   ▪ Toxoplasmosis
   ▪ Leishmaniasis
2. fungi:
   ▪ Histoplasmosis
   ▪ Blastomycosis
3. spirochetes : syphilis

Question 21

foreign body type granuloma occurs when in response to —– forge in materials it can be exogenous as:
or endogenous as:

Answer 21

• poorly digestible foreign materials
• exo : splinter , suture , graft material
• endo: keratin , hair shafts in pilonidal sinus

Question 22

type IV delayed hypersensitivity is the interaction between —- and —–

Answer 22

CD4 helper T cells and macrophages
(* Macrophages present Ags via MHC II to CD4 helper
cells causing their activation
* T cells produce cytokines (IL-2 and IFN-γ)
▪ TB
▪ Fungal infection
▪ Sarcoidosis )

Question 23

microscopic appearance ( important )

Answer 23

1. Foreign body granuloma
   ▪ Macrophages cluster around the foreign material
   ▪ Multinucleated giant cells with haphazardly arranged
   nuclei throughout the cytoplasm
2. Type IV delayed hypersensitivity :
   ▪ Langhans type giant cells
   ▪ Caseous necrosis in TB

Question 24

true or false:
- tubersulsoris are caused by mycobacterium tuberculosis
- these organisms induce type IV hypersensitivity
- lungs and spleen are main sites of infection

Answer 24

• true
• true
• false: lungs and lymph nodes

Question 25

historical features of tb includes:

Answer 25

▪ Caseating granuloma
▪ Central necrosis
▪ Epithelioid macrophages and Langhans ’giant cells
▪ T-helper cells (within the granuloma)
▪ Occasional plasma cells
▪ Peripheral rim of suppressor T cells and fibroblasts
▪ ZN stain
* Culture
* Fluorescent staining with auramine
* PCR

Question 26

sarcoidosis is the granulomatous condition of —- which affects — adults and occurs in — more than —- and may affect —- tissues
- histological features include:

Answer 26

• unknown aetiology
• young adults
• black more than white
• any tissue
• features include:
• Histological features
  ▪ Non caseating naked granuloma
  ▪ Schaumann bodies - concentric calcification (calcium
  oxalate crystals)
  ▪ Asteroid bodies

Question 27

morphological patterns in acute and chronic inflammation includes:

Answer 27

• Serous inflammation
• Fibrinous inflammation
• Suppurative inflammation
• Ulcers
• Sinus
• Fistula

Question 28

• Accumulation of thin fluid derived from the blood serum
  or secretion of mesothelial lining
  ▪ Effusion
• Peritoneal
• Pleural
• Pericardial
  ▪ Skin blisters
• Viral infection
• Burn
  this inflammation is known as —–

Answer 28

serous inflammation and the morphological pattern is blister

Question 29

fibrinous inflammation is the accumulation of —–
- contains body cavities
- maybe removed by fibrinolysis ( resolution )
- organisation

Answer 29

• fibrin and fluid

Question 30

suppurative inflammation is characterised by — and can be see associated w certain organism(staphylococcus) and may lead to the formation of —–

Answer 30

• pus
• abscess

Question 31

—- is the localised formation of pus includes:
▪ Dead and degenerate leucocytes
▪ Dead and degenerate host tissue cells
▪ Oedema fluid
▪ Dead microorganisms

Answer 31

• abscess

Question 32

—- local defect in an epethilal surface produced by the shedding of dead epithelial cells , skin and mucousal surfaces as peptic ulcers and are distinguished from erosions by the — of the tissue loss

Answer 32

• ulcers
• extent

Question 33

▪ Loss of the full thickness of the epithelium
▪ May or may not be associated with scarring at the
base of the ulcer
are characteristics of —- ulcers

Answer 33

acute ulcers

Question 34

▪ Usually deep penetrating
▪ Always associated with scarring at the base of the
ulcer
are characteristics of —- ulcers

Answer 34

chronic ulcers

Question 35

sinus:
tract lined by —- tissue leading from — inflamed cavity to a surface
- they are associated w osteomyelitis
- pilondial sinus

Answer 35

• granulation
• chronically inflamed

Question 36

• track opened at — ends through which abnormal communication between 2 surfaces is established
• Gastrointestinal fistula in Crohn’s disease
• these characterstics are for :

Answer 36

• both ends
• fistula

Question 37

systemic inflammator response syndrome = ——
inflammatory mediators are produced by —- and —– in repose to infection of injury

Answer 37

1- acute phase response
2- leucocytes and hepatocytes

Question 38

pyercxia is a —- réponse by which the bacterial product — stimulates leuocytes to release —- and —- and increases —- which leads to —- and then the neurotransmitters affect the —-
—– inhibits prostaglandin production

Answer 38

• acute phase repose
• pyrogen
• IL1and TNF alpha
• coox
• prostagladin PGE2
• hypothalamus
• NSAIDS

Question 39

acute phase proteins are — proteins produced by the —- which include:

Answer 39

• plasma
• liver
  ▪ C-reactive protein (CRP)
  ▪ serum amyloid A (SAA)
  ▪ Fibrinogen → binds to RBC→ ↑ESR
  ▪ Iron regulating peptide- hepcidin → Anaemia

Question 40

acute phase response includes:

Answer 40

• Increased pulse and blood pressure
• Increased sweating and rigors
• Tendency to sleep
• Anorexia and malaise
• Severe sepsis → DIC, hypotension and shock