Chronic Inflammation 2

Question 1

What is granulomatous inflammation characterised by?

Answer 1

Presence of granulomas in tissues and organs

Question 2

What is granulomatous inflammation stimulated by?

Answer 2

Indigestable antigen

Question 3

What can the cause of granulomatous inflammation be described as?

Answer 3

Idiopathic (no known cause)

Question 4

What does idiopathic mean?

Answer 4

No known cause

Question 5

What are granulomas composed of?

Answer 5

Aggregates of epitheloid macrophages in tissue

May contain giant cells

May be surrounded by lymphocytes

Contains neutrophils and eosinophils

Question 6

What may granulomas surround?

Answer 6

Dead tissue

Question 7

What are granulomas the response to?

Answer 7

Indigestable antigen

Question 8

What kinds of hypersensitive reaction are many granulomas?

Answer 8

Type IV

Question 9

What are giant cells?

Answer 9

Fusion of macrophages to form larger cells (larger cytoplasms and multinucleated)

Question 10

What are different kinds of granulomas?

Answer 10

Langans type

Foreign body type

Silicone associated

Warthin-Finkeldy type

Question 11

Where are Langhans type granulomas commonly found?

Answer 11

In tuberculosis

Question 12

What are properties of Langhams type granulomas?

Answer 12

Peripheral rim of nuclei

Large eosinophillic cytoplasm

Question 13

What do foreign body type granulomas contain?

Answer 13

Neutrophils

Pus

Giant cells

Question 14

How are the nuclei arranged in foreign body type granulomas?

Answer 14

Scattered around the cytoplasm

Question 15

What are silicone associated granulomas due to?

Answer 15

Rupture of silicone implants, vacouls contain leaked silicone

Question 16

Where are Wartin-Finkeldy type granulomas found?

Answer 16

Measles

Question 17

How are the nuclei arranged in Warthin-Finkeldy granuloma?

Answer 17

Clustered in the centre

Question 18

What are examples of infectious granulomatous diseases?

Answer 18

Tuberculosis (mycobacterium tuberculosis)

Leprosy (mycrobacteria leprae)

Syphilis (treponema pallidum)

Question 19

What is tuberculosis caused by?

Answer 19

Mycobacterium tuberculosis

Question 20

What is leprosy caused by?

Answer 20

Mycobacterium leprae

Question 21

What is syphilis caused by?

Answer 21

Treponema pallidum

Question 22

What are examples of non-infective granulomas?

Answer 22

Rheumatoid disease (tissue specific autoimmune disease, targets synovial fluid in joints)

Sarcoidosis

Crohn’s disease (chronic inflammatory bowel disease)

Question 23

What is Rheumatoid disease?

Answer 23

Tissue specific autoimmune disease, targets synovial fluid in joints

Question 24

What is Crohn’s disease?

Answer 24

Chronic inflammatory bowel disease

Question 25

What is the process of wound healing?

Answer 25

1) Phase of acute inflammation 2) Granulation tissue formation 3) Local angiogenesis (new vessels grow) 4) Fibrosis and scar formation

Question 26

What does ideal surgical wound healing involve?

Answer 26

Healing by primary intention Minimal gap Small amount of granulation tissue Small linear scar

Question 27

What does healing of larger defects lead to?

Answer 27

Healing by secondary intention Lots of granulation tissue ingrowth Contraction and scarring

Question 28

What is the detailed process of healing?

Answer 28

1) Injury, blood clot, acute inflammation, fibrin formation 2) Many growth factors and cytokines involved 3) Granulation tissue growth - angiogenesis 4) Phagocytosis of fibrin 5) Mycofibroblasts move in and lay down collagen 6) Contraction of scar 7) Re-epithelialisation

Question 29

What are factors that help wound healing?

Answer 29

Cleanliness Apposition of edges (no haemotoma) Sound nutrition Metabolic stability and normality Normal inflammatory and coagulation mechanisms Local mediators

Question 30

What are things that would impair wound healing?

Answer 30

Dirty, gaping wound, large haematoma Poorly nourished, lack of vitamines A and C Abnormal metabolism, diabetes Inhibition of angiogenesis

Question 31

How does fracture healing compare to regular tissue healing?

Answer 31

Similar except the addition of repairing bony structures

Question 32

What are the sequence of events for healing a fracture?

Answer 32

1) Trauma, fracture, haematoma 2) Bits of dead bone and soft tissue 3) Acute inflammation, organisation, granulation tissue, macrophages remove debris 4) Granulation tissue contains osteoblasts as well as fibroblasts

Question 33

What does the granulation tissue of a healing fracture contain?

Answer 33

Osteoblasts Fibroblasts

Question 34

What is a haematoma?

Answer 34

Solid swelling of clotted blood within tissues

Question 35

What is formed during fracture repairing?

Answer 35

A callus

Question 36

What is the process of a callus being formed in fracture healing?

Answer 36

1) Osteoblasts lay down woven bone 2) Nodules of cartilage are present 3) Followed by bone remodelling where osteoclasts remove dead bone, progressive replacement of woven bone by lamellar bone and reformation of cortical and trabecular bone

Question 37

What happens during the bone remodelling when a callus is formed while healing a fracture?

Answer 37

1) Osteoclasts remove dead bone 2) Progressive replacement of woven bone by lamellar bone 3) Reformation of cortical and trabecular bone

Question 38

What is angiogenesis?

Answer 38

Formation of new blood vessels

Question 39

What is the process of angiogenesis?

Answer 39

1) Vascular endothelial growth factor (VEGF) release by hypoxic cells stimulation proliferation 2) Enzyme secretion aids process 3) New vessels form 4) Enable blood supply to enter damaged tissue

Question 40

How does the purpose of angiogenesis differ?

Answer 40

It differs in different situations such as: Thrombosis Malignant tumours Fibrosis and scarring in athlerosclerosis

Question 41

What is the purpose of angiogenesis in thrombosis?

Answer 41

Limits thrombus propagation Reinstatement of flow

Question 42

What is the purpose of angiogenesis in malignant tumours?

Answer 42

Potential for therapeutic control

Question 43

In malignant tumours what does angiogenesis occur in?

Answer 43

Tumour growth

Question 44

What is the purpose of angiogenesis in fibrosis and scarring in athlerosclerosis?

Answer 44

Similar to chronic inflammation