DD2

Question 1

Extravascular fluid w/ ↑ protein [ ] (exudate) indicates what?

Answer 1

increase permeability of small blood vessels due to tissue injury/ inflammation

Question 2

Is edema due to an excess of fluid in interstitial tissue, serous cavities or the vessels?

Answer 2

Interstitial tissue or serous cavities

Question 3

What is the fluid glucose ratio for transudate?

Answer 3

> 1.0

Question 4

What is the fluid glucose ratio for exudate?

Answer 4

<1.0

Question 5

Does transudate have cells (leukocytes)?

Answer 5

No

Question 6

Where is the source of PMNs in acute inflammation?

Answer 6

peripheral blood

Question 7

Is acute or chronic inflammation a rxn of innate immunity?

Answer 7

acute

Question 8

Main characteristic of acute inflammatory phase

Answer 8

exudation of fluid and plasma proteins (edema) and emigration of leukocytes (PMNs)

Question 9

Is acute or chronic inflammation a rxn of adaptive immunity?

Answer 9

chronic

Question 10

Name 3 cells involved in chronic inflammation repair and what they contribute

Answer 10

§ Macrophages → growth factors
§ Fibroblasts → fibrosis/scar
§ Endothelial cells → neovascularization

Question 11

Where is the source of cells for chronic inflammation?

Answer 11

Sentinal/local cells in tissue

or

peripheral blood (like acute)

Question 12

Can you have chronic inflammation w/o an acute phase?

Answer 12

Yes

Question 13

During inflammation, what purpose do the lymph nodes serve?

Answer 13

Aggregation site of lymphocyte : barrier to infection

Question 14

What are the two infrastructure cells that provide support during inflammation? How?

Answer 14

§ Fibroblasts
□ Response to injury: proliferate + produce collagen + other extracellular material
§ Endothelial cells:
□ Line blood vessels
□ Response to injury: proliferate + form new blood vessels

Question 15

Describe the best outcome of acute inflammation

Answer 15

1. Complete resolution

a. Macrophage clean up necrotic debris → Tissue regeneration →lymphatic drainage decreasing edema

Question 16

What are the best to worst outcomes of acute inflammation?

Answer 16

1. Complete resolution
2. Scarring: “patch” not 100% function
3. Abscess formation: cant get rid of infection → walls off
4. Progression to chronic inflammation

Question 17

Which cells are involved in Fibrinopurulent/purulent/suppurtive inflammation?

Answer 17

PMNs

Question 18

Which cells are involved in granulomatous inflammation?

Answer 18

Macrophages

Question 19

Which cells are involved in eosinophilic inflammation?

Answer 19

Eosinphils

Question 20

What is your DDX for granulatomatous inflammation?

Answer 20

Infections
Inflammatory vascular diseases
Foreign bodies

-materials can be walled off

Question 21

Eosinophils participate in immune rxns mediated by which immunoglobulin?

Answer 21

IgE

Question 22

Acute inflammation vascular response

Answer 22

dilation/increased flow
increased permeability (transudate/exudate)

Question 23

Chronic inflammation vascular response

Answer 23

variable dilation + leakiness

endothelial cell activated (ready to proliferate)

Question 24

Which phase of inflammation is repair stimulated?

Answer 24

Chronic

• macrophages: cytokines/growth factors
• fibroblasts: fibrosis/scar
• endothelial cells: neovascularization

*note: acute mainly neutrophils: phagocytose - no damage

Question 25

5 macroscopic appearance of inflammation

Answer 25

1. Fibrinopurulent/purulent/suppurtive 2. Abcess 3. Empyema 4. Cellulitis 5. Granuloma

Question 26

Location of abcess

Answer 26

w/in parenchyma/confined space ie: brain, lung, liver cavity walled off by immune system - prevent infection of neighbors

Question 27

Location of empyema

Answer 27

w/in anatomic space or cavity

Question 28

Location of granuloma

Answer 28

usually w.in parenchyma (just like abcess)

Question 29

Of the 5 macroscopic appearance of inflammation, all but one have neutrophils being the primary inflammatory cell. Which one?

Answer 29

Granuloma - macrophages, lymphocytes, plasma cells

Question 30

What is empyema

Answer 30

exudative inflammation (pus) within a body cavity -commonly lungs

Question 31

What is granuloma

Answer 31

collection of immune cells due to inflammation, usually mineralized walled off by immune system bc it cant eliminate

Question 32

Chronic inflammation show 3 characteristic histologic features: how does acute inflammation differ?

Answer 32

1. collection of chronic inflammatory cells 2. destruction of parenchyma 3. replacement of CT ______________ 1. neutrophils (pinker than inflammatory cells) fill spaces and blood vessels congested

Question 33

collateral tissue damage associated with inflammation.

Answer 33

Leukocytes do not distinguish between offender and host: Activated Macrophages release: - reactive oxygen and nitrogen species - proteases - cytokines - coagulation factors - AA metabolites

Question 34

eating lots of fava beans can cause which anemia?

Answer 34

G6PD deficiency

Question 35

Macrophage repair mechanism (not tissue injury)

Answer 35

release: - growth factors - fibrogenic cytokines - angiogenic factors - remodeling collagenesis

Question 36

Do both neutrophils and macrophages produce microbicidal substances (ROS, NO, lysosomal enzymes) that are released into extracellular space?

Answer 36

Yes. Both.

Question 37

Neutrophils survive for how long after migration?

Answer 37

1-2 days

Question 38

Lymphatic vessels are involved in acute or chronic inflammation? What does it do?

Answer 38

Acute - Normally filters and polices extravascular fluid (outside BV) - In inflammation-> lymph vessels proliferates-> drains edema accumulated due to vascular permeability -> drains injurious agent

Question 39

What happens if the lymphatic system cannot contain infection during acute inflammation?

Answer 39

M.o gains access to blood -> screwed (bacteremia, fungemia, viremia) -> Pt. becomes septic

Question 40

Useful lab tests supporting an inflammatory process (6)

Answer 40

1. hematologic profile 2. acute phase reactants 3. DIC related markers 4. Microbiology and Immunology lab studies 5. Immunoglobulin quantitation 6. Chemical mediators

Question 41

Describe this useful lab tests supporting an inflammatory process: -Hematologic profile

Answer 41

WBC | Differential including platelet count

Question 42

Describe this useful lab tests supporting an inflammatory process: -Acute phase reactant

Answer 42

Erythrocyte sedimentation rate | C-reactive protein

Question 43

Describe this useful lab tests supporting an inflammatory process: -DIC related markers

Answer 43

``` Fibrin split products (D-DImer) platelet count (consumption) ```

Question 44

Describe this useful lab tests supporting an inflammatory process: -Microbiology and immunology lab studies

Answer 44

rapid identification testing (crytococcus, viruses) culture serology (IgM vs IgG)

Question 45

Describe this useful lab tests supporting an inflammatory process: -chemical mediators

Answer 45

``` Prostaglandins Leukotrienes Thromboxanes Interleukins "PILT" ```