Inflammation

Question 1

____-____ receptors recognize microbes.
___-___ receptors can sense cell damage.

Answer 1

Toll-like
NOD-like

Question 2

Inflammation leads to the recruitment of _____.

Answer 2

Leukocytes

Question 3

Causes of inflammation:

Answer 3

Infection
Tissue necrosis
Foreign body
Immune reactions, such as hypersensitivity

Question 4

Cardinal signs of inflammation:

Answer 4

Redness, warmth, swelling, pain, loss of function

Question 5

_____ is due to leakage of the fluid from a post capillary venules into the interstitial space. key mediators are ____ which causes endothelial cell contraction, and ___ ____ resulting in endothelial cells disruption.

Answer 5

Swelling
Histamine
Tissue damage

Question 6

____ and ____ are due to vasodilation which results in increased blood flow via relaxation of arteriolar smooth muscle. Key mediators are ___, ____, and ____.

Answer 6

Redness
Warmth
Histamine
Prostaglandins
Bradykinin

Question 7

Loss of function is from cellular and tissue damage related to ___ ___ ___ created by lysosomal enzymes.

Answer 7

Reactive oxygen species

Question 8

The most important mediators of acute inflammation are:

Answer 8

Vasoactive amines, arachidonic acid derivative lipid products such as prostaglandins and leukotrienes, cytokines including chemokine, and products of complement activation

Question 9

_____ come from mast cells and leukocytes. It causes vasodilation, pain and fever.

Answer 9

Prostaglandins

Question 10

____ is produced by mast cells, basophils and platelets. It causes vasodilation, increase vascular permeability, and endothelial activation.

Answer 10

Histamine

Question 11

_____ is produced by mast cells and leukocytes. It increases vascular permeability, chemotaxis, and leukocyte adhesion and activation

Answer 11

Leukotrienes

Question 12

Cytokines such as ____, ___, and ____ are produced by macrophages, endothelial cells, and mast cells. Locally, they cause endothelial activation. Systemically, they produce a fever, metabolic abnormalities, and hypotension (shock)

Answer 12

TNF, IL-1, and IL-6

Question 13

_____ are produced by leukocytes and activated macrophages. They cause chemotaxis and leukocyte activation.

Answer 13

Chemokines

Question 14

____ comes from Plasma and is produced in the liver. It causes leukocyte chemotaxis and activation, direct target killing, and vasodilation

Answer 14

Complement

Question 15

Diagram of mediators of inflammation:

Answer 15

Question 16

Principal actions of arachidonic acid metabolites in inflammation:

Answer 16

Question 17

Prostaglandins, bradykinin, and substance P are the main mediators of ____.

Answer 17

Pain

Question 18

Lysosomal enzymes and reactive oxygen species are the main mediators of tissue damage, and ___ ___ ___.

Answer 18

Loss of function

Question 19

Histamines and prostaglandins are the main mediators of ___ and ___.

Answer 19

Redness
Warmth

Question 20

Histamines, serotonin, C3a and C5a, leukotrienes C4, D4, and E4 are the main mediators of increased ____ ____.

Answer 20

Vascular permeability

Question 21

TNF, IL-1, chemokines, C3a and C5a, leukotriene B4 are the main mediators of ____ recruitment and activation.

Answer 21

Leukocyte

Question 22

Inflammation allows inflammatory cells such as neutrophils and macrophages, lymphocytes, etc., plasma proteins, and fluid to exit the ___ ___ and enter the ___ ___.

Answer 22

Blood vessels
Interstitial space

Question 23

____ inflammation is fast, onset in minutes or hours. Mainly neutrophils with prominent local and systemic signs.

Answer 23

Acute

Question 24

____ inflammation can take days. It is mainly monocytes/macrophages and lymphocytes. The tissue injury is often severe and progressive. There are less local and systemic signs.

Answer 24

Chronic

Question 25

Acute inflammation arises in response to ____ or ___ ____. It is characterized by the presence of edema and neutrophils. It is immediate response with limited ____.

Answer 25

Infection Tissue necrosis Specificity

Question 26

Three Major components of the acute inflammatory response:

Answer 26

Vascular changes Leukocyte recruitment Leukocyte activation

Question 27

Acute inflammation: ____ is mediated by histamines serotonin prostaglandins, leukotrienes, and complement. It increases blood flow and produces ____ (redness).

Answer 27

Vasodilation Erythema

Question 28

Acute inflammation: ____ ___ ____ is mediated by histamines serotonin, and kinins. The result is gaps between endothelial cells that allows for leakage of fluid, which causes ___.

Answer 28

Increased vascular permeability Edema

Question 29

Vascular changes allow movement of ___ ___ and ___ ___ from vascular space to site of infection/injury.

Answer 29

Inflammatory cells Plasma proteins

Question 30

When there is no inflammation there is a ___ hydrostatic pressure and ___ colloid osmotic pressure.

Answer 30

Higher Lower

Question 31

When exudates and transudates form, hydrostatic pressure ____ and colloid osmotic pressure ____. There is ____ interendothelial spaces allowing for fluid and protein leakage. When

Answer 31

Increases Decreases Increased

Question 32

Decreased colloid osmotic pressure is caused from ____ protein synthesis (liver disease) or ____ protein loss (kidney disease).

Answer 32

Decreased Increased

Question 33

Increased hydrostatic pressure is caused from venous ____ obstruction (congestive heart failure).

Answer 33

Outflow

Question 34

____ refers to when vasodilation slows blood flow and cells move to periphery of vessels

Answer 34

Margination

Question 35

____ refers to the up regulation of selectins on endothelial cells. Leukocytes have ____ __ __ on the surface, which binds to selectins.

Answer 35

Rolling Sialyl Lewis X

Question 36

Endothelial adhesion molecules, ____ and ___, are up regulated by TNF and IL-1. Leukocyte ____ are upregulated by C5a and LTB4 and converted to their high affinity form. ICAM and VCAM are ligands for Integrins. This process is referred to as ____, which stops the cell rolling.

Answer 36

ICAM VCAM Integrins Adhesion

Question 37

Leukocyte adhesion deficiency is most commonly due to an autosomal recessive defect of ____.

Answer 37

Integrins

Question 38

Migration: _____ is expressed on both leukocytes and endothelial cells. It facilitates transmigration. This process is driven by ____ produced at the site of injury (chemotaxis). Neutrophils are attracted by bacterial products, ___, ___, and ___.

Answer 38

PECAM-1 (CD31) Chemokines IL-8 C5a LTB

Question 39

Diagram of acute inflammation- leukocyte recruitment: Rolling, adhesion, and migration

Answer 39

Question 40

_____ is a cytokine that is produced by macrophages, mast cells, and T lymphocytes. It stimulates expression of endothelial adhesion molecules and secretion of other cytokines. It has its systemic effects.

Answer 40

TNF

Question 41

____ is a cytokine that is produced by macrophages, endothelial cells, and some epithelial cells. It is similar to TNF, but plays a greater role in fever.

Answer 41

IL-1

Question 42

____ is a cytokine produced by T lymphocytes. It recruits neutrophils and monocytes.

Answer 42

IL-17

Question 43

____ is a cytokine that is produced by macrophages and other cells. It produces systemic effects (acute phase response).

Answer 43

IL-6

Question 44

_____ are cytokines that are produced by macrophages endothelial cells, T lymphocytes, and mast cells. It recruits leukocytes to sites of inflammation and plays a role in migration of cells in normal tissues.

Answer 44

Chemokines

Question 45

There are 10 different kinds of ___-___ receptors, each for a different set of microbial molecules

Answer 45

Toll-like

Question 46

_____ receptors bind to mannose, C3b, and Fc (antibodies).

Answer 46

Phagocytic

Question 47

Picture of myocardial infarct, showing acute inflammation:

Answer 47

Question 48

Graph of acute inflammation:

Answer 48

Question 49

Removal of the offending agent: _____ is mediated by phagocytic receptors ( ____, ___, ____ ___). It is facilitated by coating (opsonization) by the ____ IgG, C3b, and others.

Answer 49

Phagocytosis Mannose, opsonin, scavenger receptors Opsonins

Question 50

Destruction of phagocytosed material is performed by ___ ___ ___. ___ ___ (NADPH oxidase) produces superoxide anion. ___ ___ ___ (NOS) with superoxide produces peroxynitrite. ___ ___ (proteases) also assist with destruction, but are less effective than ROS.

Answer 50

Reactive oxygen species Phagocyte oxidase Nitric oxide synthetase Granule enzymes

Question 51

Diagram of removal of offending agents:

Answer 51

Question 52

Altered phagocytosis: _______ syndrome is a protein trafficking defect characterized by impaired phagolysosome formation. Immunodeficiency, diminished hemostasis.

Answer 52

Chediak-Higashi

Question 53

Altered phagocytosis: ____ ____ disease (CGD) is characterized by poor oxygen, dependent, killing due to NADPH oxidase defect. It is X-linked or autosomal recessive. Characterized by recurrent infections.

Answer 53

Chronic granulomatous

Question 54

Altered phagocytosis: ____ ___ results in defective hypochlorite formation. Increased risk for candida infections, however, most patients are asymptomatic

Answer 54

MPO deficiency

Question 55

During resolution of acute inflammation, neutrophils undergo ____ and disappear within 24 hours after resolution.

Answer 55

Apoptosis

Question 56

____/____ can result after acute inflammation in the healing connective tissue

Answer 56

Scarring/fibrosis

Question 57

_____ of acute and chronic inflammation results in an ____ with persistent acute inflammation and surrounding chronic inflammation.

Answer 57

Combination Abscess

Question 58

Diagram of inflammation:

Answer 58

Question 59

If unchecked or inappropriately directed against host tissues, the ____ itself becomes the offender. This underlies, many acute and chronic human diseases. Adjacent tissues to inflammation may suffer ___ ___.

Answer 59

Leukocyte Collateral damage

Question 60

The inflammatory response may be inappropriately directed against host tissues, causing ___ ___.

Answer 60

Autoimmune disease

Question 61

The host may react excessively against usually harmless, environmental substances, causing ___ ___ and ___.

Answer 61

Allergic reactions Asthma

Question 62

Table of disorders caused by inappropriate immune system actions:

Answer 62

Question 63

____ inflammation is characterized by the presence of macrophages lymphocytes and plasma cells in tissue. It is a delayed response but more ____.

Answer 63

Chronic Specific

Question 64

Persistent infections, hypersensitivity diseases, and prolonged exposure to toxic agents and foreign material can cause ___ inflammation.

Answer 64

Chronic

Question 65

The _____ is the dominant cell in most chronic inflammatory reactions. It ingests and eliminates microbes, and dead tissue. Peak activity is 2 to 3 days after inflammation begins.

Answer 65

Macrophage

Question 66

Macrophages, secrete cytokines such as ___, ___, ___, and others that initiate inflammatory reactions. Macrophages also display ____ and respond to signals from T cells.

Answer 66

TNF IL-1 Chemokines Antigens

Question 67

Macrophage development occurs in the bone marrow starting with a ___ stem cell. In the blood, it is a ____ which gets activated into a macrophage by inflammation.

Answer 67

Hematopoietic Monocyte

Question 68

In the fetal liver, there is a ___ in the yolk sac which turns into a resident tissue ___.

Answer 68

Progenitor Macrophage

Question 69

Picture of monocytes and activated macrophages:

Answer 69

Question 70

Diagram of classically activated versus alternatively activated macrophage:

Answer 70

Question 71

____ refers to classically activated macrophage and ___ refers to alternatively activated macrophage.

Answer 71

M1 M2

Question 72

Microbes and other antigens activate T & B lymphocytes. They amplify and propagate ___ ___. They generate ___ cells, allowing for persistent and severe reactions.

Answer 72

Chronic inflammation Memory

Question 73

_____ T lymphocytes promote, and influence the nature of the inflammatory reaction.

Answer 73

CD4+

Question 74

____ cells secrete INF-gamma which activate macrophages by the classical pathway

Answer 74

Th1

Question 75

____ cells secrete IL-4, IL-5, IL-13 which recruit and activate eosinophils and are responsible for the alternative pathway of macrophage activation

Answer 75

TH2

Question 76

Diagram:

Answer 76

Question 77

____ cells produce IL-17 which induces the secretion of chemokines responsible for recruiting neutrophils and monocytes into the reaction

Answer 77

Th17

Question 78

____ is a cytokine produced by dendritic cells and macrophages. It increases production of INF-gamma

Answer 78

IL-12

Question 79

____ is a cytokine that is produced by T lymphocytes and natural killer cells. It activates macrophages.

Answer 79

INF-gamma

Question 80

Picture of plasma B cells in chronic inflammation:

Answer 80

Question 81

Granulomatous inflammation: A pattern of chronic inflammation induced by persistent ___ ___ in some infections, immune mediated diseases, and foreign bodies

Answer 81

T-cell response

Question 82

Composition of granulomatous: Aggregates of activated ___ with abundant pink cytoplasm, peripheral lymphocytes, multinucleated giant cells (fusion of numerous ___), and sometimes central necrosis

Answer 82

Macrophages Macrophages

Question 83

____ plays a crucial role in evolution of macrophages to epithelioid cells and giant cells. ___ ___ therapy can cause granulomatous to break down. This could make a previously contained infection such as TB disseminate

Answer 83

TNF Anti TNF

Question 84

Picture of peripheral lymphocytes

Question 85

Conditions with granulomas: TB, bartonella henselae, listeria, treponema pallidum (tertiary syphilis) Fungal: histoplasmosis Parasitic: schistosomiasis

Question 86

Conditions with granulomas non-infectious:

Answer 86

Sarcoidosis, crohn disease, primary biliary cholangitis, Churg-Strauss, giant cell arteritis, Takayasu arteritis, foreign body

Question 87

____ is used when the predominating disease state is inflammation. If inflammation is not the main disease state, do not use the term ___.

Answer 87

-itis -itis