inflammation

Question 1

____, ____, and _____ are due to vascular changes; ____ and _____ are due to chemical mediators and infiltration of leukocytes

Answer 1

heat (calor); redness (rubor); swelling (tumor)

pain (dolor); loss of function

Question 2

acute inflammation is characterized by ____ and ____

Answer 2

exudation (emitting fluid); neutrophil infiltration

Question 3

chronic inflammation is characterized by _____ with _____ and _____ in later stages

Answer 3

mononuclear inflammatory cell infiltration (lymphocytes, macrophages, plasma cells); vascular proliferation; fibrosis

Question 4

fever is mediated by:

Answer 4

IL-1, TNF, and PGE2

Question 5

vascular changes in acute inflammation include _____ and ______

Answer 5

vasodilation; increased vascular permeability

Question 6

vasodilation is mediated by endothelial cell release of ____ which induces vascular smooth muscle relaxation and _____ release of ____; vasodilation is maintained by ______

Answer 6

NO; mast cell; histamine; prostaglandins (PGI2, PGD2, PGE2, and PGF2)

Question 7

vasodilation beings in the _____ and results in engorgement of ______

Answer 7

pre-capillary arterioles; capillary beds

Question 8

movement of inflammatory cells out of the vessels (bc of increased vascular permeability), called ____, occurs at the level of _____

Answer 8

diapedesis; post-capillary venules

Question 9

transudate usually accumulates due to _____ (due to ______) and/or _____

Answer 9

increased hydrostatic pressure (usually due to reduced venous return); decreased serum oncotic pressure

Question 10

exudate is indicative of ____ and _____ damage

Answer 10

tissue; endothelial cell

Question 11

increased vascular permeability may be due to _____ or ____ to the endothelial cells

Answer 11

inflammatory mediators; direct injury

Question 12

endothelial cell contraction forms _____ (mainly in ______) due to reversible contraction; occurs rapidly and lasts for 15-30 min

Answer 12

intercellular gaps; post-capillary venules

Question 13

endothelial cell contraction is mediated by ____ and ____ early, and later on by ____ and _____; ____ and ____ induce vasoactive amine release which leads to edema

Answer 13

histamine; bradykinin; leukotrienes; PAF; C3a and C5a

Question 14

endothelial cell retraction due to ____ of _____ is mediated by _____; takes 4 to 6 hours to develop and lasts for 24 hours or more

Answer 14

restructuring; cytoskeletal proteins; IL-1, TNF, and IFNgamma

Question 15

direct venule endothelial cell injury may occur from _____ of _____ and ______ during the inflammatory response

Answer 15

neutrophilic release of ROS and lysosomal enzymes (proteases)

Question 16

3 cellular changes during inflammation

Answer 16

• endothelial cell activation
• leukocyte extravasation
• leukocyte activation/phagocytosis

Question 17

factors that will activate endothelial cells

Answer 17

histamine, thrombin, complement factors, cytokines (IL-1, TNF), bacterial products, hypoxia, viruses, PAF

Question 18

activated ECs are characterized by production of ___ and ___ that induce vasodilation, ____, rearrangement of cytoskeletal proteins leading to ____, increased expression and affinity of _____, and synthesis and release of ____

Answer 18

PGI2; NO
contraction/retraction
retraction
surface cell adhesion molecules
inflammatory mediators: IL-1, IL-6, PGI2, PAF, chemokines

Question 19

sequence of leukocyte extravasation

Answer 19

1. leukocyte margination
2. leukocyte rolling
3. leukocyte adhesion
4. emigration or transmigration
5. chemotaxis

Question 20

_____ mediate the processes involved in the movement of leukocytes from the blood stream into the extravascular tissue

Answer 20

cell adhesion molecules (CAMs)

Question 21

in rolling, _____ mediate a weak, transient sticking that slows the cells forward progression

Answer 21

selectins (adhesion molecules)

Question 22

adhesion is mediated by _____

Answer 22

integrins (ICAM and VCAM on endothelial cells)

Question 23

emigration/transmigration of ECs through the vessel wall (diapedesis) mediated by _____; occurs mainly in the ____ of the systemic vasculature

Answer 23

PECAM-1; venules

Question 24

chemotactic factors involved in chemotaxis

Answer 24

PAF (potent)
LTB4- leukotriene B4 (potent)
C5a, chemokines, bacterial lipids and peptides, fibrin degradation products (FDP)

Question 25

factors that activate leukocytes during an inflammatory reaction

Answer 25

bacterial products, cellular debris, Ab-Ag complexes, cytokines and chemokines, chemotactic factors

Question 26

activation of leukocytes characterized by production of ____ and ____ from _____; degranulation and release of _____; production of ____; synthesis and secretion of ____; altered expression of _____

Answer 26

``` leukotrienes and prostaglandins from arachidonic acid lysosomal enzymes ROS cytokines cell adhesion molecules ```

Question 27

4 steps of phagocytosis

Answer 27

1. attachment 2. engulfment 3. lysosomal degranulation 4. oxidative burst

Question 28

attachment mediated by ____ on targets and specific _____; engulfment into a _____; lysosomal degranulation by fusion with the ____; oxidative burst releasing ____

Answer 28

opsonins (IgG, C3b, collectins); specific leukocyte receptors (Fc receptor for IgG, complement receptors) phagocytic vacuole phagosome ROS (superoxide, hydrogen peroxide, hypochlorous radical)

Question 29

other mechanisms of intracellular killing by leukocytes

Answer 29

lysozyme, major basic protein, defensins, bactericidal permeability-increasing protein

Question 30

cells of acute inflammation

Answer 30

neutrophils (morphologic hallmark of acute inflammation) | monocytes (macrophages/histiocytes)

Question 31

activated macrophages have several functions including ____ and ____ cellular debris and organisms; they also take up and metabolize ____ and present _____ to immunocompetent T cells

Answer 31

phagocytize; digest | antigens; membrane-bound Ag

Question 32

activated macrophages elaborate various factors including:

Answer 32

enzymes (proteases); complement and coagulation factors; cytokines (IL-1, TNF), ROS and NO, prostaglandins, growth factors

Question 33

other inflammatory cell types

Answer 33

1. lymphocytes, plasma cells (immune functions) 2. eosinophils (allergic rxns, parasitic infections) 3. mast cells- surface IgE- release histamine

Question 34

while prostaglandins generally cause vasodilation, ____ causes vasoconstriction; another example of opposing effects: _____ promotes platelet aggregation and ____ inhibits platelet aggregation

Answer 34

thromboxane A2; thromboxane A2 ; prostacyclin

Question 35

cells of chronic inflammation

Answer 35

lymphocytes macrophages plasma cells eosinophils

Question 36

role of growth factors and cytokines in wound healing

Answer 36

``` epithelial proliferation monocyte chemotaxis fibroblast proliferation angiogenesis collagen synthesis ```

Question 37

3 types of exudate

Answer 37

1. fibrinous- high protein (fibrin), few cells, cloudy 2. purulent (pus)- contains cells (neutrophils); opaque 3. sanguineous- pink/red fluid due to blood

Question 38

neutrophils infiltrate tissue in response to _____ and _____ infections

Answer 38

tissue necrosis; bacterial (some fungal) infections

Question 39

in acute inflammation, neutrophils begin to accumulate within ____ hours; neutrophils are replaced with monocytes/macrophages within ____ hours

Answer 39

4-6; 48

Question 40

diffuse, permeative infiltration of neutrophils with edema

Answer 40

cellulitis

Question 41

localized area of neutrophils or liquefactive necrosis (pus)

Answer 41

abscess

Question 42

erosion of an epithelial surface exposing underlying connective tissue

Answer 42

ulcer

Question 43

causes for chronic inflammation include:

Answer 43

1. persistent infections 2. prolonged exposure to a toxic agent 3. immune-mediated inflammatory disease

Question 44

non-specific chronic inflammation often assoc with _____

Answer 44

tissue repair (granulation tissue/fibrosis)

Question 45

granulomatous inflammation linked to the _____

Answer 45

delayed type IV hypersensitivity immune reaction

Question 46

morphology of granulomatous inflammation includes:

Answer 46

1. epithelioid (activated) histiocytes 2. central caseous necrosis 3. multinucleated giant cells (langhans) 4. collar of mononuclear cells 5. heal by fibrosis

Question 47

diseases characterized by granulomatous inflammation include:

Answer 47

1. bacterial infection- M. tuberculosis 2. parasitic infection 3. fungal infection 4. inorganic matter 5. unknown etiology

Question 48

PGs and LTs are derived from arachidonic acid through the action of ____ or ____

Answer 48

cyclo-ocygenase (PGs) ; lipo-oxygenase (leukotrienes)

Question 49

aspirin and non-steroidal anti-inflam drugs reduce inflammation by ______; steroids inhibit release of ____ from _____

Answer 49

blocking cyclo-oxygenase activity; arachidonic acid; cell membrane phospholipids

Question 50

factors that affect wound healing

Answer 50

1. infection 2. nutrition 3. steroids 4. mechanical factors 5. poor tissue perfusion 6. DM, atherosclerosis

Question 51

increased vascular permeability- immediate transient- EC contraction mediated by:

Answer 51

histamine, BK, PAF, leukotrienes

Question 52

in direct EC injury, increased vascular perm med by _____ or _____

Answer 52

injurious agents; ROS/enzymes from PMNs

Question 53

EC retraction mediated by:

Answer 53

IL-1, TNF, IFN gamma

Question 54

pain mediated by:

Answer 54

BK and PGE2