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MRCEM Pathology > Inflammatory responses > Flashcards

Inflammatory responses Flashcards

1
Q

What are the 5 causes of acute inflammation?

A
  1. Physical agents (e.g. trauma, heat, cold, UV light, radiation)
  2. Irritant chemicals (e.g. acids, alkali)
  3. Microbial infections (e.g. pyogenic bacteria)
  4. Immune-mediated hypersensitivity reactions
  5. Tissue necrosis (e.g. myocardial infarction)
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2
Q

In acute inflammation, what 3 forms of vascular response occur?

A

Vasodilation
Increased vascular permeability
Inflammatory oedema

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3
Q

As part of the vascular response to acute inflammation, endothelial intracellular proteins contract under the influence of chemical inflammatory mediators - name 5 of them?

A

Histamine
Serotonin
Bradykinin
Nitric oxide
Leukotriene B4

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4
Q

In acute inflammation, chemotaxis of neutrophils migrating towards the site of tissue injury, attracted by chemotaxis such as what (name 3)?

A

Leukotrienes
Complement components
Bacterial products

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5
Q

Chronic inflammation usually develops as a primary response to 1 of 4 situations - name them?

A
  1. Microorganisms resistant to phagocytosis or intracellular killing mechanisms (e.g. TB, leprosy).
  2. Foreign bodies, which can be endogenous (e.g. bone adipose tissue, uric acid crystals) or exogenous (e.g. silica, suture materials, implanted prostheses).
  3. Some autoimmune diseases (e.g. rheumatoid arthritis).
  4. Primary granulomatous diseases (e.g. Crohn’s, sarcoidosis).
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6
Q

The site of chronic inflammation is dominated by what 3 things?

A
  1. Lymphocytes
  2. Plasma cells for antibody production
  3. Macrophaes for phagocytosis (some macrophages fuse to form multinucleate giant cells)
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7
Q

Macrophages in inflamed tissue are formed from the transformation of what?

A

Monocytes

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8
Q

In both acute and chronic inflammation, fever can occur, why?

A

Neutrophils and macrophages produce pyrogens (e.g. IL-1) which act on the hypothalamus

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9
Q

Why can lymphadenopathy happen in acute and chronic inflammation?

A

Reactive hyperplasia of the mononuclear phagocyte system

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10
Q

In granulomatous chronic inflammation, what is important for 1. initiating granuloma formation 2. causing them to enlarge 3. maintains them?

A
  1. IL-1
  2. IL-2
  3. TNF-alpha
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11
Q

Metaplasia, in which one cell type is switched for another, thought to be the result of progenitor cells differentiating into a new cell type, is seen almost exclusively in what kind of cell?

A

Epithelial cells

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12
Q

Cell recovery is associated with removal of damaged components by what process?

A

Autophagy

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13
Q

Name 3 forms of cell damage that tend to be reversible?

A
  1. Swelling of endoplasmic reticulum and some mitochondria
  2. Loss of ribosomes
  3. Cell stress response
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14
Q

Apoptosis, a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammation is seen, may be induced in what 2 main ways?

A
  1. By the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway)
  2. Through cellular injury (intrinsic pathway)
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15
Q

What is the most common form of necrosis?

A

Coagulative necrosis - characterised by the loss of cell nuclei, but with general preservation of the underlying architecture

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16
Q

What type of necrosis is typically seen in the brain following cerebral infarction?

A

Liquefactive necrosis - leads to complete loss of cellular structure and conversion into a soft, semi-solid mass

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17
Q

What type of necrosis is most commonly seen in TB?

A

Caseous necrosis - histologically, the complete loss of normal tissue architecture is replaced by amorphous, granular and eosinophilic tissue with a variable amount of fat and an appearance reminiscent of cottage cheese

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18
Q

What type of necrosis is seen in malignant hypertension?

A

Fibrinoid necrosis - in malignant hypertension increased arterial pressure results in necrosis of smooth muscle. Eosinophilic and fibrinous deposits are seen.

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19
Q

What type of necrosis typically follows trauma or from enzymatic lipolysis in acute pancreatitis?

A

Fat necrosis

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20
Q

What is gangrenous necrosis?

A

Necrosis with putrefaction of tissues due to exposure to air (dry gangrene) or infection (wet gangrene). The tissue is black due to iron sulphide from degraded haemoglobin.

21
Q

Name 8 different inflammatory mediator systems which interact to produce inflammation?

A

The complement system
Kinins
Prostaglandins and leukotrienes
Platelet activation factors
Vasoactive amines
Cytokines
Nitric oxide
Acute-phase proteins (APPs)

22
Q

The kinin system is stimulated by which activated coagulation factor?

A

Activated coagulation factor XII

23
Q

Cytokines are secreted by what?

A

Leucocytes

24
Q

Nitric oxide, a potent vasodilator, is released from what?

A

Endothelial cells and macrophages

25
Q

The acute phase response is a systemic reaction to infection or tissue injury induced by increased circulating levels of what?

A

IL-1, IL-6 and TNF-alpha

26
Q

C-reactive protein (CRP) is an acute phase protein produced by the liver. CRP binds to what, found on the surface of many bacteria?

A

Phosphorylcholine

27
Q

The erythrocyte sedimentation rate (ESR) is particularly helpful in diagnosing and monitoring treatment in what 2 inflammatory disease?

A

Temporal arteritis and polymyalgia rheumatica

28
Q

ESR is raised with inflammation and infection but may also be raised in what other situations?

A

Anaemia
Renal impairment
Pregnancy
Old age
Multiple myeloma or Waldenstrom’s macroglobulinaemia

29
Q

Although a low ESR is not usually important, it can be seen in what diseases?

A

Polycythaemia
Extreme leucocytosis
Some protein abnormalities

30
Q

Raised antinuclear antibodies are almost always present in what condition?

A

SLE

31
Q

High levels of rheumatoid factor are associated with which 2 conditions?

A

RA and Sjogren’s syndrome

32
Q

Anticardiolipin antibodies are the most commonly detected antiphospholipid antibodies and are associated with what condition?

A

Primary antiphospholipid syndrome

33
Q

c-ANCA (cytoplasma) are associated with which conditions?

A

Granulomatosis with polyangiitis (Wegener’s), micropolyarteritis, Churg-Strauss, polyarteritis nodosa and RPGN

33
Q

c-ANCA (cytoplasma) are associated with which conditions?

A

Granulomatosis with polyangiitis (Wegener’s), micropolyarteritis, Churg-Strauss, polyarteritis nodosa and RPGN

34
Q

c-ANCA (cytoplasma) are associated with which conditions?

A

Granulomatosis with polyangiitis (Wegener’s), micropolyarteritis, Churg-Strauss, polyarteritis nodosa and RPGN

35
Q

p-ANCA (perinuclear) is associated with what conditions/

A

Microscopic polyangiitis, Churg-Strauss, anti-GBM disease, crescentic glomerulonephritis and Wegener’s

36
Q

Pernicious anaemia is associated with what antibody?

A

Intrinsic factor

37
Q

Autoimmune gastritis is associated with what antibodies?

A

Parietal cell antibodies

38
Q

Coeliac disease is associated with what antibodies?

A

IgA anti-tissue transglutaminase (anti-tTG), anti-gliadin and endomysial antibodies (EMAs)

39
Q

Primary biliary cirrhosis is associated with what antibodies?

A

Antimitochondrial antibodies

40
Q

Autoimmune hepatitis is associated with what antibodies?

A

Anti-smooth muscle antibodies

41
Q

Type 1 diabetes is associated with what antibodies?

A

Glutamic acid decarboxylase (GAD), islet cell and insulin antibodies

42
Q

Autoimmune thyroid disease is associated with what antibodies?

A

Anti-thyroid peroxidase (TPO), TSH (thyrotropin) receptor and thyroglobulin (TG) antibodies

43
Q

Name 2 conditions steroid cell antibodies are associated with?

A

Addison’s disease
Autoimmune gonadal failure

44
Q

Acetylcholine receptor antibodies are associated with what condition?

A

Myasthenia gravis

45
Q

Goodpasture’s syndrome is associated with what antibodies?

A

Anti-glomerular basement membrane (GBM) antibodies

46
Q

Name 3 conditions that cardiac muscle antibodies are associated with?

A

Heart failure
Myocarditis
Dilated cardiomyopathy

47
Q

The dermatological condition pemphigus is associated with which antibody?

A

Intra-epidermal/desmosome antibody

48
Q

The dermatological condition pemphigoid is associated with which antibody?

A

Basement membrane zone antibody

MRCEM Pathology (4 decks)

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