Path - Inflammation (Granulomatous diseases, Exudate vs. Transudate, ESR, & Iron poisoning)

Question 1

Name 13 Granulomatous diseases.

Answer 1

(1) Bartonella henselae (cat scratch disease) (2) Berylliosis (3) Churg-Strauss syndrome (4) Crohn disease (5) Francisella tularensis (6) Fungal infections (e.g., histoplasmosis, blastomycosis) (7) Granulomatosis with polyangitis (Wegener) (8) Listeria monocytogenes (granulomatosis infantiseptica) (9) M. leprae (leprosy; Hansen disease) (10) M. tuberculosis (11) Treponema pallidum (tertiary syphilis) (12) Sarcoidosis (13) Schistosomiasis

Question 2

What are the cellular mechanisms leading to granuloma formation?

Answer 2

Th1 cells secrete g-interferon, activating macropages. TNF-alpha from macrophages induce and maintain granuloma formation.

Question 3

What side effect can Anti-TNF drugs have, and what effect does this have on granulomatous disease?

Answer 3

Anti-TNF drugs can, as a side effect, causes sequestering granulomas to breakdown, leading to disseminated to disease

Question 4

What should patients be tested for prior to starting anti-TNF therapy?

Answer 4

Always test for latent TB before starting anti-TNF therapy

Question 5

Of exudate and transudate, which is thick versus thin?

Answer 5

Exudate (“Thick…”); Transudate (“and Thin”)

Question 6

Compare/Contrast the cellular content of exudate versus transudate.

Answer 6

EXUDATE: Cellular; TRANSUDATE: Hypocellular

Question 7

Compare/Contrast the protein content of exudate versus transudate.

Answer 7

EXUDATE: Protein-rich; TRANSUDATE: Protein-poor

Question 8

What is the specific gravity of exudate versus transudate?

Answer 8

EXUDATE: Specific gravity > 1.020; TRANSUDATE: Specific gravity < 1.012

Question 9

What are 3 causes of exudate?

Answer 9

Due to: (1) Lymphatic obstruction (2) Inflammation/infection (3) Maligancy

Question 10

What are 3 causes of transudate?

Answer 10

Due to: (1) High hydrostatic pressure (e.g., CHF) (2) Low oncotic pressure (e.g., cirrhosis) (3) Na+ retention

Question 11

What effect do products of inflammation have on RBCs? Give an example of such a product.

Answer 11

Products of inflammation (e.g., fibrinogen) coat RBCs and cause aggregation

Question 12

How does aggregation affect RBCs within a test tube?

Answer 12

When aggregated, RBCs fall at a faster rate within the test tube

Question 13

What are 6 conditions in which there is a high ESR?

Answer 13

(1) Most anemias (2) Infections (3) Inflammation (e.g., temporal arteritis) (4) Cancer (e.g., multiple myeloma) (5) Pregnancy (6) Autoimmune disorders (e.g., SLE)

Question 14

What are 3 conditions in which there is a low ESR?

Answer 14

(1) Sickle cell (altered shape) (2) Polycythemia (increased RBCs “dilute” aggregation factors) (3) CHF (unknown)

Question 15

Why is iron poisoning important?

Answer 15

One of the leading causes of fatality from toxicologic agents in children

Question 16

What is the mechanism of iron poisoning?

Answer 16

Cell death due to peroxidation of membrane lipids

Question 17

What are 4 acute symptoms of iron poisoning?

Answer 17

ACUTE: nausea, vomiting, gastric bleeding, lethargy

Question 18

What are 2 chronic symptoms of iron poisoning?

Answer 18

CHRONIC: metabolic acidosis, scarring leading to GI obstruction

Question 19

What is the treatment for iron poisoning?

Answer 19

Chelation (e.g., IV deferoxamine, oral deferasirox) and dialysis

Question 20

What are 2 examples/forms of chelation that can be used to treat iron poisoning?

Answer 20

Chelation (e.g., IV deferoxamine, oral deferasirox)