Pathophysiology

Question 1

What are the principle characteristics of acute inflammation?

Answer 1

minutes lasting hours to days; EXUDATION of fluid and plasma proteins and emigrantion of WBCs; when offender is over inflammation subsides;

Question 2

How may repair to inflammation occur?

Answer 2

regeneration of tissue (as in hepatitis) or scarring (mass of collagen laid down)

Question 3

characteristics of TRANSUDATE

Answer 3

clear/pale yellow and water-like; no tissue fragments; no odor; alkaline; 1.015 specific gravity’ low (>3%) protein content; low cell count (b/c not infectious); low enzyme content; no bacteria or inflammation

Question 4

What conditions would you find transudate?

Answer 4

renal failure; CHF; acites

usually has to do w/ hydrostatic or osmotic issues

Question 5

Characteristics of EXUDATE

Answer 5

cloudy/white/yellow/red; thick and creamy w/ tissue fragments; may have odor; acidic; higher specific gravity and protein content; high cell ct; high enzyme content; bacteria may be present; associated w/ inflammation

Question 6

explain the vascular response in acute inflammation

Answer 6

first vasocontriction b/c prevents bleeding and piles up cells that are needed; then vasodilation to bring in all cellular components needed for repair (what produces heat); then permeability changes in which the endothelium of venule becomes leaky so things can move in and out - causes swelling

Question 7

what process of acute inflammation causes pain?

Answer 7

chemotaxis: chemoattractant chemicals activate sensory nerves to cause pain

Question 8

Rouleaux phenomenon

Answer 8

stacks of RBCs aggregate in presence of inflammation to slow blood flow

Question 9

What are examples of stimuli for acute inflammation?

Answer 9

infections - most commonly bacteria. viruses and fungi
tissue damage
foreing bodies (splinters, dirt, sutures) immune reactions: aunto immune disease, alergies

Question 10

segs

Answer 10

segmented neutrophils; 60% of WBCs are segs; has 3-5 lobed nucleus; 4-10k per cubic mm of blood, normally. contain enzymes that are chemoattractants.

Question 11

B lymphocytes

Answer 11

produce antibodies; activated b cell = plasma cell that pumps out abs against something

Question 12

t helper lymphocytes

Answer 12

CD4+; when activated, induces b cells to become plasma cells

Question 13

what happens w/o T helper cells?

Answer 13

b cells don’t mount an effective antibody response (ex. HIV kills CD4+ cells so lowered immune response = oportunistic infections)

humoral mediated immunity

Question 14

T nk cells

Answer 14

CD8+; when activated, produce perforin which inserts into membrane of cells causing them to be leaky

cell mediated immuntity

Question 15

monocytes

Answer 15

immature cells in circulation that when called up emigrate and become macrophages to eat debris and bacteria

Question 16

eosinophils and basophils

Answer 16

WBCs - only about 1% of them; high eosinophil count would be seen in roundworm infection and in allergies

Question 17

mast cells

Answer 17

in subQ tissue where there is an openeing in the body; have granules that produce and immune response when released

Question 18

what would be the use of a mast cell stabilizing drug?

Answer 18

preventing the mast cell from releasing the granules

asthma drugs

Question 19

histamine is found in

Answer 19

mast cells, basophils, plts

Question 20

heparin found in

Answer 20

mast cells, plts

Question 21

serotonin found in

Answer 21

plts

Question 22

release of IL1 and IL6 produces what?

Answer 22

fever

Question 23

bradykinin and substance p

Answer 23

made by neuron and packaged into granules and when release, causes pain and swelling

Question 24

what is a drug that degrades the enzyme for substance p and bradykinin?

Answer 24

ACE inhibitors

when they build up in tissues, cough

Question 25

TNF

Answer 25

involved in fever and chemotaxis

Question 26

what drugs are anti TNF agents?

Answer 26

biologics (inbrel and rimicade) - reduce inflammation

Question 27

what chemical mediators are involved in vasodilation?

Answer 27

prostaglandins NO histamine

Question 28

What chemical mediators are involved in increased vascular permeability?

Answer 28

``` histamine and seratonin C3a & C5a bradykinin leukotrienes substance P ```

Question 29

What chemical mediators are involved in chemotaxis?

Answer 29

TNF, IL1 chemokines C3a C5a leukotriene

Question 30

What chemical mediators are involved in fever?

Answer 30

IL1 and TNF | prostaglandins

Question 31

What chemical mediators are involved in pain?

Answer 31

prostaglandins | bradykinins

Question 32

What chemical mediators are involved in tissue damage?

Answer 32

leukocyte enzymes ROS NO

Question 33

Viagra/cialis

Answer 33

blocks degradation of NO, therfore producing vasodilation and an errection

Question 34

singular

Answer 34

leukotriene inhibitor

Question 35

chomalin sodium

Answer 35

mast cell stabilizer: used in exercise induce asthma

Question 36

what are some systemic manifestions of acute inflammation?

Answer 36

fever, shaking, weakness, aches, decreased appetite, increased sleep

Question 37

leukomoid rxn

Answer 37

in some people, WBC count will be 50k when normally it's never overe 20k; you would think leukemia first but have to consider leukomoid rxn which is always present in acute inflammatory process

Question 38

left shift

Answer 38

increase in bands; (bands = banded immature segs pushed out by marrow during inflammatino) (normal is 4% bands)

Question 39

acute phase reactants

Answer 39

proteins present in the blood that increase in acute inflammatory process (CRP, complement, fibrinogne)

Question 40

what is responsible for the releaux phenom?

Answer 40

fibrinogen

Question 41

what tests both show that there is an inflammatory response, just that it is non specific?

Answer 41

CRP (goes up in presence of inflammaion) ESR (erthyrocyte sedimentation rate) - sed rate increases (normal is 15) due to rouleaux.

Question 42

wheal and flare

Answer 42

allergic response - superficial skin rxns to ags. ex. poison ivy and dermatographism

Question 43

serous inflammation

Answer 43

one producing a serous exudate; esentially a filtrate of blood; could be caused by a friction burn or sunburn or effusion of joints

Question 44

catarrhal inflammation

Answer 44

affects mainly a mucous surface, originating from a mucous membrane; runny nose to conjuctivits

Question 45

supperative inflammation

Answer 45

marked by the presenve of pus

Question 46

paronychia

Answer 46

supperative type of inflammation - usually staph which is penicillin resistant; seen in mani pedis

Question 47

hydradenitis suppurativa

Answer 47

form recurrent furuncles and carbuncles in areas w/ apocrine glands

Question 48

abcess

Answer 48

cystic collection of pus w/i a tissue - liquifaction necrosis

Question 49

empyema

Answer 49

collection of pus w/i a naturally occuring anatomical cavity ex: staph in lungs; gallbladder empyema

Question 50

lymphadenitis

Answer 50

swollen lymph nodes

Question 51

lymphadema

Answer 51

blocked lymph channels

Question 52

bubos

Answer 52

seen in lymphogranuloma venerum, bubonic plague, chalmydia, syphilis, chancroid, TB

Question 53

what organism causes chancroid?

Answer 53

homophiles duchrey (seen in sex workers in 3rd world countries)

Question 54

fibrinous inflammation

Answer 54

marked by an exudate of coagulated fibrin - may form adhesions. ex: pericarditis

Question 55

serosanguinous inflammation

Answer 55

thin bloody fluid

Question 56

ulcerative inflammation

Answer 56

that in which necrosis on or near the surface leads to loss of tissue and creation of local defect (ulcer). tissue that forms when trying to heal is granultion tissue (starts around rim and works in - its active tissue) so dominant cell type is fibroblast and endothelium.

Question 57

examples of ulverative inflammation

Answer 57

ulcerative colitis; ulcerative gingivitis; duodenitis (peptic ulcer disease); decubiti

Question 58

gangrenous inflammation

Answer 58

implies enzymatic and bacterial decomp (putrefaction) ex: TSS; decrotizing fascitis

Question 59

when acute, if gangrene is due to ischemia like a blood clot entering circulation and traveling to instestines, that is a what?

Answer 59

mesenteric ischemia (gangrenous inflammatory ex) pt. present w/ pain out of proportion to physcial findings

Question 60

membranous/ | pseudomembranous inflammation

Answer 60

matted fibrin, mucus and inflammatory cells on focally necrotic epithelial surface

Question 61

examples of membranous or pseudomembranous inflammation

Answer 61

``` diptheria (grey membrane) pseudomembranous colitis (c diff overgrowth in colon) ```

Question 62

if acute inflammation fails to clear invaders, what is the cause?

Answer 62

chronic inflammation

Question 63

immune mediated diseases examples

Answer 63

``` asthma myasthenia gravis (ab against Ach receptor which is on skeletal muscles so weakness) ```

Question 64

chronic inflammation caused by prolonged exposure ex

Answer 64

silicosis (glass making) | asbestos

Question 65

granulomatous inflamation

Answer 65

basically a cellular attempt to contain an offending agent that is difficult to eradicate - walls it off

Question 66

what are the 2 types of granulomatous inflammation?

Answer 66

caseous - turning to cheese meaning necrosis present non caseous

Question 67

examples of granulomatous inflammation

Answer 67

``` Tb (caseating) syphilis (gumma is CNS) sarcoidosis (noncaseating) leprosy (non) crohns (occasional caseation) ```

Question 68

cat scratch disease

Answer 68

granulomatous inflammation caused by bartonela hensalia from scratch of cat - produces huge lymph node