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SURGERY > SYSTEMIC RESPONSE TO INJURY > Flashcards

SYSTEMIC RESPONSE TO INJURY Flashcards

1
Q

occurs as a
consequence of the local or systemic release of
“damage-associated” molecules to mobilize the
necessary resources required for the restoration
of homeostasis

A

inflammatory response

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2
Q

Traumatic injury activates the innate immune
system to produce a __________ in an attempt to limit damage
and to restore homeostasis.

A

systemic inflammatory

response (SIR)

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3
Q

2 GENERAL RESPONSES (CELLULAR INJURY)

A

acute proinflammatory response

anti-inflammatory response

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4
Q

Systemic inflammatory response (SIRs)
is achieved clinically by two or more of
the following criteria:

A

■ If you have hypothermia or
hyperthermia
■ Tachycardia or Tachypnea
■ Abnormal WBC count

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5
Q

Endogenous molecules that are produced as
a consequence of tissue damage or cellular
stress

A

DAMAGE- ASSOCIATED MOLECULAR PATTERNS

(DAMPS) OR ALARMINS

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6
Q

DAMPS interact with immune and
non immune cell receptors to initiate a
“______” systemic inflammatory response
following severe traumatic injury.

A

Sterile

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7
Q

In many cases, DAMP molecules are sensed by
______, which
are the same receptors that cells use to sense
invading pathogens.

A

pattern recognition receptors (PRRs)

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8
Q

Identifiable source of microbial insult

A

Infection

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9
Q

In SIRS, 2 or more of the following criteria are met:

Temperature:____
Heart rate:_______
Respiratory rate:____
PaCO2:_____

A
  1. ≥38c (100.4F) or ≤36C (96.8F)
  2. ≥90 beats per minute
  3. ≥20 breaths per minute
  4. ≤32 mmHg
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10
Q

Identifiable source of infection + SIRS

A

Sepsis

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11
Q

Sepsis + organ dysfunction

A

Severe sepsis

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12
Q

Sepsis + Cardiovascular collapse

A

Septic shock

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13
Q

Released passively from damaged or necrotic
cells and is detected rapidly in the circulation
within 30 minutes post injury.

A

HIGH-MOBILITY GROUP PROTEIN B1

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14
Q

In particular, HMGB1 binding to TLR24 triggers
the proinflammatory cytokine release that
mediates____

A

“sickness behavior”

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15
Q

activation of TLRs mainly occurs in ____

A

myeloid

cells

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16
Q

Acute Lung Injury (ALI) is caused by ____ in

Traumatic Brain Injury (TBI)

A

HMGB1

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17
Q

can act as
DAMPs by triggering an inflammatory response
to necrosis and cellular stress.

A

Mitochondrial proteins and/or DNA

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18
Q

Leaked from damaged mitochondria, leads both
to inflammasome activation and activation of the
_______

A

stimulator of interferon gene pathway (STING)

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19
Q

Function as molecular chaperones to monitor
and maintain appropriate protein folding,
physiological seen in our cytoplasm which
discard improperly folded proteins

A

HEAT-SHOCK PROTEINS

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20
Q

Surface and cytoplasmic receptors that sense
DAMPS and mediate the innate immune
response

A

PATTERN RECOGNITION RECEPTORS (PRRS)

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21
Q

Classes of receptors that are important for
sensing damaged cells and cell debris / DAMPs
which are the same receptors that cells use to
sense invading pathogens

A

PATTERN RECOGNITION RECEPTORS (PRRS)

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22
Q

molecularly diverse group of molecules that
share a conserved mode of action defined by
complement activation, agglutination and
neutralization, and opsonization

A

SOLUBLE PATTERN RECOGNITION MOLECULES: THE

PENTRAXINS

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23
Q

short pentraxin; first PRM to be

identified

A

C-REACTIVE PROTEIN (CRP

24
Q

has 51% sequence similarity to human
CRP, also contains the pentraxin
molecular signature

A

SERUM AMYLOID PROTEIN (SAP)

25
Q

A long pentraxin family member, in the
“sterile” inflammatory response
associated with cellular stress

A

PENTRAXIN 3 (PTX3)

26
Q

CNS receives information with regard to
injury-induced inflammation via _____ as well as direct neural projections
that transmit information to regulatory areas in
the brain

A

soluble

mediators

27
Q

NEUROENDOCRINE RESPONSE TO INJURY

A

● Hypothalamic-Pituitary-Adrenal Axis

● Sympathetic nervous system

28
Q

HYPOTHALAMIC- PITUITARY- ADRENAL AXIS (pathway)

A

Injury → Circulating cytokines or direct neural
input via vagal fibers → hypothalamus →
corticotropin-releasing hormone (CRH) release
→ anterior pituitary → ACTH release → zona
fasciculata of the adrenal glands →
glucocorticoids release

29
Q

Major glucocorticoid in humans, with

anti-inflammatory actions

A

CORTISOL

30
Q

atrophic adrenal glands

caused by exogenous steroid administration

A

Adrenal insufficiency

31
Q

exaggerated proinflammatory response
associated with a blunted adrenocortical
response

A

Critical illness-related corticosteroid

insufficiency (CIRCI)

32
Q

Counteract the anti-inflammatory activity of

glucocorticoids

A

MACROPHAGE MIGRATION INHIBITORY FACTOR

33
Q

Expressed by the pituitary gland that has both

metabolic and immune-modulatory effect

A

GROWTH HORMONE

34
Q

Insulin enhances enhanced hepatic synthesis of

________

A

insulin-like growth factor-1 (IGF-1)

35
Q

Anabolic growth factor that is known to improve
the metabolic rate, gut mucosal function, and
protein loss after traumatic injury

A

INSULIN-LIKE GROWTH FACTOR-1 (IGF-1)

36
Q

T or F
IGF-1 is decreased in critical illness, leading to a
catabolic state

A

True

37
Q

appetite stimulant that is secreted by the

stomach

A

GHRELIN

38
Q

Ghrelin is a natural ligand for _____

A 
GH-secretagogue
receptor 1a (GHS-R1a)
39
Q

T or F
low ghrelin levels were a positive predictor of
ICU-survival in septic patients

A

False

40
Q

are
hallmarks of injury and critical illness due to the
catabolic effects of circulating mediators,
including catecholamines, cortisol, glucagon,
and growth hormone.

A

Hyperglycemia and insulin resistance

41
Q

A mineralocorticoid released by the zona

glomerulosa of the adrenal cortex

A

ALDOSTERONE

42
Q

T or F
Aldosterone also gives positive feedback to
anti-inflammatory effects by inducing
pro-inflammatory cytokines.

A

False

-negative feedback

43
Q

are small molecules that are
highly reactive due to the presence of unpaired
outer orbit electrons

A

Reactive oxygen and nitrogen species (ROS,

RNS, respectively)

44
Q

Reactive oxygen and nitrogen species (ROS,

RNS, respectively)-These are commonly known as ____

A

Free radicals

45
Q

a way of disposing of
damaged organelles and debris aggregates,
ROS

A

AUTOPHAGY

46
Q

Autophagy is stimulated by Th1 cytokines with
activation of TLR in macrophages but is
inhibited by________

A

Th2 cytokines

47
Q

Mechanism for clearing senescent or
dysfunctional cells without promoting an
inflammatory response

A

APOPTOSIS

48
Q

the side effects of too much cortisol and growth hormone

A

insulin resistance and hyperglycemia

49
Q

Aldosterone reduces expression of the insulin-sensitizing factors which contribute to ________________

A

insulin resistance

50
Q

ROS has also been shown to have important roles as signaling messengers, particularly in the immune system through their ability to modulate________

A

cysteine residues by oxidation

51
Q

Provides negative feedback for ROS synthesis

A

Pyruvate kinase

52
Q

Important proteins involved in the unfolded protein response are:

A

IRE1, PERK, ATF6

53
Q

Neutrophil apoptosis is inhibited by _______

A

Inflammatory products

54
Q

Is activated through the binding of death receptors, which leads to the recruitment of Fas-associated death domain protein and subsequent activation of capsase 3

A

Extrinsic pathway

55
Q

proceeds through protein mediators that influence mitochondrial membrane permeability

A

Intrinsic pathway

(Increased membrane permeability leads to the release of mitochondrial cytochrome c, which ultimately activates caspase 3 an thus induces apoptosis)

56
Q

Difference between apoptosis and necroptosis

A

Necroptosis- nucleus of the cell remains intact

57
Q

Form of regulated cell death that is dependent on the activity of the proinflammatory caspase enzyme associated with inflammasome

A

Pyroptosis

SURGERY (6 decks)

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