Sytemic Inflammation: Yankee

Question 1

which of the following substances are most likely to be recognized by toll-like receptors?
a. antibodies
b.C5a
c. Chemokines
d HIV gag peptide
e. Lipopolysaccharide

Answer 1

e. Lipopolysaccharide: found in a lot of gram negative bacteria and will be recognized (LPS) by an antigen receptor but not a pattern recognition receptor

A. antibodies: created by

Question 2

which of the following molecules is an acute phase reactant?

antibody
C-reactive protein
IFN-I
NKG2D
TLR5

Answer 2

C-Reactive Protein: things that are produced by liver in response to inflammation.

WRONG:
IFN-1: includes interferon alpha and interferon beta; not much known about the difference between the two; available in drugs
IFN-2: interferon gamma

Question 3

relevant labs if you are thinking infection

Answer 3

CBC (WBC, Hct, RBS, Hgb, MCH, MCV, Platelet, Neutrophils–infection, Lymphs, Monos, Eos, Baso, Bands–immature neutrophils indicating young infection)

blood culture

C-reactive protein: measures inflammation
ESR: Erythrocyte Sedimentation Rate; rate at which the RBCs settle in westergren tubes. Acute phase reactants cause higher sedimentation rate because RBCs clump, rate can also increase in anemia which fewer RBCs

Question 4

Difference between C Reactive Protein Test and Erythrocyte Sed Rate

Answer 4

CRP: good for acute inflammation, disease progression, more SENSITIVE but less specific for low-grade inflammation, wide range of values, NOT affected by size/shape/number of RBCs

ESR: not very useful for dx of acute inflam, very useful for monitoring disease progression, more SPECIFIC less sensitive for low-grade inflammation, limited range of values, YES affected size/shape/number of RBCs

Question 5

22 yo male, low BP, high HR, was working and crushed leg, bleeding was contained. Which molecule is directly responsible for continued low BP?

Answer 5

TNF-alpha; when you have vasodilate on a large scale the BP will decrease.

Question 6

Pathogenesis of inflammatory response

Answer 6

pathogen breaches–>PAMP–>Pattern Recognition Receptor–> Cells that receive this signal (Neutrophil, Macrocytic cells, Dendritic cells (main fx to present antigen to lymph node), endothelial cells)–> Danger Signals (cytokines mainly produced by Macrophages)

Question 7

Types of cytokines that are made as part of the danger signal and their individual fx.

Answer 7

1. ) IL-1–initiate fever
2. ) TNF, IL-6–travel to liver and initiate acute phase reactants (CRP, fibrinogen. complement); also act on endothelial cells to cause vasodilation and increase in permeability and neutrophils get recruited

3.) Chemokines

Question 8

Standard and Experimental therapies for pt. with infection

Answer 8

Standard: broad spectrum antibiotics, fluids, oxygen if O2sat low

Experimental: steroids in cases when dealing with vital organs in spite of being Tcell inhibitors but if the pt. isn’t breathing in case of pneumonia for example.

Question 9

What would happen if pt. comes in with infection having progressed significantly?

Answer 9

could go into shock, BP drop, lose fluids

AV shunting, DIC.

Question 10

SIRS vs. Sepsis vs. Septic Shock

Answer 10

SIRS: systemic inflammatory response system; not necessarily in the presence of inflammation; ex: autoimmune disorders, pancreatitis, vasculitis, thromboembolism, burns, surgery

Sepsis: life-threatening organ dysfunction caused by dysregulated host response to infection

Septic Shock: Vasodilatory or distributory shock charac by endothelial cell activation, tissue edema, disseminated intravascular coagulation, metabolic derangements, that can lead to organ failure and death