Epithelioid cells have an increased ability to:
secrete lysozyme
Caseous necrosis in granulomas caused by micro-organisms is related to:
a delayed type (Type IV) hypersensitivity reaction
Exudation refers to:
increased movement of fluid and proteins out of vessels due to increased permeability
Non-granulomatous chronic inflammation is seen with:
chronic viral infections
The two major components of the process of acute inflammation are:
vascular changes and cellular response
The increased blood flow into inflamed tissues is termed:
hyperemia
The synthesis of arachidonic acid metabolites is increased at inflammatory sites. T/F
true
Increased vascular permeability in inflammation will allow large protein molecules to leave the vascular space. These include:
a. albumin
b. fibrinogen
c. urea
b. fibrinogen
Persistence of an antigen or injurious stimulus will cause chronic inflammation to develop. T/F
true
In acute inflammation, the term 'pavementing' refers to the tendency for:
leucocytes to adhere to vessel walls
The marked active dilation of vessels in acute inflammation is due to:
release of chemical mediators by damaged cells
The fever associated with acute inflammation is a result of:
mediators such as interleukin-1 and prostaglandins causing a 'resetting' of core temperature
Neutrophil diapedesis is assisted by:
enlarged endothelial pores
The process by which certain inflammatory cells ingest and destroy particulate matter is termed:
phagocytosis
The type of inflammatory cell with the greatest role in inflammation is the:
Neutrophil
A focus of necrotic debris and dead neutrophils surrounded by a fibrous capsule is best termed:
abscess
The most common cause of osteomyelitis is:
bacterial seeding from the blood
Non-granulomatous chronic inflammation is characterized by sensitized lymphocytes, plasma cells and macrophages, together with:
areas of necrosis and fibrosis
Granulomatous inflammation is characterized by:
aggregation of activated (epithelioid) macrophages
Neutrophils leave capillaries in inflammation by the process of:
Diapedesis
In acute inflammation, leucocytes tend to 'stick' more to endothelial cells of the microvasculature. T/F
true
Neutrophils contain:
enzymes which can degrade biologic material
Exudate contains:
contains fluid, protein, and inflammatory cells
The specific movement of neutrophils toward a focus of inflammation is termed:
chemotaxis
The systemic fever response is a result of:
pyrogens influencing the hypothalamic thermoregulatory centre in the brain
Describe the composition of pus
degenerating neutrophils, plasma, tissue debris and dead microbes
The increased vascular permeability seen early in acute inflammation is primarily the result of:
widening of intercellular junctions between endothelial cells
Mast cells have an imporant role in inflammation because their granules release:
histamine
Fibrinous inflammation develops when:
vascular permeability has increased sufficiently to allow fibrinogen to leave the vessels
Opsonization refers to the:
enhanced recognition by leucocytes of injurious agents, due to coating with a variety of opsonins
Which of the following statements about acute inflammation is NOT true?
a) it is the first line of defense against an injury
b) the extent of the inflammatory reaction is proportionate to the degree of tissue damage
c) the leakiness of the vessels allows
c) the leakiness of the vessels allows fluids and proteins but not cells to escape
Septicemia refers to:
spread of bacteria and their toxins via the bloodstream
Relative to transudates, exudates are characterized by:
greater numbers of cells
The acute inflammatory process may cause an elevated number of:
white blood cells in the peripheral blood
The inflammatory mediators having the greatest role in the early phase of the acute inflammatory response are:
vasoactive amines (histamine and serotonin)
The cerebral plaque lesions of Alzheimer disease contain a specific type of amyloid. T/F
True
Amyloid depositions seen in a wide variety of body tissues in association with chronic inflammatory disease are termed:
reactive amyloidosis
Amyloid deposition in renal glomeruli is associated with:
protein loss in urine
Which of the following is a cause of non-granulomatous chronic inflammation?
a) foreign material such as talc or sponge fibres
b) chronic viral infections
c) chronic mycobacterial infections
b) chronic viral infections
Amyloid consists of:
a) insoluble beta-pleated fibrillar proteins
Which of the following statements is NOT true of granulomatous inflammation?
a) it develops when macrophages phagocytose an "indigestible" agent
b) an active B cell-mediated immune response must occur
c) it is characterized by the presence of epithelioid
b) an active B cell-mediated immune response must occur
The role of T cells in granulomatous inflammation is to:
produce lymphokines which inhibit macrophage migration
Non-granulomatous chronic inflammation is seen with:
chronic viral infections
Osteomyelitis is a classic example of:
chronic suppurative inflammation
A surgical sponge (gauze) mistakenly left in the abdominal cavity during surgery would cause:
foreign body granuloma formation
Tuberculosis is characterized by:
granulomatous inflammation in lungs or other tissues
Chronic inflammation is characterized by: (4)
1) immune response
2) macrophages
3) granulation tissue
4) ongoing tissue necrosis
The immune response is indicated by the presence of:
mononuclear cells (plasma cells, lymphocytes, etc)
tissue healing through the development of granulation tissue is characterized by:
tissue fibrosis and angiogenesis
desired outcome of inflammation:
healing and repair, so function of injured tissue can be restored (if possible)
___________ is the predetermined/non-specific response to injury, consisting of microcirculatory response and mobilization of phagocytic cell
acute inflammatory response
acute inflammation is characterized by: (symptoms) (5)
redness, heat, swelling, pain and loss of function
-itis" is used to describe:
areas of inflammation
What's the first line of defence against injury?
acute inflammatory response
The extent of inflammation is proportionate to:
the degree of tissue damage
Once inflammation develops, the progression towards resolution and healing begins:
~ immediately
Healing time depends on: (4)
1) cause/nature of injury
2) extent of injury, tissue affected
3) genetic make-up of an individual
4) status of immune system
During the acute inflammatory response, vessels ______ to ________ to area, and become ________ to allow_______ to leave circulation and enter injured site
dilate
increase blood flow
more permeable
plasma proteins
The cellular response to acute inflammation is:
leukocytes leave microcirculation and accumulate at injury site
swelling is caused by:
leakiness - fluid moves out of vessels and into tissue spaces
Active dilation of arterioles, capillaries and venules caused by:
the release of chemical mediators from damaged and necrotic cells
Chemical mediators, including ________ and ______, are released during platelet aggregation.
vasoactive amines and kinins
Histamine is a chemical mediator released by _______, that causes ______.
mast cells
capillary dilation
mast cells contain _________ that contain histamine.
membrane bound vacuoles ("granules")
injury or activation of mast cells leads to:
mast cell degranulation (releasing histamine)
Normally, ________ remain closed, causing blood to pass through tissues via _________ (directly from arteries to veins)
precapillary sphincters
"freeway" channels
Precapillary sphincters open and blood is diverted from freeway channels to perfuse tissues in response to:
increased metabolism
Increased capillary and venular permeability initially occurs because of ___________ between endothelial cells
widening of intercellular junctions
When selectively permeable membrane is damaged by inflammation, spaces between endothelial cells become wider (increased vascular permeability) and increased amounts of fluid and proteins will pass out of vessels, into extravascular space. This describes:
exudation
the fluid = exudate
causes of increased vascular permeability: (5)
1) endothelial cell contraction
2) direct injury to endothelium
3) leukocyte-mediated endothelial injury
4) increased transcytosis
5) leakage from newly forming blood vessels
Endothelial cell contraction (the widening of intercellular junctions) is a transient process occurring primarily in ______, which is mediated by _______ and ________.
venules
tumor necrosis factor (TNF) and interleukin-1 (IL-1)
direct injury to endothelium causes:
endothelial cell necrosis and detachment
Leukocytes release ________ and _________ that further endothelial cell injury and detachment
proteolytic enzymes and toxic oxygen species
_________ is the movement of fluid across endothelial cells via vesicles
transcytosis
The movement of fluid into interstitial space that causes blood to become more viscid, which causes blood to slow down. This describes:
stasis
_______ is the fluid that leaves vessels due to increased hydrostatic pressure OR that fails to return to vasculature due to low osmotic pressure
Transudate
(the ultrafiltrate of plasma)
Large plasma proteins that are able to leave vessels during increased vascular permeability (inflammation) include:
immunoglobulins, complement and fibrinogen
Specific gravity of exudate is _______ than transudate because of ________.
greater
increased protein content in exudate
Movement of large molecules from plasma into interstitium __________ effect of plasma proteins, which favours _________, furthering swelling.
decreases osmotic pressure
fluid remaining in interstitium
Transudate form with ______. Exudates form with ______.
normal vascular permeability
increased vascular permeability
transudate is turbid, yellow/white/pink. T/F
False
Exudate is turbid, yellow/white/pink
transudate is clear
______ is effusion into peritoneal cavity
ascites
______ is an inflammation of the peritoneum
peritonitis
_________ is a systematic diagnostic method used to identify an entity where multiple alternatives are possible (process of elimination)
differential diagnosis
a _________ is the final diagnosis made after getting results of tests
definitive diagnosis
The fluid that accumulates in ascites is:
transudate
exudate suggests the presence of:
inflammation
Benefits of exudation: (3)
1) dilutes offending agent
2) brings defensive proteins into area (immunoglobulins and complements)
3) increases drainage of area via lymphatics
-lymphatic drainage takes agents to local lymph nodes, where protective immune response is facilitated
Fibrin is synthesized from _______ precursor ______, in the ______.
plasma
fibrinogen
liver
Inactive fibrinogen in plasma contributes to:
plasma osmotic pressure
_______ converts fibrinogen to fibrin
thrombin
thrombin is formed from:
tissue thromboplastin
When formed, fibrin exists in _______ form. Then _________ converts it to ________ polymer, "fibrin", that aids neutrophil movement
monomeric
coagulation factor XIII
insoluble fibrillary
________ is lobar pneumonia in cattle, caused by infection with Mannheimia hemolytica bacteria, characterized by ________ production within lung and at pleural surface, where it causes ______ between pleura of lung and ribcage
Shipping fever
abundant fibrin
adhesions
Shipping fever occurs in:
cattle that have been stressed by transportation
Vascular changes in acute inflammation establish:
infrastructural transit system that allows inflammatory cells to reach site of injury
Acute inflammation is characterized by: (cellular response)
active emigration of inflammatory cells from blood into area of tissue injury
leukocytes (white blood cells) are derived from:
myeloid cell line within bone marrow
-move into blood stream when mature
2 "arms" of the myeloid cell line:
-mononuclear cells: smoothly outlined, round cells
- granulocytes: contain multi-lobulated nucleus and cytoplasmic granules
Most leukocytes, RBCs and platelets undergo differentiation within:
bone marrow
Neutrophils, basophils and eosinophils are:
granulocytes
Characteristics of neutrophils: (4)
-seen in greatest numbers in early inflammation (granulocyte with greatest role in acute inflammation)
- actively motile
- capable of phagocytosis
- contain enzymes that degrade biologic material
The main function of the neutrophil is:
phagocytosis of microorganisms
________ describes low neutrophil numbers, often seen as a side effect of cancer therapy with cytotoxic drugs or radiation
neutropenia
lymphocytes, plasma cells, monocytes and macrophages are:
mononuclear cells
Mononuclear cells are most important in __________ of inflammation
later (more chronic) stages
Monocytes in blood can migrate into tissues, and become fixed into:
macrophages
________ are the mononuclear cells with the greatest role in acute inflammation. They _______ and _______ .
macrophages
ingest microoganisms(phagocytosis) and help clear cellular debris (debridement)
Stasis disorders __________ within vessel causing leukocytes to move __________, increasing contact between leukocytes and ________. This is called _________.
normal laminar flow
out toward vessel wall
endothelium
margination
Marginated leukocytes "roll" along endothelial surface, transiently sticking in place. This is mediated by:
selectins
-up-regulated after stimulation by inflammatory mediator
Endothelial cells become "sticky", causing leukocytes to adhere to vessel wall. This process is called ________ and is mediated by _______.
pavementing/adhesion
integrins (on leukocyte surface, interact with ligands on endothelial cells)
Once adhered to endothelium, leukocytes squeeze out of vessel through intercellular junctions. This process is called:
diapedesis
Neutrophils are focally degraded by ________, enabling them to pass through basement membrane into tissue spaces. This occurs in __________.
secreted collagenases
venules in systemic circulation
diapedesis is mediated by:
cell adhesion molecules
_________ is the process by which inflammatory cells are attracted to injury sit by directional migration along chemical concentration gradient.
chemotaxis
chemical mediators that act as chemotactic signals in chemotaxis are: (4)
factor C3a, C5a, leukotriene and cytokines
_________ bind to receptors on leukocyte surfaces, leading to ________ and triggering assembly of intracellular contractile elements, that allow leukocytes to move by _________.
exogenous chemotactic molecules
increased intracellular calcium
extending pseudopods
________ must be activated for effector mechanisms to bear against invaders. They're activated by _______ released by inflammatory response.
leukocytes
cytokines
Leukocytes have surface receptors that recognize __________ on bacteria and pathogens
Pathogen-associated molecule patterns (PAMPs)
________ on leukocytes recognize PAMPs on viral, bacterial and fungal components.
Toll-like receptors
Opsonins, present normally in tissues, bind foreign substances and indirectly mediate leukocyte activation. This describes:
innate immunity
Because of innate immunity, introduction of a pathogen into tissue induces immediate response from leukocytes already in tissues without recognition and up-regulation of ___________
acquired immunity
initial activation of leukocytes in innate immunity leads to: (3)
1) phagocytosis
2) up-regulation of mechanisms for degradation and killing of microbes
3) production of inflammatory mediators
______ and ______ ingest/destroy particulate matter
neutrophils and macrophages
Neutrophils and macrophages undergo ________(large inert particles) or ________ (opsonized agents) of particulate matter
nonspecific or specific phagocytosis
-opsonization is the process of coating antigens in opsonins
-opsonins- antibody (IgG) or complement factor 3b (C3b)
______ are CHO-binding lectins in plasma that bind to microbial cell walls as opsonins
collectins
opsonization enhances:
phagocytosis
_______ phagocytosis dominates early acute inflammation, but when immune response develops ________ is more efficient.
nonspecific phagocytosis
immune phagocytosis
After opsonized particles are recognized and bound, they're _______, forming membrane-bound vacuoles within phagocytes cytoplasm, called _______.
engulfed
phagosome
Phagocytosis stimulates an increase in oxygen-dependant metabolism in leukocytes leading to the production of _________, which mediate pathogen destruction.
ROS (reactive oxygen species)
pathogens are further degraded by the fusion of the phagosome with ________, that release ________ to kill pathogens
lysosomes
hydrolase
________ give inflammatory exudate its cloudy/opaque appearance
inflammatory cells
Inflammatory mediators are __________ or formed when required
pre-formed and stored in cytoplasmic granules
__________, histimine and serotonin cause vasodilation and increased permeability, evoking __________ of the acute inflammatory response.
vasoactive amines (mediators)
the immediate phase
_________ are plasma-derived mediators initially activated by _________, a protein synthesized in the liver that circulates in plasma in inactive form - activated by endothelial injury. Activated form ___________.
plasma proteases
Hageman factor XII (XIIa = activated form)
cleaves protein substrates
In the kinin system, ________ enzyme converts precursor plasma protein into ________ that increases vascular permeability and mediates pain.
- Kallikrein (prod by XIIa from inactive plasma precursor prekallikrein)
bradykinin (the final product of the kinin system)
__________, initiated by XIIa, activates ________, ultimately leading to the production of fibrin.
the coagulation cascade
thrombin
________, released during the breakdown of fibrin, are chemotactic factors for _______, that increase vascular permeability.
fibrinopeptides
neutrophils
____ , formed in the compliment system, activates lipooxygenase pathway of the arachidonic acid metabolism and and is a phagocytosis activator
C5a
C3 and C5 are activated by:
proteolytic enzymes in inflammatory exudate
-their activation amplifies influx of neutrophils to the inflammatory site
___, ____, and _______ are important mediators of vascular permeability and pain
C3a, C5a, and bradykinin
Activated Hageman factor (XIIa) initiates: (4)
1) kinin system - producing vasoactive kinins
2) clotting system - inducing activation of thrombin, fibrinopeptides and factor X
3) fibrinolytic system - producing plasmin and deactivating thrombin
4) complement system - producing anaphylatoxins C3a and C
Roles of thrombin: (4)
1) cleaves circulating soluble fibrinogen and generates fibrin clot
2) binds to protease-activated receptors and enhances leukocytes adhesion
3) generate fibrinopeptides
4)cleaves C5, to generate C5a, linking coagulation with complement activation
______ generate toxic oxygen-based free radicals and protease
neutrophils
prostaglandin, leukotiene and lipoxin are produced in :
arachidonic acid metabolism
arachidonic acid metabolism is the target of:
anti-inflammatory agents
_________ is a phospholipid-derived inflammatory mediator, generated from cell membranes, by _________
Platelet-activating factor
phospholipase A2
cytokines (IL-1, TNF, etc) induce ______ and _______, and activate ______.
- endothelial activation
-systemic acute-phase responses (fever, lethargy, etc)
- tissue fibroblasts
Synthetic glucocorticoids (corticosteroids) can suppress/inhibit inflammation by:
by suppressing the immune response, by:
1) blocking conversion of cell membrane phospholipids to arachidonic acid
2) stabilizing lysosomal membranes of inflammatory cells, decreasing the release of enzymes/vasoactive amines
prednisone, dexamethasone and betamethasone are examples of:
corticosteroids
_________, like aspirin, ibuprofen or naproxen, inhibit conversion of of arachidonic acid to prostaglandins.
NSAIDs (non-steroidal anti-inflammatory drugs)
-anti-inflam and analgesic activity
__________ , fever-inducing agents, generated in acute inflammation, enter blood circulation at inflammation site and travel to brain, where they act at specific loci in hypothalamus, via prostaglandin synthesis, to reset body temperature
endogenous pyrogens
eg. interleukins, TNF, etc
________ increases with fever and decreases with hypothermia (not body temp)
metabolic rate
neuronal dysfunction and delirium occur at temperatures:
greater than 42.2�C
-death at ~43.3�C
Fever is good because it helps body combat infections by:
inhibiting some microorganism growth and by stimulating interferon production
neutrophilia:
increased neutrophil numbers
A ________ occurs when there's immature neutrophils in blood and indicates __________, reflecting extent of inflammation
left shift
heavy neutrophil demand
In acute viral infections, there's _______ (neutropenia) and _______ (lymphocytosis)
decreased neutrophils numbers
increased lymphocyte numbers
Leukocyte release from bone marrow is mediated by:
cytokines TNF and IL-1
In acute inflammation, increased acute phase reactant (plasma protein) levels is detected via:
increased erythrocyte sedimentation rate
___________ is the process of pus formation, resulting in a liquified mass of necrotic tissue, dead organisms, and neutrophils
suppurative/purulent inflammation
An ________ forms when an area of suppurative inflammation becomes "walled off" by fibrous tissue
abscess
If an abscess ruptures without draining enough, it may:
reform or remain as chronic inflammation
Chronic inflammation can progress from acute inflammation or:
arise directly in association with antigens, persistant injury or autoimmune disease
If an antigen persists for several days, _______, _______ and ______ accumulate at the site of inflammation.
activated T cells, plasma cells and macrophages
Immune response doesn't have time to develop in:
acute inflammation
____________ is characterized by aggregates of activated macrophages with scattered lymphocytes
granulomatous inflammation
_________ are activated macrophages with large foamy pale cytoplasms that are characteristic of chronic granulomatous inflammation
epithelioid cells
Granulomatous inflammation occurs when: (2)
1) causal agent is phagocytosed, but survives and persists within macrophages
2) phagocytosis of causal agent is impaired
Differential diagnoses for granulomatous inflammation: (5)
1) Atypical bacteria
2) fungal pathogens within tissues
3) parasites within tissues
4) inert foreign bodies
5) immune-mediated diseases
________ develops in patients with _________. It is characterized by nodular skin thickening and extensive tissue destruction, with disfiguring lesions on figures and face
leprosy
poor T cell responsiveness
Functional tissue around a granuloma is lost by ______ and replaced by _______.
necrosis
scar tissue
T cell mediated Type IV hypersensitivity causes central areas of:
caseous necrosis
When foreign materials that are inert, non-antigenic and indigestible enter tissues:
foreign body granulomas develop
- inert: doesn't elicit inflammatory response
- non-antigenic: doesn't elicit immune response
-indigestible: too large to be phagocytosed by single macrophage
Langhans giants cells have:
nuclei at periphery
_______ is inflammation caused by an ingrown hair/pimple, which occurs when immune system doesn't recognize keratin as a "self-protein
furunculosis
Any chronic inflammation NOT characterized by epithelioid cells =
non-granulomatous inflammation
characterized by: lymphocytes, plasma cells and macrophages scattered through affected tissue, along with areas of necrosis and fibrosis
Causes of non-granulomatous chronic inflammation: (5)
1) Chronic viral infections
2) other chronic infections
3) Chronic autoimmune disease
4) allergic conditions and parasitic infections
5) chronic toxic diseases
Chronic active", "recurring acute", "subacute" and "chronic suppurative" describe inflammation which has:
characteristics of BOTH chronic AND acute inflammation
Chronic suppurative inflammation develops when:
the body's unable to clear strong pyogenic stimulation
- pyogenic=pus producing
Initial injection of bacteria into subcutaneous tissues results in _______ that becomes exuberant, forming large pus pockets. If infection persists, body attempts to prevent infection spread by ______________, resulting in an abscess.
local suppurative inflammation (cellulitis)
walling damaged tissue off with granulation tissue
-abscesses are typically the result of pyogenic bacterial infection lasting > a week
Abscesses appear as roughly round ______ structures, with ________ walls and a central cavity filled with ______, ______ and sometimes_______.
cyst-like
thick white fibrous
large quantities of pus, necrotic debris
fibrin
Osteomyelitis results from infections with:
pyogenic bacteria
In ___________, bacteria enter through skin, subcutaneous tissues, GI tracts or umbilicus and are carried to bone by bloodstream
hematogenous osteomyelitis
_______ may occur 2� to implantation of bacteria into bone through open fracture site
2� osteomyelitis
________ progresses to chronic phase more often than other pyogenic bacterial infections
osteomyelitis
________ disrupt blood supply, causing bone ischemia, which results in the formation of a _________, a fragment of dead infected bone that persists despite attempts of inflammatory response to clear it out.
Subperiosteal abscesses
sequestrum
Chronic osteomyelitis is difficult to resolve because of destruction of local blood supply, which is necessary to: (2)
1) deliver leukocytes to destroy infection and clear bulk of necrotic tissue
2) deliver systemic antibiotics to infection site
-surgical debulking is often important for healing
_____ is caused by decreased transport of stored iron into plasma
anemia
-when hemoglobinization is inadequate
_______ refers to a group od diseases characterized by the deposition of insoluble protein in interstitium of tissues
amyloidosis
_______ is an amorphous eosinophilic �-pleated fibrillar protein
amyloid
3 most common amyloid forms:
1) serum amyloid-associated non-immunoglobulin protein - derived (AA-amyloid)
2) immunoglobulin light chain-derived amyloid (AL-amyloid)
3) A�-amyloid - characterize cerebral plaque lesions of alzheimers
3 classes of amyloidosis:
1)systemic
2) localized
3) familial
In 1� systemic amyloidosis, the formation of ______ amyloid is associated with ________ or ________.
AL-type
multiple myeloma
B cell dysfunction
______ is often associated with chronic inflammation produced in autoimmune diseases
2�(reactive) amyloidosis
Amyloid depositions seen in endocrine tumors are derived from:
peptide hormone precursor molecules
________ are inherited disorders in which amyloid is deposited locally in organs
familial amyloidosis