Pathophysiology 1

Front 1

A nonspecific but predictable response of living tissue to injury

Back 1

Inflammation

Front 2

It is a dynamic process, evolving through several phases which lasts from a few minutes to days or even months and years

Back 2

Inflammation

Front 3

Has a protective role and is generally beneficial to the body, but the side effects may be noxious (I.e. fever). Also the process may become uncontrollable, producing more harm than good. (Pulmonary TB elicits a protective tissue reaction than can erode pulmonary vessels, causing massive bleeding

Back 3

Inflammation

Front 4

Only occurs in living tissue

Back 4

Inflammation

Front 5

Forensically, __________ is considered to be a vital reaction: If histologic signs of _____________ are found in tissues recovered at autopsy, this indicates that the injury occurred before death because _____________ cannot develop postmortem

Back 5

Inflammation,Inflammation, Inflammation

Front 6

What are the five cardinal signs of inflammation:

Back 6

heat, redness, swelling, pain, loss of function

Front 7

This represents the body's first response to injury:

Back 7

changes in blood flow

Front 8

The relaxation of these allow blood to rush into capillaries after an injury and this accounts for redness, swelling, and warmth of tissue

Back 8

smooth muscle cells on precapillary arterioles

Front 9

This is a rupture along the natural or surgical suture lines. Can be a complicaiton of surgery that is secondary to poor healing

Back 9

wound dehiscence

Front 10

This results because formed elements are too large to pass through cell membranes but the plasma can, forming:

Back 10

blister

Front 11

The first response of arterioles to an injurious stimulus is ___________ , which lasts for a few seconds, and is then followed by vasodilatation, with the relaxation of the pre-capillary sphincters.
This results in flooding of the capillary network with arterial blood, with redness and swelling of the tissue.
The arterial blood is warm and is pumped into the area in large quantities, so the inflamed tissue also becomes warm (hyperemia).

Back 11

vasoconstriction

Front 12

An increase in blood flow to different tissue of the body:

Back 12

hyperemia

Front 13

This influx of blood also dilates the capillaries and venules, which consists of only an endothelial layer and basement membrane, and therefore cannot actively regulate the incoming blood flow.
The increased pressure in the capillaries and venules forces plasma filtration through the vessel wall, leading to edema.
This causes the blood flow in the dilated capillaries and venules to be slow, due to the increased hemoconcentration, and leads to congestion

Back 13

hemoconcentration

Front 14

Sludged erythrocytes form stacks, called “_______” formation, which impedes and slows down the circulation even more

Back 14

Rouleux

Front 15

When WBCs marginate and become attached to the edge of the endothelium:

Back 15

Pavementing

Front 16

During this process, leukocytes develop elongated protrusions on their surface cytoplasm and become sticky, which allows them to adhere to the endothelial cells lining the capillaries and venules.

Back 16

Pavementing

Front 17

Adhesion is accomplished by surface adhesion molecules, which are normally present on leukocytes (neutrophils) and endothelial cells in an inactive form.
During inflammation, the surface components of leukocytes and endothelial cells are activated by soluble mediators of inflammation, the best known are the _________, normally present in the blood

Back 17

Interleukins

Front 18

The greatest concentration of Interleukins is at the site of inflammation, derived in part from ________ and in part from leukocytes.

Back 18

platelets

Front 19

The adhesion of __________ to the endothelial cells is one of the most important triggers for the release of mediators of inflammation.

Back 19

leukocytes

Front 20

________ initiate clotting, which ultimately lead to the formation of fibrin strands that anchor the leukocytes to the vessel wall and prevent them from moving away.

Back 20

Platelets

Front 21

The increased permeability of the vessel walls of the capillaries and venules lasts for several hours to several days and is usually accompanied by leakage of fluid from the vessels into the interstitial spaces.
This process is called “__________” and typically accounts for the formation of Edema, which is rich in protein, but contains few cells.

Back 21

Transudation

Front 22

There is an important distinction between transudates and exudates. Transudates are caused by disturbances of hydrostatic or colloid osmotic pressure, not by __________. Medical distinction between transudates and exudates is through the measurement of the specific gravity of extracted fluid. Specific gravity is used to measure the protein content of the fluid. The higher the specific gravity, the greater the likelihood of capillary permeability changes in relation to body cavities. For example, the specific gravity of the transudate is usually less than 1.012.

Back 22

inflammation

Front 23

This is the hallmark of acute inflammation:

Back 23

neutrophils

Front 24

________ contains much more protein than transudates, and contains inflammatory cells that emigrate across the vascular wall.
In acute inflammation, most of the cells are neutrophils (PMN’s).

Back 24

Exudate

Front 25

As the inflammation evolves, PMN’s are joined by other cells, such as ________, which becomes apparent within the first 24 hrs

Back 25

monocytes

Front 26

In common parlance, the term polymorphonuclear leukocyte often refers specifically to ___________ granulocytes, the most abundant of the granulocytes.

Back 26

neutrophil

Front 27

Granulocytes or PMN are released from the _________ by the regulatory complement proteins.

Back 27

bone marrow

Front 28

__________ are circulationg cells that only have life span of a few hours, same as macrophage, except macrophages are found at tissues and do not circulate.

Back 28

monocytes

Front 29

As the inflammation proceeds into chronic stages, the PMN’s, which have a life span of 2-4 days only, become less prominent and are replaced by ___________, __________, and ____________.

Back 29

macrophages, lymphocytes, and plasma cells

Front 30

An accumulation of pus in an enclosed tissue space is known as an _________

Back 30

abscess

Front 31

A visible collection of pus within or beneath the epidermis is known as a pustule or ________.

Back 31

pimple

Front 32

Something that creates pus is called suppurative, _________, or __________.

Back 32

pyogenic, purulent

Front 33

Something that creates mucus as well as pus, it is called _________:

Back 33

mucopurulent

Front 34

Dr. Fish considers staph aureous & strep pyogenese to be:

Back 34

two bastards

Front 35

Emigration of Leukocytes
1. ______________________ .
2. Insertion of cytoplasmic pseudopods between the junctions of the endothelial cells.
3. Passage through the basement membrane.
4. Ameboid movement away from the vessel toward the cause of the inflammation (I.e. bacteria)

Back 35

Adhesion of PMN’s to the endothelium

Front 36

Emigration of Leukocytes
1. Adhesion of PMN’s to the endothelium.
2. _______________________.
3. Passage through the basement membrane.
4. Ameboid movement away from the vessel toward the cause of the inflammation (I.e. bacteria)

Back 36

Insertion of cytoplasmic pseudopods between the junctions of the endothelial cells

Front 37

Emigration of Leukocytes
1. Adhesion of PMN’s to the endothelium.
2. Insertion of cytoplasmic pseudopods between the junctions of the endothelial cells.
3. ______________________.
4. Ameboid movement away from the vessel toward the cause of the inflammation (I.e. bacteria)

Back 37

Passage through the basement membrane

Front 38

Emigration of Leukocytes
1. Adhesion of PMN’s to the endothelium.
2. Insertion of cytoplasmic pseudopods between the junctions of the endothelial cells.
3. Passage through the basement membrane.
4. ______________________________ (I.e. bacteria)

Back 38

Ameboid movement away from the vessel toward the cause of the inflammation

Front 39

Leukocytes secrete proteases that degrade the basement membrane, allowing them to escape the blood vessel – a process known as ___________:

Back 39

diapedesis

Front 40

Active movement of PMN’s along a concentration gradient is called “________”, the chemoattractant being derived from bacteria or tissues destroyed by inflammation, or from activated __________.

Back 40

chemotaxis, complement

Front 41

Chemotactic substances stimulate ________ to move along this gradient until they reach their source or site of the inflammation.

Back 41

PMNs

Front 42

PMN’s that reach the bacteria or other sources of chemotactic substances lose their mobility and begin acting as scavengers by the process of “___________”.

Back 42

phagocytosis

Front 43

A PMN encounters and recognizes a bacterium as foreign by the _________ extending from the surface of the PMN.

Back 43

psuedopods

Front 44

Macrophages, monocytes, dendritic cells, and granulocytes are all capable of:

Back 44

phagocytosis

Front 45

Recognition is followed by attachment of the cell membrane of the PMN to the bacterial cell wall.
The attachment can be facilitated by immunoglobulins or complement which act as __________.
Many leukocytes have receptors for __ complement and the Fc portion of immuno-globulin which mediate contact with bacteria.

Back 45

opsonins, C3

Front 46

An _________ is any molecule that acts as a binding enhancer for the process of phagocytosis

Back 46

opsonin

Hint 46

o

Front 47

Engulfment of the bacterium is a process by which the cytoplasm of the PMN surrounds the foreign particle and encloses it into an invagination of the cell membrane.
Inside the phagocytic vacuole, the bacterium is killed by _________ substances released from the cytoplasm of the PMN

Back 47

bacteriocidal

Hint 47

b

Front 48

Inflammation can be classified in clinical practice according to the duration, etiology, and location.
DURATION: Acute inflammation lasts from a few hours to a few days and usually the infections are mediated by ________ and _______.

Back 48

PMNs and fibrin

Hint 48

P an f

Front 49

Chronic inflammation is usually mediated by ________, ________, _________ and can appear shortly after an acute inflammation.

Back 49

lymphocytes, macrophages, and plasma cells

Hint 49

l, m, pc

Front 50

Some chronic infections evolve without a typical ________ phase and represent a slow-smoldering process from their onset (I.e. TB has a gradual onset and lasts for a long time, but without an ________ phase of the disease).

Back 50

acute, acute

Hint 50

a, a

Front 51

________ are indicative in viral infections and ________ are indicative in bacterial infections:

Back 51

mononuclear cells, PMNs

Hint 51

m, P

Front 52

Chronic inflammation also develops in response to foreign substances; persons exposed to silica dust develop chronic lung silicosis, which does not have an acute phase.
_________ diseases, such as Rheumatoid Arthritis, are also characterized by a chronic course, although these diseases tend to have _______ and _________- .

Back 52

autoimmune, recrudescence's and exacerbations

Hint 52

AI, re and ex

Front 53

____________ is the reappearance of a disease after it has been quiescent.

Back 53

recrudescence

Hint 53

r

Front 54

Inflammations are mostly caused by _________ pathogens, or they may be caused by chemical, physical, or immune factors.
Many inflammations are a combination of many different causes (I.e. Thermal burns, which are physical inflammations, may be complicated by a secondary bacterial infection).

Back 54

infectious

Hint 54

i

Front 55

Inflammation may be localized or widespread.
A boil or furuncle is a localized skin infection, but ____________ boils occur in people with a reduced resistance to bacterial infections

Back 55

disseminated

Hint 55

d

Front 56

_____ or ________ is a skin disease caused by the inflammation of hair follicles, thus resulting in the localized accumulation of pus and dead tissue. Individual boils can cluster together and form an interconnected network of boils called _________.

Back 56

boil or furuncle, carbuncle

Hint 56

b or f, c