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227 Cards in this Set
- Front
- Back
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What is the process by which WBC are driven out of blood stream to tissues ? |
Inflammation |
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If WBCs are driven out then what type of inflammation is it ? |
Acute |
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If lymphocytes are driven out then what type of inflammation is it ? |
Chronic |
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Acute inflammation is characterized by presence of what two things in tissue ? |
Edema Neutrophils |
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Acute inflammation arises in response to which two things ? |
Infection Tissue necrosis |
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Acute inflammation has : ------ response -----specifity ----- immunity |
Immediate Limited Innate |
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What are the five mediators of acute inflammation ? |
Toll like receptors Arachnoid acid metabolites Mast cells Complement Hegeman factor |
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What is the location of toll like receptors ? |
On cells of innate immune system (Mac and dendritic ) |
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Till like receptors are activated by ? |
Pamps |
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Example of toll like receptors ? |
Cd14 (TLR) |
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TLR Activation leads to ? |
Up regulation of NF kapa B |
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NF kapa b activates? |
Immune response that produces immune mediators |
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AA is released from ? By what ? And then acted upon by? |
Phospholipid cell membrane Phospholipase A2 Cyclopxygenase or 5-lipo oxygenase |
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Cyclo oxygenase produces ? |
PG |
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PG I2, D2, E2 mediate ? |
Vasodilation and increase vascular permeability |
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PG E2 also mediates ? |
Pain and fever |
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5- lipooxygenase produces ? |
Leukotrines |
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LT B4 attract and activate ? Along with ? |
Neutrophils c5a, IL8 and bacterial products |
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LTc4,LtD4,LTE4 mediate ? |
Vasoconstriction Bronchospasm Increased vascular permeability |
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Mast cells Are activated by? |
Tissue trauma Complement proteins C3a and C5A Cross linking of cell surface IgE by antigen |
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Imdiate response of mast cells involves release of preformed ----granules . Which mediate ? |
Histamine Vasodilation and increase vascular permeability |
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Delayed response of mast cells involves production of ? |
AA metabolites like leukrotrines |
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proinflammatory serum proteins that complement inflammation are called? |
complement |
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complement circulate as active precursors, activation occurs via which 3 pathways? |
classical pathway alternative pathway mannose binding lectin pathway |
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in classical pathway, ____ binds ___&____ that is bound to Antigen |
c1 igG and iGm |
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in ____ pathway, microbial products directly activate complement |
alterntive |
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in MBL pathway, ____ binds to mannose on micro-orgranisms and activate complement |
MBL |
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all pathways result in production of _______ |
c3 convertase |
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c3 convertase mediates ___>>>____ and ____ |
c3 c3a and c3b |
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c3 convertase produces ____ |
c5 convertase |
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c5 convertase mediates ____>>>____&___ |
c5 c5a and c5b |
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what complexes with c6-c9 to form _____? |
c5b MAC |
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----&----- are anaphylatoxins they trigger mast cell degranulation, resulting in histamine medicated vasodilation and increased vascular permeability |
c3a and c5a |
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what is chemotactic for neutrophils ? |
c5a |
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what is opsonin for phagocytosis? |
c3b |
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what lyses microbes by creating a hole in cell membrane? |
MAC |
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what is an incative proinflammatory protein? |
hageman factor (factor XII) |
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hageman factor is produced in/? |
liver |
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hageman factor is activated upon exposure to ? |
subendothelial or tissue collagen |
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hageman factor activaites what 3 systems? |
coagulation and fibrinolytic complement kinin system |
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kinin system cleaves what to what? |
high molecular weight kininogen to bradykinin |
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kinin system mediates?? |
vasodilation and increased vascular permeability pain |
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other names for? redness warmth swelling pain |
rubor calor tumor dolor |
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redness and warmth occurs due to ? mediators? |
vasoldilation histamine, prostaglandins, bradykinin |
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swelling is due to ? mediators? |
leakage of fluid from postcapillary venules into interstitial space histamine, tissue damage |
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in pain, which 2 things sensitize sensory nerve endings? |
bradykinin and PGE2 |
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in fever, ___ cause macrophages to release ___&____, which increase cyclo-oxygenase activity in hypothalamus. |
pyrogens iL1 and TNF |
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increased ____ raises temperature set point |
PGE2 |
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what are the 7 stages of neurtophil arrival and function? |
margiantion rolling adhesion transmigration and chemotaxis phagocytosis destruction of phagocytosed material resolution |
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in margination, what slows blood flow? |
vasodilation |
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in margination, cells marinate from ------to _____ |
Centre periphery |
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in rolling, ____(speed bumps) are upregulated on endotherlial cells |
selectin |
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p-selectin is released from ? and is mediated by ? |
weibel palade bodies histamines |
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e-selectin is induced by ? |
TNF and iL1 |
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selectins bind _____ on leukocytes? |
sialyl lewis x |
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cellular adhesion molecules are called? |
CAMs such is Icam and Vcam |
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cellular adhesion molecules are upregulated by endothelium by ___&___ |
TNF and iL1 |
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integrins are regulated on leukocytes by ___&____ |
C5a and LTB4 |
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interaction between CAMs and integrins result in firm adhesion of ___ to vessel wall. |
leukocytes |
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an autosomal recessive defect of integrins (c18 subunit) |
leukocyte adhesion deficiency |
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clinical features of leukocyte adhesion defiency? |
delayed separation of umbilical cord increased circulating neutrophils recuurent bacterial infection without pus |
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leukocytes transmigrate across the endotheliu and move toward chemical attractants using ? |
PECAM 1 |
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neutrophils are attracted by? hint: clik? |
bacterial products c5a ltb4 il-8 kallikrein |
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phagocytosis is enhanced by? |
opsonis (igG and c3b) |
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a protein traffickign defect characterized by impaired phagolysosome formation |
chediak higashi syndrome |
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clinical features of chediak higashi syn? (6) |
increased risk of pyogenic infection neutropenia giant granules in leukocytes defective primary hemostasis albinism peripheral neuropathy |
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what type of killing is most effective mechanism of phagocytosed material? |
oxygen dependent |
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____ generated by oxidative burst in phagolysosome destroys phagocytosed microbes |
HOCl |
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oxygen is converted to o2' by? |
nadph oxidase |
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o2' is converted to h2o2 by ? |
superoxide dismutase |
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h2o2 is converted to hocl by? |
mpo |
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disease characterized by poor oxygen depdenet killing? |
CGD |
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what is defective in CGD? |
nadph oxidase |
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what are the 2 features in CGD? |
recurrent infection granuloma formation |
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granuloma fromation in CGD is with catalse postive organisms such as ? |
s-aureus pseudomonas cepacia serratia macrescens nocardia aspergillus |
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name of the test use to screen for CGD? |
nitroblue tetrazolium test |
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leukocytes turn blue if ___ can convert oxygen to O2' but remain colorless if nadph is defective |
nadph oxidase |
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defiency of what results in conversion of h2o2 to hocl |
MPO deficiency |
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in mpo deficicncy, there is increased risk of ___ infection |
candida |
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in mpo def, nbt is ? |
normal |
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true or false? most bacteria naturally produce h202>> hocl but catalase positive done have this pathway either? |
true |
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__ occurs when neutrophils undergo apoptosis within 24 hours |
resolution |
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macrophages are dervied from? |
monocytes |
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macrophages ingest organisms via? and destroy the phagocytosed material by? |
phagocutosis lysozyme |
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how do macrophages manage the next step ?(4) |
reolution and healing continued acute inf abscess chronic inf |
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in resolution , anti inf cytokines are produced such as? |
il10 and tgf beta |
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continued acute inf is marked by ___ formation and ___ recruits additional neutrophils |
pus il-8 |
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marcrophages mediate fibrosis via? |
fibrogenic growth factor and cytokines |
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chronic inf activate ____, which secrete ___ |
cd4t cytokines |
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chronic inf is characerized by ___ and ___ in tissue? |
lymphcotyes plasma cell |
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chronic inf is ___ response ___ immunity |
delayed adaptive |
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most common cause of chronic inf is ? |
persitent infection |
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t-lymphocytes are produced in ? |
bone marrow |
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t lymphocytes are produced in bone marrow as ? |
progenitor t-cells |
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t-lymphocytes further develop where? and become __ or ___ |
thymus CD4 helper t cells or CD8 cytotoxic t cells |
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what do T cells use for antigen surveillance? |
TCR complex |
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TCR complex includes___ &____ |
TCR and CD3 |
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TCR complex recognizes ____ presented on MHC molecules. |
antigen |
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CD4+ t cells and CD8+ t cells use which class of MHC molecule? |
class 2 class 1 |
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in CD4+ activation, extracellular antigen is phagocytosed and presented to MHC 2, which is expressed by? |
Antigen presenting cell |
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___ on APC binds ____ on CD4 helper t cells providing the second activation signal |
b7 CD28 |
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activated cd4 t cells secrete? and help what? and divided into which 2 subsets? |
cytokines inflammation th1 and th2 |
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th1 subset secrets ? |
il2 and ifn gamma |
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th2 subset secrete ? |
il4, il5 and il10 |
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il 2 functions? |
cd8 t cell activator t cell growth |
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gamma interferon functions are? |
macrophage activator inhibits th-2 |
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function of il4? |
helps class switching to igG and igE |
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function of il5? |
eosiniphil activation and chemotaxis maturation of b cells to plasma cells class switching to igA |
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function of il10? |
inhibits th-1 |
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in cd8 t cell activation, intracellular antigen is presented to ___, which is expresssed by all nucleated cells and platelets |
mhc class 1 |
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what provides the second activation signal from cd4+th1 |
il-2 |
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cytotoxic t cells kill via which 2 processes? |
secretion of perforin and granzyme and expression of Fas L |
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both these processes activate what? |
apoptosis |
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immature B cells are produced in ? to become ? and express what? |
bone marrow naive B cells surface igM and igD |
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b cell activation occurs via, Ag bonding by surface ___ and ___ results in maturation to ? |
igM or igD maturation to igM or igD secreting plasma cells |
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b cell activation also occurs via, b cell antigen presentation to ___ cells via MHC class 2 |
CD4 helper t cells |
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in b cell antigen presentation to CD4 helper t cells , CD40 receptor on B cells binds CD40L on _____ cell, providing second activation signal. helper t cell secretes ___ and ___ |
helper t il4 and il5 |
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il4 and il5 functions? |
mediate b-cell isotype switching hypermutation maturation to plasma cells |
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granulomatous inflammation is characterized by ? |
granuloma |
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two types of granulomatous inflammation? |
caseating and noncaseating |
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noncaseating granulomas lack ? |
central necrosis |
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common etiologies of non ceasating granu? |
reaction to foreign material sarcoidosis beryillium exposure crohn disease cat scratch disease |
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caseating granulomas have? |
central necrosis |
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caseating granulomas are characterics of which 2 diseases? |
TB fungal infections |
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defining feature of granulomatous inflammation is ? |
epitheloid histiocytes |
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histoligcal landmark of ulcerative colotis is ? |
crypt absecces |
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in the formation of granuloma, macrohphages process and present antigen via ____ to ____ cells. interaction leads macrophages to secrete?? inducing CD4+ helper t cells to differentiate into ____ subtype? th-1 cells secrete ____ which converts macrophages to ____ |
mhc class 2 to cd4 helper t cells il12, th-1 ifn-gamma, epitheloid histiocytes |
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failure of the third and fourth pharyngeal pouches development is called which disease? |
digerorge syndrome |
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digerorge syndrome is due to microdeletion of what? |
22q11 |
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digeorge syndrome presents with ? |
t-cell deficiency hypocalcemia abnormilities of heart, great vessels and face |
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which is there tcell deficiency? |
because of lack of thymus |
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where is there hypocalcemia? |
because of lack of parathyroids |
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in severe combined immunodeficiency, there is defective ___ and ___ immunity |
cell mediated humoral |
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causes of SCID? |
cytokine receptor defects adenosine deaminase deficiency MHC class 11 deficiency |
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cytokine signaling is important for proliferation and maturation of which 2 cells |
b and t |
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ADA is important to deaminate ___ and ____ for excretion as waste products |
adenosine deoxyadenosine |
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build up of adenosine and deoxyadenosine is toxic to ? |
lymphocytes |
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what is necessary for CD4+ helper t cells activation and cytokine production? |
mhc class 2 |
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SCID is characterized by suspecibility to which 5 infections and which vaccine? |
fungal, viral, bacterial, protozoal, opportunistic live |
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treatment for SCID? |
sterile location , bubble baby stem cell transplantation |
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which disease? complete lack of immunoglobin due to disordered B cell maturation |
xlinked agammaglobulinemia |
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in xlinked agammablobinemia, ___ cells cant mature to plasma cells |
naive b cells |
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which enzyme is mutated in xlinked agamma...? |
bruton tyrokinase |
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which infenctions are present in xlinked agamma??? |
bacterial enterovirus giardia lamblia |
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which vaccine must be avoidedin xlinked agamma? |
live |
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what is present during first 6 months in xlinked agamma? |
maternal antibodies |
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in common variable immunodef, there is low IG due to ___ or ____ defects |
b-cells helper t-cells |
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there is increased risk of which type of infections? |
bacterial enterovirus giardia lamblia |
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there is increased risk of which two things in common variable immuno? |
autoimmune disease lymphoma |
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low serum and mucosal igA most common iG deficiency |
iga deficiency |
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there is incerased risk of which type of infections in iga deficiency? |
mucosal infections |
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hyper igm syndrome is characterized by? |
elevated igm |
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there is mutation of what 2 things in hyper igm syndrome? |
cd40L on t-cells cd40 receptor on b cells |
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can second signal be delievered to helper t cells during b cell activation? |
NO |
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___ necessary for Ig class switching are not producded |
cytokines |
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low __,___,___ result in progenic infections especially at mucosal sites |
iga, igg, ige |
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what will be high becasue first signal is working in hyper igm syndrome? |
igm |
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wiskott -aldrich syndrome is characterized by ? (ERT) |
thrombocytopenia eczema recurrent infections |
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there is mutation in which gene of wiskott-aldrich syndrome? |
WASP gene |
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wiskott aldrich synrome is genetically? |
xlinked |
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in c5-c9 deficiency, there is in increased risk of ___ infections. |
neisseria |
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in c1 inhibitory deficiency, results in which feature? |
hereditary angioedema |
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autoimmune diseases are more common in which gender? etiology of autoimmune is ____trigger in genetically susceptbile individuals in twins and with ___ subtypes |
female environmental, HLA |
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in sle, antibodies against the host damage multiple tissues via ___ and ____ hypersensitivity. |
type 2 and 3 |
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sle is more common in which gender and which type of people? |
african american females |
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clinical features of sle?(14) |
fever weight loss malar "butterfly" rash arthritis pleuritis pericarditis CNS psychosis renal damage endocarditis, myocarditis, pericarditis anemia, thrombocytopenia, leukopenia |
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what is the most common renal injury? |
diffuse proliferative glomerulonephritis |
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what type of endocarditis is a classical finding in sle? |
libman sacks endocarditis |
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in libman sacks endo, there are sterile deposits on which valve? |
both sides of mitral valce |
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what are the most common causes of death in sle? |
renal failure infection |
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sle is characterized by ___ antibody? |
antinuclear |
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sle is ___ sensitive, but not specific and _____ antibodies |
ana anti ds DNA antibodies |
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what is characteristic of drug induced sle? |
antihistone antibody |
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3 drugs which are the most common causes of drug induced sle? |
hydralazine procainamide isonizaid |
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what syndrome is realted to sle and characterized by autoantibody angainst protein bound to phospholipds. |
antiphospholipid antibody syndrome |
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what are the 2 most common antibodies leading to false positive syphilis test and falsely elevated PTT lab studies.? |
alicardiolipin and lupus anticoagulant |
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treatment of antiphospholipid antibody syn? |
lifelong anticoagulant |
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autoimmune destruction of lcarcimal and salivary glands is called? |
sjogern syndrom |
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in sjogern syn, therer is ____ mediated damage? which type of hypersensitivity? |
lymphocyte type 4 |
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presentation of sjogern syn?(cant chew a cracker, dirt in my eyes) |
dry eyes dry mouth recurrent dental carries |
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characterized by which antibodides? |
ana anti ribonucleroprotein |
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sjogern syn is also related to which other disease? |
rheumatoid arthritis |
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there is increases risk of what with sjogern syn? |
b-cell lymphoma |
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b cell lymphoma presents with ? |
unilateral enlargement of parotid gland |
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autoimmune disease in which there is tissue damage with activation of fibroblasts and deposition of collagen. |
scleroderma |
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scleroderma is divided into which 2 types? |
systemic and localized |
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localized scleroderma is in which part? |
skin |
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most common subtype pf localized scleroderma is ? |
morphea |
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localized scleroderma is characterized by which antibody? |
DNA topoisomerase 2 |
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systemic scleroderma is found in? |
skin and visceral organs |
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systemic scleroderma is divided into? |
limited and diffuse |
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limited is found in which parts? |
limited areas of skin and visceral organs |
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diffuse is found in which parts? |
skin and any viseral organ |
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which syndrome is related to limited scleroderma? |
CREST |
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autoimmune mediated tissue damage with mixed features of SLE, systemic sclerosis and polymyositis is called? |
mixed connective tissue disease |
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mixed connective tissue diseases is characterized by serum antibodies against |
U1 ribonucleoprotein |
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what occurs via a combination of regneration and repair? |
wound healing |
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tissues are divided into three types based on regnerative capacity called? |
labile stable permanent |
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which tissues posses stem cells that continuously cycle to regenerate the tissue? |
labile tissue |
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example of labile tissue? |
small and large bowel skin bone marrow |
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--___ tissues are compromised of cells that are in G0 but can reenter cell cycle to regenerate tissue when necessary |
stable |
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example of stable tissue? |
regeneration of liver PCT |
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which tissue lack regnerative potential? examples are? |
permanent myocardium, skeletal muscle, neurons |
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what occurs when regenerative stem cells are lost or when a tissue lacks regnerative capacity? |
repair |
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what is the initial phase of repair? |
granulation tissue formation |
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granulation tissue consists of which 3 things? |
fibroblasts capillaries myofibroblasts |
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granultation tissue fromation results in formation of a ? in which type ___ collagen is converted to ___ |
scar 3 to 1 |
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location of type 3 collagen |
granulation tissue embryonic tissue uterus keloids |
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location of type 1 collagen? |
skin bone tendons most organs |
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what removes type 3 collagen and which cofactor is required? |
collagenase zinc |
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mechanism of tissue regeneration and repair is mediated by? |
paracrine signaling growth factors |
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which mediator is epethielial and fibroblast growth factor? |
tgf aplha |
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important fibrblast growth factor also inhibits inflammation along with il-10 |
tgf beta |
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growth factor for endothelium, smooth muscle and fibroblasts |
platelet derived growth factor |
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important for angiogenesis mediates skeletal development |
fibroblast growth factor |
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important for angiogenesis |
VEGF |
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what type of intention is it, when wound edges are brought together(suturing) minimal scar formation |
primart |
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which intention is it? edges are not approximated granulation tissue fills the defect, and myofibriblasts contact the wound, forming a scar |
secondary |
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reasons for delayed wound healing are? |
infection vitamin c, copper and zinc deficiency foriegn body ischemia diabetes malnutrition |
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most common cause of infection in delayed wound healing? |
s-aureus |
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-__ is a cofactor for lysyl oxidase, crosslinking lysine and hydroxy lysine to form stable collagen |
copper |
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___ is a cofactor in hydroxylation of proline and lysin procollagen residues ? |
vitamin c |
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what is called a rupture of wound after abd surgery |
dehiscence |
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'_____ is excess production of scar tissue that is localized to the wound |
hypertrophic scar |
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___ is excess production of scar tissue that is out of proportion to the wound |
keloid |
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keloid is characterized by excess____ collagen |
type 3 |
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genetically keloid is more common in ? affects? |
afican americans ear lobes, face, upper extremities |
