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Inflammatory response is____
Cardinal signs of inflammation
- 1) Rubor
- 3) heat (calor)
- 4) Pain
- 5) Loss of function
- Polymorphous Neutrophil (PMN)
- Chemotaxis dependent
- 1st cell type
- allergy or parasite
- Important in asthma, 2-3 days after PMN
- viral and chronic inflammation
- Macrophage in tissue
- Longer t 1/2
Macrophage important in antigen processing Via release of
- Larger than PMN
- Mast cells
- Need chemotaxic
- No DNA
- 140,000-340,000 in circulation
Thromboxane and Platelet activating factor
Chemical mediators in acute inflammation:
- Cell derived
- Plasma derived
Activate inflammatory response in two ways
- 1) degranulation of stored material
- 2) Synthesis of mmediators in response to stimuli
Preformed material- Histamine
- Dilation of post-capillary venules
- Increased permeability resulting in exudation
Histamine receptors (3)
- H1- contracts smooth muscle (Bronchi, GI, uterus)
- H2-Gastric acid secretion
- H3-Neural tissue
Histamine increases influx of____ in the ______
Calcium in the mast cell
Inhibited by increase in cAMP (epinephine)
Eosinophils have certain enzymes...
_______ breaks down leukotrienes and ______ breaks down histamines.
Aryl sulfatase B, Histaminase
Synthesized material from Arachidonic acid
Cox-1 and Cox-2
Cox-1 is _______ while Cox-2 is _______
PGI2 is produced by_____
Cox-1 plays a large role in ________
gastric mucosal protection and renal hemodynamics
PGI2 are _______ that _______ and inhibit platelets and are bronch_______
- 1) Prostacyclins
- 2) Vasodilate
- 3) dilate
PGD2 is made mainly from ________ and ______ platelet aggregation and are broncho______.
- 1) Mast cells
- 2) inhibit
- 3) Constrictors
PGE2 is made mainly from ______
PGE2 inflammatory responses include______,_____,and _____
- Bronchial constriction
- Vasodilate arterioles and potentiates action of histamine and kinins on permeability.
PGE2 inhibitory effects to inflammatory response...
- -decrease lysosomal enzyme release
- -Decrease histamine release from mass cell
- -decrease macrophage activation and generation of some cytokines
- -inhibits degranulation
Thromboxanes cause vaso______ and promote degranulation and ________ of platelets. They also induce smooth muscle ______.
- 2) aggregation
- 3) constriction
Leukotrienes-lipoxygenase enzyme- ______ airway response to Broncho______. They also _______ release of cytokines.
LTA4, LTB4, LTC4 are ______ substances of______. along with LTD4, LTE4, LTF4.
- 1) slow reactive
- 2) Anaphylaxis
Platelet activating factor important in delayed stages of asthma, why?
Recruits eosinophils into bronchial mucosa.
Cytokines are __ produced constitutively, but are ______ de nova upon activation.
On the target cell, Cytokines act on _________ receptors.
Interleukins are mainly produced by _____ and ______. They induce response of immune cells to injury.
Macrophages and lymphocytes
Glucocorticoids and gold inhibit
Interleukin production and activity.
Interferon are produced in response to ____ stimuli and are all ___ specific but not viral specific.
Transforming growth factor
- Widest acting cytokine
- Mediates proliferation, differentiation, and angiogenesis.
Tumor necrosis factor increase ______ production which increases _____ activity. It also _____angiogenisis.
- 1) Cytokine (IL)
- 2) phagocytic
- 3) enhances
Granulocyte colony stimulating factor plays a major role in _____ production and maturation.
Plasma proteins cascades (5)
- 1) Complement
- 2) Clotting
- 3) Fibrinolytic
- 4) Kinin
- 5) Immiune
REMEMBER C3 is important in almost all stages of inflammation
Clotting forms fibrinous exudate to _____ exudates, microorganisms, and foreign bodies.
____ is the end product of clotting and uses _____ as the major enzyme.
Fibrinolytic generates ______ and activates ______. It also breaks down clots.
Kinin system activates complement and works with ____ and ____ receptors.
Immune system ______ mast cell degranulation. It is activated when ____-_____ complex forms.
- 1) Stimulates
- 2) Antigen-antibody
Hageman factor activates these systems (4)
Venules leak fluid and protein (_____g%) compared to (0.2-0.5g% in transudate)
3 steps in leukocyte infiltration "blood sludging"
Margination (neutralize cell charge), Pavementing, and Diapedesis (stepping across).
Purpose of exudate is to carry_______ to site. May contain ______ and stop spread of inflammation.
- 1) therapeutic agents
- 2) antibodies
2 stages of healing
Regeneration and repair/replacement
____cells constantly divide while _____cells stop dividing when growth ceases. _____ cells are non-dividing and post mitotic cells.
Labile, Stabile, Permanent
granulation tissue is rich in ______.
macrophages, myofibroblasts, angioblasts, and fibroblasts.
Reconstructive (proliferative or fibroblastic phase). Wound is sealed by _____ which is then dissolved by _______ system and _____ tissue is formed.
- 1) fibrin
- 2) fibrinolytic
- 3) granulation
Cells migrate under the clot to _____ the clot from the wound surface.
Macrophages in reconstruction
- Fibroblast activating factor
- angiogenesis factor
Wound contraction occurs via _______ of granulation tissue.
Maturation phase of repair occurs ___ weeks after injury and usually left with a _______ scar.
Granuloma formation begins when macrophages differentiate into ______ cells.
Necrosis and _____ are common at site of chronic inflammation
Glucocorticoids cause atrophy of lymph tissue, influences _____ response, _____ protein synthesis, inhibit _____ proliferation, and inhibits the healing process.
- 1) immune
- 2) Inhibits
- 3) fibroblast
Pyrogens are ______ or endogenous (IL-1) released from damaged tissue.
Benefits of fever
eliminates pathogen quicker, no viral replication, enhances phagocytosis and interferon production
Conditions increasing WBC (3)
- Strenuous exercise
- Sympathetic reaction
- Inflammation or infection
Viral infections ____ lymphocytes and _____ # of neutrophils.
C-reactive protein is synthesized in liver in response to ____
Normal levels of C-reactive protein
<3 mg/l and can increase to 1000X in inflammation
- Men: 1-13 mm/hr
- women 1-20 mm/hr
Neutropenia (below ____-2000 cells)
Agranulocytosis (<___ cells)
Leukopenia (<4000 cells in an adult)
Disorders of chemotaxis are ____ and ______
- Intrinsic- impaired locomotion
- Extrinsic- drugs (corticosteroids) agents that increase cAMP (decrease phagocytosis)
Deficiencies of chemotactic factors due to complement deficiences C_ and C_. High levels of Chemostatic Factor inactivators high in _______ disease.
Chronic Granulomatous Disease
phagocyte oxidase deficiencies in neutrophils.
In CGD the neutrophil is incapable of destroying _________ bacteria (staph).
Immune system can not respond if the molecular weight of foreign material is less than ______
______ can not be immunogenic alone, they must bind to more than one Antibody to form the ____ complex.
- 1) Haptens (epitopes)
- 2) Ab-Ag
Properies of immune system (3)
- 1) Self recognition
- 2) memory
- 3) specificity
Effector phase in immune response has 2 components a _____response and a _____ response
Induction phase involves production of __ and __ cells
B and T
B-system (Humoral) is _____ of the thymus and is most effective in the ____ phase of the blood and tissue.
Five classes of antibodies are
- IgG- 75%, smallest, cross placental membrane
- IgM- 10%, largest, 1st to appear.
- IgA- 5-15%, surface protection
- IgE- least concentrated, allergies
- IgD <1%, activation/maturing B-cells
T-system is thymus ___ and has a much more _____ response to B-system.
Lymphocytes in T system do not need to be ______ to kill foreign cells or other bad things.
Types of hypersensitivity (4)
- 1- IgE- Mast cell release mediators-anaphylaxis
- 2- IgM,IgG, complement- Cell lysis, cell mediated
- 3- " " Ag-Ab complex- immune complex
- 4- T-Cell mediated- contact dermititis
Brutons agammaglobuniemia is ______ and has a deficit in ___
Digeorges syndrome is due to cellular ______ Deficiency and has the absence of the _____ and the ____.
- Parathyroid and the thymus
SCID is condition with stiking _____.... absence of ____ immune systems.
Wiskott aldrich system is _____ and cannot respond to polysaccharide antigens. Triad of ____ present, _______ due to platelt deficiency, and recurrent infection.
Autoimmunity is most likely due to loss of __________
Foreign anitgen forming immune complex is a Type _ injury.
Rheumatic fever is an example of _____ reactivity.
T-cell suppressor function _____ with age.
Type 1 diabetes---------------------------->
Thyrotoxicosis (graves disease)----------->
- B islet cell of pancreas
- Adrenal cell cytoplasm
- Thyroid cell surface (TSH receptor)
Graves disease is _______ whereas Hashimotos is ________.
Malignant hypertension characterized by high incidence of increase in antibodies directed against the _____________________.
Alpha 1 adrenoreceptor
Antibodies against the _____________ may play causal role in dilated cardiomyopathy.
Beta-1 adrenergic receptors.
Asthmatic patients may have Inhibitor antibodies to the ______ adrenoreceptor
Hashimotos hypothyroidism is an example of what type(s) of injury?
Type 2 and type 4
Lupus is greater in females because _____ enhance the immune response and _______ depress the immune response.
In Lupus patients must pass _____ different diagnostic criteria to be diagnosed.
4-5 of 11
three types of joints are _______, _______, and _______.
Synarthrodial or fibrous, Cartilaginous or amphiarthrosis, and Synovial or diarthrodial.
Synovium is made of 2 layers _____ and _____
- Subintimal (vascular with mast cells, macrophages)
- Intimal (hyaluronic acid)
Synovial fluid is composed of _______acid which lubricates joints.
Mucin clot test adds ______Acid to _______ acid. With inflammation the clot formed is ______ than normal and is cloudier.
- 1) Acetic
- 2) Hyaluronic
- 3) poorer
Non-inflammatory joint disease has near normal _________
Synovial fluid and synovial membrane inflammation
Osteoarthritis characterized mainly by loss of __________ in synovial joints
Osteoarthritis primary is _______ and not assosciated with risk factors however aging is most assosciated factor.
Secondary osteoarthritis is assosicated with ________ such as joint stress and trauma.
Articulating cartilage becomes yellowish gray due to more water and less _________. The loss of _________ is the hallmark for osteoarthritic process.
Rheumatoid arthritis is a chronic _____________ disease. Characterized by inflammation of multiple joints and have ___________ of collagen. Occurs in women more frequently than men.
- 1) systemic autoimmune
- 2) Fibrinoid necrosis
A combination of _____ and ____ are responsible for Rheumatoid arthristis. No signle agent is responsible.
Genetics and environment
Rheumatoid factor bind and form complex in blood. This is a type __ injury.
Synovial fluid comprised of ___ which phagocytize and release many mediators including __.
Synovial membrane transforms into a _____ which is rich with enzymes that cause cartilage and bone destruction.
Pannus (granulation tissue)
Proteases are released from monocytes and macrophages for Bone ______.
_______ is due to diminished blood flow and causes ______ which stimulates release of hydrolytic enzymes which cause even more damage.
Rheumatoid arthritis is characterized by ________ polyarthritis and morning stiffness for ____ than 30 minutes.
RF is not present in __% of patients with RA.
Synovial fluid viscosity is _____ with RA due to more leukocytes. In order for diagnosis to be made, must pass _ of _ diagnostic criteria.
Gout is due to synthesis of _______ nucleotides resulting in elevated levels of ______.
Primary form of gout is ______ recessive and diagnosed mainly in ___.
Nyhan syndrome is ______ recessive and results in _______ of uric acid.
In gout, increased activity of PRPP synthetase is an _______ disorder which causes ______.
- Overproductiion of purine
deficiency in Glucose-6-phosphate is a _____ recessive disorder causing _______ uric acid clearance.
Normal uric acid levels are ______.... with gout _______
- 4-6 in men and 3-5 in women
- >7mg in men and >6mg in women
Less leukocyte function is ___ for people with gout.
acute gouty arthritis 90% of intial attacks start in a ___ joint.
Intractitical gout the patient is seen to be __________.
Chronic Tophaceous gout, patients form a _____ which have ______ crystals inside.
Gout can result in ________ caused by kidney stones.
Gout lessons to learn... dont be ____, dont do ____, and dont drink too much _____.
- 1) Obese
- 2) drugs that block uric acid excretion
- 3) alcohol or eat organ meats
Diagnosis of gout can be by presence of monosodium __________ in leukocytes found in the _____ fluid. Or urate crystals found in _____.
- Urate crystals
The ______ surrounds the skeletal muscle which consists of several _____ surrounded by the ______. Inside each __2___ there are many muscle fibers known as ______ which are surrounded by the _______.
- 1) epimysium
- 2) Fasicles
- 3) myofibriles
- 4) endomysium
In muscles the ____ is known as the cell membrane and the ______ ________ is the smooth ER.
- 1) sarcolemna
- 2) Sarcoplasmic reticulum
In the sliding filament model the _____ binds to the actin. This process requires energy in the form of ___.
Sources of ATP for Muscle contraction include ______ phosphate, _________, and ________.
- 1) Creatine
- 2) Aerobic respiration
- 3) Anaerobic respiration
Sustained lack of ATP results in _______
____ of calcium from the sarcoplasmic reticulum is essential for muscle contraction and the _______ of calcium from the _______ is essential for muscle relaxation.
- 1) Release
- 2) Clearance
- 3) Sarcoplasm
A motor unit is a single ________ neuron and all of the muscle fibers it innervates.
Motor endplate is
a specialized site where axon terminals from alpha motor neurons make synaptic contact with individual muscle fibers.
Latent period is the time between an ______ and the first measurable increase in _________.
- 1) action potential
- 2) muscle tension
Isometic contraction the _____ is constant even though the muscle develops _____.
Isotonic contraction can be either ________ or _______.
- Cocentric- muscle shortens
- Eccentric- muscle lengthens
Tetanus is a _______ contraction in response to a repetitive stimulation. It can be ____ or _____.
- 1) maintained
- 2) fused
- 3) unfused
___________ are small specialized motor neurons that innervate intrafusal muscle fibers.
Gamma motor neurons
The withdrawal reflex is split up into two movements: ______ and ______. An example of the withdrawal response involves a ___________ reflex.
- 1) Ipsilateral- activate flexor, inhibit extensor
- 2) contralateral- Activate extensor, inhibit flexor.
- 3) Cross-extensor
In smooth muscles thin filaments are anchored to _________. There are also no _____ in smooth muscle and they are ________.
- Dense bodies
In smooth muscle there is a _____ removal of cytosolic calcium. There is also an absent of the _____, less specialized ______.
- Sarcoplasmic reticulum
In smooth muscle input can either be _______ or _______.
Excitatory or inhibitory
smooth muscles are electically coupled by ________.
Multi unit smooth muscle fibers are not connected by ______.
Contractile responses in smooth muscle can be activated by _______.
Most multi-unit smooth muscle cells do not generate their own ___________.