PR1153 Pharmacy Foundations: Science and Therapeutics II - Chronic Inflammation, Healing, and Haemodynamic Disorders

Comprehensive practice questions covering chronic inflammation, the stages of wound healing, systemic and local factors affecting repair, and various haemodynamic disorders including oedema, shock, thrombosis, and embolism.

When does chronic inflammation occur?

It occurs when there is persistence of a damaging stimulus or injury so that complete healing cannot occur, often involving the adaptive immune response and lasting a long duration.

What are the three main causes of chronic inflammation listed in the notes?

1. Persistent infection by organisms difficult to eradicate (e.g., TB); 2. Immune-mediated disease (especially autoimmune); 3. Prolonged exposure to injurious agents (exogenous like silica or endogenous like hyperlipidaemia).

What are the three primary characteristics of chronic inflammation?

Infiltration of mononuclear cells (macrophages, lymphocytes, plasma cells), tissue destruction, and attempts at healing.

What are the components of a granuloma?

Epithelioid cells (transformed macrophages), multinucleate giant cells, and lymphocytes (particularly T cells).

What is the role of macrophages in the 'scavenging' step of tissue renewal?

They clean the inflammatory site of cell debris, including removing dead neutrophils and their secreted products; depletion of macrophages leads to delayed healing.

What characterizes 'Labile' cells in terms of regenerative ability?

They have a very good regenerative ability and can achieve almost complete restoration; examples include the epidermis, bone marrow, and connective tissue.

What characterizes 'Permanent' cells in terms of regenerative ability?

They have almost no regeneration; examples include neurons, heart muscles, and striated muscles.

How is 'Repair' defined in the context of wound healing?

Repair = Regeneration + Fibrosis.

What is 'Granulation Tissue (GT)' and what is it rich in?

It is pink, soft tissue that precedes fibrosis, rich in capillary buds (angiogenesis) and fibroblasts or myofibroblasts.

Which vitamin is essential for collagen synthesis?

Vitamin C (deficiency leads to scurvy where wounds cannot heal).

What is the difference between healing by primary intention versus secondary intention?

Primary intention involves a narrow wound with closely approximated edges (e.g., surgical incision) and produces a small scar; secondary intention involves a broad wound with widely separated margins, takes longer, and results in a large, aesthetically unsatisfactory scar.

What are the systemic factors that affect wound healing?

Age, nutrition (protein and Vitamin C), metabolic status (Diabetes mellitus), circulatory status (blood supply), and hormones (Glucocorticoids).

What is 'wound dehiscence'?

A complication of wound healing where the wound splits open due to deficient scar formation.

What is the difference between a hypertrophic scar and a keloid?

A hypertrophic scar is a raised scar; a keloid is an overgrowth of scar tissue due to the overproduction of collagen, often described as a 'maturation arrest' and more common in dark-skinned people.

At what rate do sprouts arise from a severed axon in peripheral nerve injury?

$1\,mm$ per day.

What is the difference between Hyperaemia and Congestion?

Hyperaemia is an active process involving arterial vasodilation resulting in more blood; Congestion is a passive process involving venous outflow obstruction.

What are the five primary causes of Oedema related to Starling's forces?

Increased hydrostatic pressure, reduced oncotic (osmotic) pressure, increased endothelial permeability, lymphatic obstruction, and sodium and water retention.

How do Exudate and Transudate differ in protein content?

Exudate has a high protein content similar to plasma; Transudate has low protein content, specifically < 10\,g/L (mostly albumin).

What identifies the sizes of Petechiae, Purpura, and Ecchymoses?

Petechiae are a few $mm$; Purpura are several $mm$ to $1\,cm$; Ecchymoses (bruises) are > 1\,cm.

What are the four main types of shock mentioned?

Hypovolemic shock, cardiogenic shock, septic shock, and anaphylactic/neurogenic shock.

What are the three factors of Virchow’s Triad that increase thrombotic tendencies?

Endothelial damage, altered blood flow (stasis), and hypercoagulability (thrombophilia).

What are the possible 'fates' of a thrombus?

Resolution/lysis, propagation, organization and recanalization, or embolism.

What is the definition of an embolus?

A detached intravascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its point of origin.

What are the names of the symptoms associated with the decompression sickness form of Air Embolism?

'Chokes' (lungs), 'Bends' (muscles and bones), and 'Staggers' (brain).

What is 'Infarction' and what are the two types based on color?

Infarction is necrosis due to Ischaemia (usually arterial occlusion); the two types are white infarct and red infarct (haemorrhagic).