Acute inflammation Chronic inflammation

Type of immune immediate, innate response Persistent , both the adaptive immune (major )
respone and innate
specificity Limited specificity highly specificity
Abundant cells Neutrophils T lymphocytes, macrophages
Duration short Long

Immune Granulomas Foreign body granulomas

Agent Agent difficult to eradicate, such as a Agent large enough to resist phagocytosis by a
persistent microbe or a self antigen macrophage such as talc (IV drug abuse) , sutures
Immune a persistent T cell– mediated immune absence of T cell– mediated immune responses.
response response
Which cell type predominantly migrates during acute inflammation? And what is the aim?
Neutrophils aimed at the killing of bacteria, viruses, & parasites while still facilitating wound repair
List the 5 Cardinal Signs of Inflammation
1. Heat
2. Redness
3. Swelling
4. Pain
5. Loss of function
What is the main cause of Heat in acute inflammation ?
Increased chemical activity & increased blood flow to skin surface
What is the main cause of Redness in acute inflammation ?
dilation of arterioles/ increased blood flow
What is the main cause of Swelling in acute inflammation ?
accumulation of blood & damaged tissue cells
What is the main cause of pain in acute inflammation ?
Direct injury of nerve fibers, pressure of hematoma on nerve endings, Chemical irritants - bradykinin, histamine,
prostaglandin
Explain the 3 main Vascular Changes in Acute Inflammation
1-Vasodilation
2-Increased Vascular Permeability.
3-Stasis & Margination
Explain the steps of Leukocyte Recruitment
o Margination & Rolling – Mediated by selectins.
o Adhesion – Mediated by integrins.
o Transmigration (Diapedesis) – Leukocytes move through endothelial gaps.
o Chemotaxis – Leukocytes follow a chemical gradient (C5a, IL-8, bacterial products).
Explain the steps of Phagocytosis
o Recognition and attachment – Opsonins (IgG, C3b) enhance recognition.
o Engulfment – Formation of a phagosome.
o Killing and degradation – Mediated by reactive oxygen species (ROS) and lysosomal enzymes
what is the main functions of neutrophils?
the release of ROS , degranulation, formation of NETs & phagocytosis.
What is the mean by Neutrophil Extracellular traps? explain its composition and function
They are web-like structures
composed of double stranded DNA, histones, antimicrobial peptides, and proteases, ejected by neutrophiles
to trap microbes in a sticky matrix of extracellular chromatin and microbicidal proteins.
Mention the 3 main causes of chronic inflammation and one example for each
Persistent infections → mycobacteria
Immune mediated inflammatory diseases → rheumatoid arthritis
Prolonged exposure to potentially toxic agents → silicosis
Why do immune-mediated inflammatory diseases often show mixed patterns of inflammation?
as characterized by repeated attacks of inflammation, as the eliciting antigen can’t be eliminated
How does atherosclerosis develop as a chronic inflammatory condition?
Through excessive cholesterol deposition in arterial walls
How do environmental substances contribute to chronic inflammation?
Can trigger allergic responses and chronic inflammation
What distinguishes exogenous from endogenous inflammatory triggers? and give example for each
Exogenous come from outside the body (silicosis) , endogenous from within (atherosclerosis)
What is the mean by Granulomatous Inflammation? and give 3 examples of disease
chronic inflammation → collections of activated macrophages + T lymphocytes+ central necrosis.
•Mycobacterium TB •Mycobacterium Leprae •Treponema pallidum
What is the Morphological Features of chronic inflammation
1. Infiltration with mononuclear cells (macrophages, T lymphocytes)
2. Tissue destruction
3. Attempts at healing by fibrosis
What are the two key cell types apposed to foreign material in foreign body granulomas?
Epithelioid cells and multinucleated giant cells
What is the Outcomes of Acute Inflammation Resolution
– Complete tissue repair and return to normal function.
- Healing by fibrosis (Scar formation)
- Chronic Inflammation If the stimulus persists
- Abscess Formation
The most abundant leukocyte, reach the inflammatory site in a cascade-like manner, leading to
activation of specific effector
They are web-like structures composed of doublestranded DNA, histones, antimicrobial peptides,
and proteases, ejected by neutrophiles
is formed when a phagosome fuses with a lysosome
is an immediate, innate response with limited specificity caused by noxious stimuli, such as infection
and tissue damage.
The sum of the responses mounted by tissues against a persistent injurious agent: bacterial, viral,
chemical, immunologic, etc.
Or A response of prolonged duration (weeks or months) in which inflammation, tissue injury and
attempts at repair coexist.
It is a form of chronic inflammation characterized by collections of activated macrophages, often with
T lymphocytes, and sometimes associated with central necrosis.
It is a common feature of inflammatory reactions, especially those induced by bacterial infections.
The leukocyte count usually climbs to 15,000 or 20,000 cells/mL
a simple test for an inflammatory response caused by any stimulus.
Plasma proteins, mostly synthesized in the liver, whose plasma concentrations may increase several
hundred-fold as part of the response to inflammatory stimuli
 Generalized immune response of the body to infection, It is abnormal rise in body temperature

1. Neutrophils
2. Neutrophil Extracellular traps
3. Phagolysosome
4. Acute inflammation
5. Chronic Inflammation
6. Granulomatous Inflammation
7. Leukocytosis
8. erythrocyte sedimentation rate
9. Acute-phase proteins
10. Fever

F 1. the primary characteristics of acute inflammation is limited specific with immediate adaptive
response
F 2. Acute inflammation is characterized by transudation of plasma proteins & fluids
F 3. Chronic inflammation may follow acute inflammation and may begin, as a high-grade, with a
manifestations of a preceding acute reaction
1. F
2. F
3. F
Complete
1) During phagocytosis, what is responsible for killing and degradation ……………….and ……………….
2) …………….. is Transmigration of Leukocytes move through endothelial gaps
3) Persistent infections is infections by microorganisms that are difficult to eradicate …………………immune
response
4) the key characteristic of immune-mediated inflammatory diseases is …………… trigger self-immune reactions
5) …………………. The dominant cells in most chronic inflammatory reactions, which contribute to the reaction by
secreting cytokines and growth factors that act on various cells, by destroying foreign invaders and tissues, and
by activating ……………….
6) Microbes and other environmental antigens activate ………………… which amplify and propagate chronic
inflammation
7) ………………………….. is a cellular attempt to contain an offending agent that is difficult to eradicate.
8) The activated macrophages may develop abundant cytoplasm and begin to resemble epithelial cells, and are
called……………… Some activated macrophages may fuse, forming ………………..
9) Most bacterial infections induce an increase in the blood immune cell count, called……………….
10) Viral infections, such as, mumps, and German measles, cause ………………
11) In some allergies and parasitic infestations, there is an increase in the absolute number of immune cells ,
creating an………………..
12) Certain infections (typhoid fever and Covid-19) are associated with a decreased number of circulating white
cells called ……………….
13) Prolonged infection also induces proliferation of precursors in the bone marrow, caused by increased
production of…………………..
14) Acute-phase proteins have beneficial effects during acute inflammation, but prolonged production of these
proteins causes……………………………….
1. ROS and lysosomal enzymes
2. Diapedesis
3. induce delayed-type hypersensitivity
 4. Autoantigens
5. Macrophages, T lymphocytes
6. T and B lymphocytes
7. Granulomatous Inflammation
8. epithelioid cells, multinucleate giant cells
9. neutrophilia
10. lymphocytosis
11. eosinophilia
12. leukopenia
13. colony stimulating factors
14. secondary amyloidosis
1. What mediates vasodilation during acute inflammation?
A. Collagen and elastin
B. Histamine and nitric oxide
C. Fibrin and platelets
D. Calcium and potassium
2. Which process involves leukocyte adhesion to the endothelium due to slow blood flow?
A. Vasodilation
B. Stasis and margination
C. Phagocytosis
D. Diapedesis
3. What molecules enhance recognition during phagocytosis?
A. Opsonins (IgG, C3b)
B. Histamine
C. Bradykinin
D. Leukotrienes
4. Which of the following mediates increased vascular permeability?
A. Fibrinogen
B. Thrombin
C. Histamine and bradykinin
D. Collagen
6. Which physical agent can cause acute inflammation?
A. Autoimmune response
B. Radiation
C. Bacterial infection
D. Immune complex formation
7. What occurs during Diapedesis acute inflammation?
A. Blood vessel constriction
B. Leukocyte movement through endothelium
C. Platelet aggregation
D. Antibody production
8. What characterizes the exudation process in acute inflammation?
A. Loss of plasma proteins only
B. Migration of lymphocytes only
C. Plasma proteins and fluid movement
D. Decreased vascular permeability
9. Which process follows margination in the sequence of cellular events?
A. Chemotaxis
B. adhesion
C. Diapedesis
D. Transmigration
10. What is the main function of reactive oxygen species (ROS) in acute inflammation?
A. Blood vessel dilation
B. Pain signaling
C. Pathogen killing
D. Tissue repair
11. Which cytokine is NOT typically involved in acute inflammation?
A. TNF-α
B. IL-1
C. IL-6
D. IL-12
12. What type of mediators are prostaglandins and leukotrienes?
A. Plasma proteins
B. Cytokines
C. Arachidonic acid metabolites
D. Vasoactive amines
13. Which condition represents a persistent inflammatory stimulus?
A. Acute appendicitis
B. Minor cut healing
C. Rheumatoid arthritis
D. Simple bruise
14. What characterizes an abscess formation?
A. Excessive fibrosis
B. Chronic inflammation
C. Complete healing
D. Pus-filled cavity
18. What are immunosuppressants primarily targeting?
A. Vasoactive amines
B. Plasma proteins
C. Cytokines
D. ROS
[Link] condition is an example of an immune-mediated inflammatory disease?
A. mycobacteria
B. Acute bronchitis
C. Rheumatoid arthritis
D. silicosis
[Link] condition is an example of Mixed patterns of acute and chronic inflammation
a) multiple sclerosis
b) bronchial asthma
c) silicosis
d) Atherosclerosis
[Link] condition is an example of Persistent infections
 a) multiple sclerosis
b) bronchial asthma
c) silicosis
d) HCV
[Link] inflammatory bowel disease, what triggers the chronic inflammation?
A. Only food allergies
B. Unregulated immune responses against microbes
C. Only genetic factors
D. Strictly dietary causes
[Link] of the following is an example of Chronic inflammation from exogenous toxic exposure
a) multiple sclerosis
b) bronchial asthma
c) silicosis
d) atherosclerosis
[Link] of the following is an example of Chronic inflammation from endogenous toxic exposure
a) multiple sclerosis
b) bronchial asthma
c) Atherosclerosis
d) silicosis
26-What is the dominant cell type in most chronic inflammatory reactions?
a. Neutrophils
b. Macrophages
c. Eosinophils
d. Mast cells
27-Which function is primarily attributed to macrophages during chronic inflammation?
a. Antibody secretion
b. Release of histamine
c. Activation of T lymphocytes
d. Formation of immune complexes
28-Which type of lymphocyte is most involved in amplifying chronic inflammation?
a. CD8+ cytotoxic T cells
b. CD4+ helper T cells
c. B memory cells
d. Regulatory T cells
29-Which cytokine is produced by TH1 cells to activate macrophages via the classical pathway?
a. IL-17
b. IL-4
c. IFN-γ
d. IL-5
30-Which cytokine is produced by TH1 cells to activate macrophages via the ALTERNATIVEpathway?
a. IL-17
b. IL-4
c. IFN-γ
d. IL-2
31-TH2 cells are mainly responsible for which function in chronic inflammation?
a. Activation of cytotoxic T cells
b. Activation of macrophages via the classical pathway
c. Alternative macrophage activation through IL-4, IL-5, IL-13
d. Secretion of IFN-γ to induce neutrophil recruitment
32-Which cytokine secreted promotes neutrophil recruitment?
a. IL-5
b. IL-17
c. IL-4
d. IFN-γ
33-What is granulomatous inflammation best characterized by?
a. Infiltration of eosinophils and basophils
b. Fluid exudation and edema
c. Aggregates of activated macrophages with T cells
d. Proliferation of fibroblasts only
34-Which of the following organisms is most commonly associated with granuloma formation?
a. Streptococcus pneumoniae
b. Mycobacterium tuberculosis
c. Clostridium difficile
d. Staphylococcus epidermidis
35-What are “epithelioid cells” in the context of granulomatous inflammation?
a. Activated neutrophils that resemble epithelial cells
b. T lymphocytes with cytoplasmic granules
c. Activated macrophages with abundant cytoplasm resembling epithelial cells
d. Plasma cells that produce cytokines
36-Granuloma formation is best described as:
a. An allergic reaction to soluble antigen
b. A failed attempt at tissue repair
c. A cellular attempt to contain an agent difficult to eradicate
d. A response exclusive to viral infections
37-Which cytokine is most important for stimulating CRP and fibrinogen synthesis in hepatocytes?
a. IL-1
b. TNF
c. IL-6
d. IFN-γ
38-Which acute-phase protein contributes to the erythrocyte sedimentation rate (ESR) increase?
a. Serum amyloid A
b. Fibrinogen
c. Albumin
d. Interferon-α
39-Which acute-phase protein binds to microbial cell walls and can act as an opsonin?
a. Albumin
b. Ceruloplasmin
c. C-reactive protein
d. Transferrin
40-A rise in immature neutrophils in peripheral blood during acute inflammation is caused by:
a. Bacterial toxins
b. Increased erythropoietin
c. Cytokines such as TNF and IL-1
d. Histamine release from mast cells
41-Which of the following is the most likely leukocyte response to a viral infection such as mumps?
a. Neutrophilia
b. Eosinophilia
c. Lymphocytosis
d. Leukopenia
42-Which change is commonly seen in parasitic infestations and allergic reactions?
a. Neutrophilia
b. Eosinophilia
c. Basophilia
d. Leukopenia
43-Which of the following conditions is associated with leukopenia rather than leukocytosis?
a. Appendicitis
b. Typhoid fever
c. Pneumonia
d. Rheumatoid arthritis
44-Which of the following is not a typical feature of the acute-phase response?
a. Decreased pulse rate
b. Fever
c. Anorexia
d. Chills
1. Dendritic Cells B A. Play a secondary role by modulating inflammation through cytokine
secretion (Th1, Th2 responses) and antibody production.
2. Macrophages E B. Act as antigen-presenting cells (APCs) and link innate immunity with
adaptive immunity.
3. Lymphocytes (T & B A C. First responders, responsible for phagocytosis and releasing ROS &
Cells) proteolytic enzymes.
4. Mast Cells D D. Release histamine and other inflammatory mediators,
5. Neutrophils C E. Key players in phagocytosis and cytokine secretion (IL-1, TNF-α) to
amplify the inflammatory response

1. B
2. E
3. A
4. D
5. C

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.

b b a c ……. b b c b c d c c d
15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28.
……… ……. …….. c ……… c b d b c c b c b
29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42.
c b c b c B c c c b c c c b
43. 44.
b a