Final SEQ:

1. Discuss the Role of infections and tissue injury.

 Molecular mimicry.
 Upregulation of costimulatory molecules on
APCs in the tissue.
 Polyclonal B-cell activation.
 Release hidden Antigens
 Cytokines-induced by Infections.

2. Mechanism of septic shock.

Pathogenesis
- Endotoxins are component of cell wall of gram
negative bacteria
- Are lipopolysacchrides (LPS)
- Released when bacterial cell wall is degraded.
- Endotoxins bind to CD14 receptor on WBC and
endothelial cells causing :
1- Activation of alternative complement pathway
Result: release of C3a and C5a (vasodilation and
neutrophil chemotaxis)
2- Macrophage release of IL-1/TNF:
Result: Increased neutrophil adhesion to
Endothelial cells (e.g.increased neutrophils in
pulmonary capillaries)
3- Direct injury to endothelial cells:
Result : release of chemical mediators NO
(vasodilator) and PG I2 (vasodilator).

3. Mechanism of antibacterial drug resistance with

examples.
 1- Mutation
- Microbes contains a few mutant cells which require
high concentration of the AMA for inhibition
- After sometime these mutant cells proliferate
- Now bacteria is resistant to AMA to which it was
sensitive before
- E.g: Staph, E.coli, Enterococcus
2- Gene transfer
a. Conjugation
- Sexual contact of one bact to other
- Gene carrying ‘RFT’ (resistance transfer factor) is
transferred to another bacteria
- E.g: Chloramphenicol resistance of typhoid bacilli
b. Transformation
- One bacteria release ‘RFT’ (resistance transfer
factor) carrying DNA into medium
- Imbibed by another sensitive bacteria & become
resistance
- E.g: pneumococcal resistance to penicillin G
c. Transduction
- One bacteria release ‘RFT’ (resistance transfer
factor) carrying DNA into medium
- Imbibed by another sensitive bacteria & become
resistance
- E.g: pneumococcal resistance to penicillin G
3- Efflux mechanism
- Antibiotics are throw about by efflux pumps
- e.g. E.coli, streptococcus having efflux pumps

4. Systemic effect of inflammation and its mediators

1- Fever > TNF + IL-1
2- Elevate plasma level of acute phase protein > IL-6
3- Leukocytosis > CSFs / TNF + IL-1
4- In sever septic infection (sepsis) > TNF + IL-12 + IL-1
5- Increase heart rate, blood pressure
6- Decrease sweating
7- Rigors, malaise, chills, anorexia

5. Define pharmacokinetic & write 2 of its processes

The movement of drug in and alteration of the
drug by body.
 Absorption
 Distribution
 Biotransformation (Metabolism)
 Excretion