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APA 2 > APA 2 - Immune System > Flashcards

APA 2 - Immune System Flashcards

1
Q

Immune system begins at approximately _____

A

6 weeks of age

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2
Q

Functions of immune system

A

support, protect, vitalize functions, maintain homeostasis

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3
Q

The non-specific or _______ system provides defense against a very large number of ______

A

innate / pathogens

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4
Q

foreign substances

A

antigens

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5
Q

_____ _______ immunity involves immune cells directed at elimination or destruction of pathogen cells.

A

cell-mediated

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6
Q

_____ ______ comprises different antibodies and proteins, such as complement, that can directly or in concert with cellular immunity orchestrate cell injury and destruction.

A

humoral immunity

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7
Q

Primary defenses against bacterial invasion

A

integument, phagocytosis, killer T c ells, respsonses (sneezing, tearing, coughing, sweating, body temp, normal flora)

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8
Q

Passive immunity includes antibodies (activated T cells) given to provide protection and this usally happens by ______ and can last ___ to ____

A

transfusion / hours to weeks

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9
Q

Acquired or _______ immunity is accomplished by destruction of organisms and toxins by ______ and specific lymphocytes

A

adaptive / antibodies

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10
Q

No innate immunity exists with ______ immunity

A

acquired

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11
Q

With acquired immunity, resistance is developed after entrance to _________. At that point, antigens interact with lymphocytes to form ________. These are prodcued by __ lymphocytes and called _________ which has MEMORY

A

body / antibodies / B / immunoglobulins (IG)

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12
Q

Humoral branch consists of B-lymphocytes which originate in ____ ___ and _____ _____

A

bone marrow and plasma cells

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13
Q

Cell-mediated branch has T-lymphocytes which originate in ____ ___ and mature in the _______

A

bone marrow / thymus

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14
Q

Vaccinations are used to produce ______ ______

A

acquired immunity

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15
Q

______ _______ is immunity from serum antibodies produced by plasma cells. More specifically, someone who has never been exposed to a specific diesease can gain humoral immunity through administration of __________ from someone who has been exposed, and survived the same disease.

A

humoral immunity / antibodies

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16
Q

Humoral refers to the bodily fluids where these free-floating serum antibodies bind to antigens and assit with _______

A

elimination

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17
Q

Cell-mediated immunity can be acquired thorugh __ _______ from someone who is immune to the target disease or infection. Cell-mediated refers to the fact that the response is carried out by _______ cells

A

T-cells / cytotoxic

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18
Q

Review Slides 9 and 10

A

Now

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19
Q

______ immunity is where a pathogen is deliberately administered to an individual for the sole purpose of stimulating the immune system. After repeat exposure, _____ immune system is able to provide a quicker and more efficient response. Example vaccines

A

active / adaptive

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20
Q

_______ __________ is where a person receives another person’s _______ to help fight or prevent certain infectious diseases. Protection is immediate but short _______.

A

passive immunity / antibodies / lived

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21
Q

Fetus during pregnancy from mother via IgG

A

passive immunity

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22
Q

IgA via breast milk

A

passive immunity

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23
Q

Rh immune golbulin (RhoGAM) to Rh-negative mothers to prevent their immune system from developing antibodies to a fetal Rh antigen

A

passive immunity

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24
Q

Components of the Nonspecific Human Immune system

A

mononuclear cells, polymorphonuclear cells, eosinophils, neutrophils, basophils, mast cells, natural killer cells, platelets, B-lymphocytes, T-lymphocytes, plasma cells

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25
Q

Review slide 13

A

cells

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26
Q

Granulocytes

A

neutrophils, basophils, eosinophils

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27
Q

Granulocyte order of number

A

neutrophils > eosinophils > basophils

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28
Q

Most numerous WBC’s, 6 hour half life, fight bacteria and fungal infection

A

neutrophils

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29
Q

least common granulocyte, involved in hypersensitivity reactions, release histamine, leukotrienes, cytokines and prostaglandinds, and stimulate smooth muscle contraction (bronchospasm)

A

basophils

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30
Q

Heavy in GI (parasites), respiratory , and urinary mucosa

A

eosinophils

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31
Q

Agranulocytes

A

monocytes and lymphocytes

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32
Q

phagocytosis, release cytokines, present pieces of pathogens to T-lymphocytes

A

Monocytes

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33
Q

B-lymphocytes

A

humoral immunity and produce antibodies

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34
Q

T-Lymphocytes

A

cell-mediated immunity (DOES NOT produce antibodies)

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35
Q

A pathogen is deliberately administered to an individual for the sole purpose of stimulating the immune system. Repeat exposure, the adaptive immune system is able to provide a quicker and more efficient response (vaccines)

A

Active Immunity

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36
Q

Inflammation in both innate and acquired immunity

A

localized vasodilation, increased blood flow, increased capillary permeability, extravasation of plasma proteins (complement and coagulation factors), c hemotaxic movement of leukocytes to site of injury

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37
Q

Clinical manifestations of inflammation

A

erythema, localized edema, pain

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38
Q

Antibodies are gamma globulins called _______. Each antibody is specific for a particular _______; this characteristic is caused by its unique structural organization of amino acids in the variable portions of both the light and heavy chains.

A

immunoglobulins / antigen

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39
Q

Antibodies act mainly in two ways to protect the body against invading agents:

A
  1. by direct attack on the invader 2. by activation of the “complement system” that then has multiple means of tis own for destroying the invader
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40
Q

There ____ general classes of antibodies

A

five (IgG, IgM, IgA, IgE, IgD)

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41
Q

With allergies, antibodies attach to ____ ____ and _____

A

mast cells and basophils

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42
Q

With Allergies, antibodies attaching to mast cells and basophils initiate change which:

A

release histamines and other substances, lead to abnormal response, vary in presentation and magnitude, urticaria, hay fever-like symptoms, asthma, anaphylaxis

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43
Q

H3 receptors occur at _________ sites and inhibit the release of a variety of _______

A

presynaptic / neurotransmitters

44
Q

Type I hypersensitivity

A

anaphylaxis

45
Q

Type II hypersensitivity

A

antibodies specific to antigens attach to cell surface. Example is cytotoxic (autoimmune hemolytic anemia)

46
Q

Type III hypersensitivity

A

Immune complex disease. Antibodies bind antigens and release enzymes that cause tissue damage (SLE, rheumatoid, glomerulonephritis)

47
Q

Type IV hypersensitivity

A

Delayed sensitivity (contact dermatitis, graft rejection) CELL MEDIATED

48
Q

Type I immune reactant

A

IgE

49
Q

Type II immune reactant

A

IgG

50
Q

Type III immune reactant

A

IgG

51
Q

Type IV immune reactant

A

TH1, TH2 cells, CTL

52
Q

Type I initiation time

A

2-30 min

53
Q

Type II initiation time

A

5-8 hr

54
Q

Type III initiation time

A

2-8 hr

55
Q

Type IV initiation time

A

24-72 hr

56
Q

Anaphylaxis is ____ mediated and releases potent meidators like mast cells and basophils

A

IgE

57
Q

With anaphylaxis, hypotension is secondary to _____ ____ ______

A

increased capillary permeability (50% fluid shift)

58
Q

Anaphylaxis requires ______ _______

A

prior exposure

59
Q

Anaphylactoid is caused by mediator release from mast cells and basophils and is not ______ mediated

A

IgE

60
Q

Anaphylactoid can happen with ____ exposure

A

first

61
Q

rocuronium is indicated in ____ % of anaphylactic reactions related to periop

A

60%

62
Q

other reasons for anaphylaxis

A

latex 15%, ABX 5-10%, opiods <5%

63
Q

read slide

A

29 now

64
Q

Standard non-life threatning treatment epii

A

epinephrine 100-500 mcg subq or IM repeat 15 min (adult) children epi is 10mcg/kg-500mcg max q15 min x2, then q4hrs

65
Q

standard treatment with benadryl

A

1-2 mg/kg or 25-50 mg IV

66
Q

Treatment of anaphylaxis

A

airway maintenance, 100% 02, Epi 50-100 mcg IV or more, fluids and glucagon if on beta-blocker, CPR, pressors, fluids, bronchodilators, H1 and H2 antagonists, corticosteroids

67
Q

Mild transfusion reaction

A

hives and pruritis

68
Q

Fetal hemolytic reaction

A

usually from ABO incompatibility where antibodies destroy donor cells and bad things happen (DIC, renal failure, death). This is masked with anesthesia and will have cardiovascular instability, hypotension, fever, hemoglobinuria, bleedeing diathesis **TREAT IMMEDIATELY

69
Q

Latex allergy high risk factors

A

Health care workers, neural tube defects, multiple surgeries, spina bifida, genitourinary tract defects and allergies to bananas, kiwi, mangos

70
Q

What type of reaction is a latex allergy usually manifested as?

A

Type IV: Dermatitis AND Type I: Anaphylaxis

71
Q

Latex reactions in the AWAKE patient

A

itchy eyes, generalized pruritis, SOB, faintness, feeling of impending doom, nausea, vomiting, abdominal cramping, diarrhea, wheezing

72
Q

Latex reactions in the ANESTHETIZED patient

A

taachycardia, HTN, Wheezing, Bronchospasm, Cardiopulmonary arrest, flusing, facial edema, laryngeal edema, urticaria

73
Q

Insufficient or limited response to antigens superseded by a self-reactive state that is inadequate and dysfunctional. Alterations in response to insult cause body to attack itself. May proliferate (anemias, arthritis, adreanl dysfunction, thyroid dysfunction, platelet aberrations)

A

Autoimmude disease

74
Q

With ______, the immune system plays important role to reject and resist. It is variable with cell type and immune resposne.

A

Cancer

75
Q

________ decrease ciliary action and cause increased risk for infection

A

hypnotics

76
Q

Anesthesia agents can ______ the immune system as it relates to nonspecific host resistance mechanisms

A

depress

77
Q

Inhalation agents, opiods, and regional anesthesia have _______ or controversial effects on immune system

A

negligible

78
Q

_________ can have transient alteration of lymphocyte and killer T cell activity

A

epidurals

79
Q

Surigical site infection occurs at or near a surgical incision within _____ days of the procedure or ___ year(s) from the implant

A

30 days / 1 year

80
Q

The _______ immune system Is activated during surgery. Tissue damage and blood loss leads to a sterile systemic ______ ______. The DAMPs released promote neutrophil and macrophage migration to site.

A

innate / inflammatory response

81
Q

As it relates to surgical site infection, T cell levels _______ which correlates with procedure duration and blood loss. ___________ surgery is associated with decreased immune suppression. ________ ________ is associated with depression of the immune system and increased risk of SSI. Hyperglycemia and _____ also contribute.

A

decrease / laparoscopic / blood transfusion / hypothermia

82
Q

Retrovirus invades cell-mediated branch of immune system. Transmission through blood and certain body fluids. Usually on many drugs and little evidence to support different anesthetics.

A

HIV/ AIDS

83
Q

NNRTIs __________ CYP450 system

A

induce

84
Q

Cardiovascular abnormalities with HIV

A

abnormal EKG (50%) and pericardial effusion (25%)

85
Q

Common comorbidities with HIV

A

wasting syndrome, peripheral neuropathies, platelet instability (splenectomy), non-hodkins lymphoma and kaposi’s

86
Q

Two major concerns with HIV

A

infectioin of patient and infection of YOU

87
Q

Most common opportunistic infection with HIV/AIDs

A

pneumocystic carinii

88
Q

Chronic inflammatory disease with production of ANA

A

SLE

89
Q

Presentation of SLE

A

polyarthritis and dermatits, malar rash in 1/3 of patients, renal dz in >50% of patients which is most common cause of death and 10-20% of them will require dialysis

90
Q

Treatment of SLE

A

corticosteriods, antimalarial, immunosuppressants

91
Q

Having a dx of SLE carries a higher risk of

A

seizures, stroke, dementia, neuropathy, psychosis, pericardial effusion (tamponade rare)

92
Q

What exacerbates SLE

A

infection, pregnancy, surgical stress, drugs

93
Q

Drugs that exacerbate SLE (if patient over 80)

A

procanimide, hydralazine, captopril, enalapril, isoniazid, methyldopa, d-penicillamine

94
Q

Anesthesia implications for someone with SLE

A

Prone to PE, pneumonitis, alveolar hemorrhage, pulmonary HTN, restrictive disease

95
Q

With SLE, 1/3 of patients exhibit what?

A

cricoarytenoid arthritis and RLN palsy

96
Q

Someone with SLE may require_________

A

corticosteroids

97
Q

With SLE, Cyclophosphamide which is used to treat lupus nephritis, it may cause problems ______ LA and succinylcholine because it inhibits ______ ______

A

ester / plasma cholinesterase

98
Q

Collagen vascular disease that is characterized by inflammation, vascular sclerosis, fibrosis of skin and organs

A

scleroderma

99
Q

Sleroderma progression

A

injury to the vascular endothelium, vascular obliteration and leakage of proteins into the interstitial space, tissue edema and lymphatic obstruction due to the protein leakage, tissue fibrosis

100
Q

Review slide 57

A

Scleroderma

101
Q

Anesthetic implications of scleroderma

A

may require fiberoptic intubation, bleeding with airway manipulation, chronic HTN (contracted vascular volume), GERD (hypotonis of LES), corneal abrasion (prone to dry eyes), pulmonary HTN (avoid acidosis and hypoxemia)

102
Q

Advantages of regional anesthesia with Scleroderma

A

peripheral vasodilation and post op pain control

103
Q

Characterized by cellular hyperplasia in synovium, infiltration by lymphocytes, plasma cells and fibroblasts AND articular cartilagtge eventually completely destroyed

A

RA

104
Q

Treatment for RA

A

corticosteroids, methotrexate, immunosuppressants, NSAIDS

105
Q

Anesthetic considerations with RA

A

steroid supplement, cyclophsphamide inhibits plasma cholinesterase and NSAIDS interfere with platelet function

106
Q

Airway considerations with RA

A

neck extension restricted, antlantoaxial subluxation, TMJ, Laryngeal joints with edema and laryngeal swelling, consider glidescopoe or fiberoptic

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