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Surgical Care > Final Exam > Flashcards

Final Exam Flashcards

1
Q

How long does it take for an empty stomach after clear liquids?

A

2 hours

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2
Q

How long does it take for an empty stomach after breast milk?

A

4 hours

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3
Q

How long does it take for an empty stomach after infant formula?

A

< 3 months = 4 hours

> 3 months = 6 hours

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4
Q

How long does it take for an empty stomach after nonhuman milk?

A

6 hours

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5
Q

How long does it take for an empty stomach after a light meal?

A

6 hours

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6
Q

What conditions increase aspiration risk by elevating intra-abdominal pressure?

A

Morbid obesity and pregnancy

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7
Q

What conditions increase aspiration risk by delaying gastric emptying?

A

Gastroparesis
Pregnancy
Abdominal trauma

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8
Q

Total body water is ____ intracellular and ______ extracellular. Of extracellular fluid, _____ is intravascular and _____ is extravascular

A

2/3 intracellular
1/3 intracellular
1/4 intravascular
3/4 extravascular

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9
Q

Plasma volume is approximately ______% of TBW

A

8.3%

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10
Q

Daily maintenance fluid requirements

A

100 ml per kg for first 10 kg
50 ml per kg for second 10 kg
20 ml for remaining

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11
Q

Hourly maintenance fluid requirements

A

4 ml per kg for first 10 kg
2 ml per kg for second 10 kg
1 ml per kg for remaining kg

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12
Q

For patients with compromised pulmonary, cardiac, or renal function, fluids should be run at _______ levels to prevent ________ _________

A

Lower

Fluid overloading

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13
Q

Surgical patients require _____ mEq/kg/d of sodium for maintenance

A

1-2

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14
Q

Surgical patients require ______ mEq/kg/d of potassium for maintenace

A

0.5-1

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15
Q

Lactated Ringers contain which electrolytes?

A 
Na
K
Cl
Bicarb
Ca
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16
Q

Signs of fluid shifts out of intravascular space

A

Changes in blood pressure, heart rate, central venous pressure
Decreased urine output

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17
Q

Signs of volume excess

A

Weight gain, pulmonary edema, peripheral edema, S3 gallop

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18
Q

Fever < ______ is common after surgery. It is usually due to the _________ stimulus of surgery and will resolve spontaneously

A

103.5

Inflammatory

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19
Q

Post op fever is commonly due to the release of ________ which are a response to tissue trauma

A

Cytokines

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20
Q

Cytokines are produced by _________, ________, and ________ ______.

A

Monocytes
Macrophages
Endothelial cells

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21
Q

Fever-associated cytokines are _____, _____, _____, and ________

A

IL-1
IL-6
TNF-alpha
IFN - gamma

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22
Q

Differential diagnosis of a post op fever

A 
Wind (atelectasis, pneumonia)
Water (UTI, anastomotic leak)
Wound (wound infection, abscess)
Walking (DVT, PE)
Wonder-drug or what did we do
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23
Q

What post-op day does atelectasis normally occur?

A

POD #1

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24
Q

What post-op day does pneumonia normally occur?

A

POD #3

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25
Q

What post-op day does a UTI or anastomotic leak normally occur?

A

POD #3

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26
Q

What post-op day does a wound infection or abscess normally occur?

A

POD #5

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27
Q

What post-op day does a DVT or PE normally occur?

A

POD #7

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28
Q

Risk factors for atelectasis

A 
Painful abdominal or thoracic incision
Smoking
Pulmonary disease (asthma, cystic fibrosis)
Obesity
Respiratory muscle weakness
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29
Q

How to differentiate pneumonia from atelectasis?

A

Single sided, sputum production, elevated WBC, and temp curve that progresses upward

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30
Q

Risk factors for post-op UTI

A 
Catheter use during surgery
Delays in bladder emptying due to anesthesia
Bladder manipulation during surgery
Female gender
Older age
Diabetes
Immobilization
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31
Q

Things to consider with an early fever

A 
Necrotizing fasciitis
Malignant hyperthermia
Anastomotic leak
Pulmonary embolism
MI
Allergic Rxn
EtOH withdrawal
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32
Q

Most common bacterial agents of necrotizing fasciitis

A

Clostridiuim perfringens

Group A B-hemolytic streptococcus

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33
Q

Treatment for necrotizing fasciitis

A

Resuscitation
Pen G
Surgical debridement

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34
Q

Treatment for malignant hyperthermia

A

Resuscitation
Rapid cooling
IV dantrolene

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35
Q

Physical assessment for post-op fever

A
  1. Check the wound or surgical site
  2. Lung sounds, heart/abd/extremity exam
  3. Check IV sites, central line, foley tubes
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36
Q

Raise the threshold for CNS toxicity of local anesthetics

A

Benzodiazepines

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37
Q

ADRs of sedation, disorientation

A

Benzodiazepines

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38
Q

Tolerance observed in patients with chronic use of alcohol

A

Barbiturates

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39
Q

Agents pentobarbital and thiopental

A

Barbiturates

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40
Q

ADRs of cardiac and respiratory depression (monitoring is very important)

A

Barbiturates

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41
Q

Avoid in porphyria

A

Barbiturates

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42
Q

Etomidate has hypnotic but not ______ properties. Must follow with ______ and _______ ______ drugs

A

Analgesic

Analgesic and muscle relaxant

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43
Q

ADRs of hypotension, cardiac dioxide retention, suppresses corticosteroid synthesis at adrenal cortex

A

Etomidate

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44
Q

Often included in rapid response or intubation kits, induces sleep for 5 minutes

A

Etomidate

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45
Q

ADRs of respiratory depression, N/V, constipation

A

Opioids

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46
Q

Often used for emergency surgical procedures (ER use with orthopedic indications, use in children)

A

Ketamine

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47
Q

Associated with unconsciousness, analgesia, and amnesia

A

Ketamine

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48
Q

ADRs of hallucinations, bad dreams, increased muscle tone/rigidity

A

Ketamine

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49
Q

Lipophilic anesthetic, cannot see through it

A

Propofol

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50
Q

Used often in neuro ICU

A

Propofol

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51
Q

ADRs of significant respiratory depression, hypotension, and injection site pain

A

Propofol

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52
Q

ADRs of N/V, malignant hyperthermia, caution in patients with renal/hepatic dysfunction

A

Inhaled anesthetics

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53
Q

Agents include nitrous oxide, sevoflurane, isoflurane, desfurane

A

Inhaled anesthetics

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54
Q

Lidocaine, bupivacaine, prilocaine, dibucaine

A

Amino amides

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55
Q

Frequently used in epidurals

A

Bupivacaine

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56
Q

Suppository use for pain relief and analgesia for hemorrhoids

A

Dibucaine

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57
Q

Benzocaine, cocaine, procaine, tetracaine

A

Amino esters

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58
Q

Concentration, max dose, onset, and duration of lidocaine

A

1-2%
4.5-5 mg/kg
< 2 min
0.5-1 hour

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59
Q

Concentration, max dose, onset, and duration of lidocaine with epinephrine

A

1-2%
7 mg/kg
< 2 min
4-6 hours

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60
Q

Concentration, max dose, onset, and duration of bupivacaine

A

0.25%
2.5 mg/kg
5 min
2-4 hours

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61
Q

Concentration, max dose, onset, and duration of bupivacaine with epinephrine

A

0.25%
max 225 mg
5 min
3-7 hours

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62
Q

ADRs of CNS effects (seizures), bradycardia, arrhythmias, respiratory arrest, burning sensation, skin discoloration, tissue necrosis/sloughing, neuritis

A

Local anesthetics

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63
Q

ADRs of hematoma, infection, headache

A

Spinal anesthesia

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64
Q

Risk factors that affect pain control in perioperative settings

A 
Preoperative pain (higher baseline)
Anxiety
Genetics
Female gender
Opioid tolerance
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65
Q

Reduce opioid requirements and may contribute to lessened PONV when used

A

NSAIDs and COX-2 inhibitors

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66
Q

Ketorolac, ibuprofen, naproxen

A

NSAIDs

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67
Q

Celecoxib

A

COX-2

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68
Q

Ketorolac has a limit of ____ days for patients

A

5

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69
Q

Used in ICU setting for sedation and in anesthesia for brief procedures

A

Dexmedetomidine

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70
Q

Often times completely locked down by hospitals, has sedative, anxiolytic and analgesic properties

A

Dexmedetomidine

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71
Q

ADRs of monitoring HR, blood pressure, and sedative effects

A

Dexmedetomidine

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72
Q

Risk factors for PONV

A 
Female gender
Motion sickness/previous PONV
Non-smoking status
Post-op use of opioids
Use of inhaled anesthetics
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73
Q

Pre operative approach of PONV

A 
Benzodiazepines for anxiolysis
Compassionate interaction with staff
Aprepitant
Dexamethasone
Pre-hydration
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74
Q

Intra operative approach to PONV

A 
Use of regional anesthetics
Propofol
Analgesia (non-opioid)
Ketamine
Anti-emetic therapy
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75
Q

Pharmacologic treatment for PONV

A 
Serotonin antagonists
Neurokinin inhibitors
Steroids
Antihistamines
Butyrophenones
Benzodiazepines
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76
Q

ADRs of HA, diarrhea, constipation, arrhythmias

A

Serotonin Antagonists

Ondansetron, Granisetron

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77
Q

ADRs of HA, diarrhea, weakness, dizziness

A

Neurokinin Inhibitors

Aprepitant

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78
Q

Administered pre-anesthesia reduces nausea and vomiting up to 48 hours after surgery

A

Neurokinin Inhibitors

Aprepitant

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79
Q

ADRs of dizziness, mood change, nervousness

A

Steroids

Dexamethasone

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80
Q

ADRs of sedation, confusion, dry mouth, urinary retention

A

Antihistamines

Dimenhydrinate, promethazine

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81
Q

ADRs of prolonged QT interval (black box), hypotension, tachycardia, extrapyramidal symptoms

A

Butyrophenones

Droperidol

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82
Q

Types of burns

A

Thermal
Electrical
Chemical
Radiation

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83
Q

Four crucial assessment of burns

A
  1. Airway management
  2. Evaluation of other injuries
  3. Estimation of burn size
  4. Diagnosis of CO and cyanide poisoning
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84
Q

Consider intubation in burns if:

A

Suspect airway injury
Full thickness burns to the face/mouth
Circumferential chest burns

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85
Q

Steps to take for burn patients

A

Large-bore IVs and begin fluids ASAP (high risk for intravascular fluid loss)
May need central venous access
Transfer in clean dry blankets
Treat the pain and anxiety (benzodiazepines)

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86
Q

In burn patients, there is no need for ___________ but there is need for _________

A

Prophylactic abx

Tetanus booster

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87
Q

__________ is the most common type of burns in pediatrics

A

Scalding

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88
Q

_______ are the most common cause for hospital burn admissions

A

Flames

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89
Q

Burn: only epidermal layer. Dry, red, painful, blanching. Typically heal in 3-6 days. NO blisters.

A

Superficial (1st degree)

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90
Q

Burn: usually very painful and do blister

A

Partial-thickness (2nd degree)

Superficial vs deep partial thickness

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91
Q

Burn: painless, non blanching, do NOT spontaneously heal

A

Full-thickness (3rd degree)

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92
Q

Burn: may extend into tissue, fascia, muscle, bone, organs

A

4th degree

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93
Q

Burns TSA for adults

A 
Chest and back: 18%
Arms: 9%
Legs: 18%
Hands: 1%
Head: 9%
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94
Q

Burns TSA for kids

A 
Chest and back: 18%
Arms: 9%
Legs: 14%
Hands: 1%
Head: 18%
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95
Q

Parkland formula for burns

A

LR 4cc x kg x %BSA = amount given in 24 hours

Half over the first 8 hours, over half over the next 16 hours

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96
Q

Circumferential burns to the chest or limbs

A

Check pulses frequently, escharotomy may be needed

Consider intubation

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97
Q

IV fluids typically given for burns

A

LR

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98
Q

Burns > ____% BSA get fluids

A

10%

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99
Q

Large amounts of NS could cause ______________

A

Hyperchloremic acidosis

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100
Q

Most widely used as prophylaxis against infection with burns

A

Silver sulfadiazine

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101
Q

Important to know that silver sulfadiazine destroys ____________

A

Skin grafts

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102
Q

Surgery is typically indicated for burns not expected to heal in ____ weeks

103
Q

Potential complications of electrical burns

A

Cardiac arrhythmias, compartment syndrome, and rhabdomyolysis

104
Q

Treatment for inhalational injuries

A

Oxygen, possible intubation, bronchodilators (albuterol)

105
Q

Symptoms of CO poisoning

A

Headache, lightheadedness, dizziness, confusion (CHECK NEURO STATUS), tachypnea, hypoxia

106
Q

If you have a patient with symptoms of CO poisoning but COHb is normal

A

Hydrogen cyanide toxicity

107
Q

ASA Physical Status Classification and Mortality

A 
Normal, healthy pt (0.1%)
Mild sys dz (0.2%)
Severe sys dz (1.8%)
Severe sys dz thrt to life (7.8%)
Moribund pt, won't survive w/o surgery (9.4%)
108
Q

Overall surgical risk dependent on 3 factors

A

Specific surgical risk
Patient specific clinical variables
Exercise capacity/tolerance

109
Q

Lower risk surgeries

A

Endoscopic, ophthalmologic, dental, skin/superficial

110
Q

Intermediate risk surgeries

A

Nonvascular major abdominal, infra-inguinal vascular, carotid, head and neck, orthopedic, prostate

111
Q

Higher risk surgeries

A

Emergent, major thoracic, aortic or supra-inguinal vascular surgery, procedures expecting major fluid shifts or blood loss

112
Q

Cardiac Risk Raters

A

RCRI (revised cardiac risk index)

MACE (major adverse coronary events)

113
Q

Goldman’s Criteria

A 
High risk surgery?
Hx of ischemic heart dz
Hx of CHF
Hx of CVD (CVA/TIA)
Pre-op insulin treatment
Serum creatinine > 2 mg/mL

More than 2 factors generally yields > 5 % risk of MACE

114
Q

Most important pulmonary complication of surgery

A

Pneumonia

Significant increase in mortality and length of stay

115
Q

Risk factors for post-op pneumonia

A 
Upper abdominal or cardiothoracic procedures
Prolonged anesthesia (>4 hr)
Age > 60
Tobacco abuse (> 20 pack yrs)
COPD/HF/OSA/Pre-op sepsis
Hypoalbuminemia
Impaired cognition
116
Q

Criteria for preoperative EKG

A

Asymptomatic women > 50 or men > 45

Known cardiac history

117
Q

How many calories does a surgical patient need?

A

30 kcal/kg/day

118
Q

How much protein does a surgical patient need?

A

1 gram protein/kg/day

119
Q

Phase of wound healing that begins immediately and lasts for the first few days

A

Hemostasis and Inflammation

120
Q

Phase of wound healing that starts after the first few days and lasts for several weeks

A

Proliferation

121
Q

Phase of wound healing that begins after 2-3 weeks and lasts several months

A

Maturation

122
Q

Initiates the inflammatory phase with platelet activation and release of cytokines. Initial cells are platelets quickly followed by neutrophils and macrophages.

A

Hemostasis and Inflammation Phase

123
Q

Fibroblasts are the principal cell involved in this phase. These cells are activated by the many cytokines released by white blood cells. Initially type III collagen is laid down and over time this is replaced by type I collagen. Endothelial cells, leading to new blood vessels (granulation tissue), and epithelial cells, forming new skin, are also activated.

A

Proliferation Phase

124
Q

During this phase, there is maturation of the wound collagen with collagen breakdown. Scar remodeling continues for up to 12 months during which the wound will reach about 80% of its original strength.

A

Maturation Phase

125
Q

__________ are a specialized type of fibroblast, contains contractile proteins that contract the wound and make it physically smaller (Secondary intention)

A

Myofibroblasts

126
Q

If a patient can stop smoking for 4 weeks prior to surgery, it reduces their potential mortality by ____%

127
Q

Prevention of surgical site infxns

A

Prophylactic abx should be given before incision
Stop abx within 48 hours
Clip, don’t shave, hair
Minimize personnel changes intraoperatively

128
Q

Liters of blood in an adult male is approximately __% of their body weight, while an adult female is approximately _____% of their body weight

129
Q

Minimal urine output for an adult on maintenance fluid is:

A

0.5 cc/kg/hour

130
Q

Wound healing - how to check tissue perfusion

A

ABI (0.9-1.2)

If abnormal, refer to vascular surgeon

131
Q

Wound healing - if there is edema present

A

Check tissue perfusion - if normal, consider compression

132
Q

Chronic wounds are usually caused by or are the result of:

A

Pressure ulcers
Venous and arterial insufficiency
Diabetes and neuropathy

133
Q

P.U. Staging - skin intact but with non-blanchable redness for > 1 hour after relief of pressure

134
Q

P.U. Staging - blister or other break in the dermis with partial thickness loss of dermis, with or without infection.

135
Q

P.U. Staging - full thickness tissue loss. Subcutaneous fat may be visible; destruction extends into muscle with or without infection. Undermining and tunneling may be present.

136
Q

P.U. Staging - full thickness skin loss with involvement of bone, tendon, or joint, with or without infection. Often includes undermining and tunneling.

137
Q

P.U. Staging - full thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar in the wound bed

A

Unstageable

138
Q

P.U. Staging - purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying tissue from pressure and/or shear

A

Suspected deep tissue injury

139
Q

Venous ulcers account for ____% of all lower extremity ulcers

140
Q

Venous ulcers are more common in ______ and __________

A

Women

the elderly

141
Q

Risk factors for venous ulcers

A 
Previous leg injuries
DVT
Phlebitis
Obesity
Older age
142
Q

Present with pain, swelling, and varicosities with an open wound that is generally irregular and shallow

A

Venous ulcers

143
Q

Characteristics include edema, weeping wound, irregular shape, hemosiderin deposition

A

Venous ulcers

144
Q

Treatment for venous ulcers

A

Compression therapy

May need surgery for venous insufficiency

145
Q

Typically associated with moderate to severe pain which is made worse with leg elevation

A

Arterial Ulcers

146
Q

Present with “punched out” ulcer

A

Arterial Ulcers

147
Q

Risk factors for arterial ulcers

A 
Smoking
HTN
Hyperlipidemia
Diabetes
(((risk factors for atherosclerosis)
148
Q

Diagnosis testing of arterial ulcers

149
Q

Treatment for arterial ulcers

A

Wound care and vascular surgery if possible.

DO NOT COMPRESS

150
Q

Characteristics include painful, well circumscribed, and dry

A

Arterial ulcer

151
Q

Peripheral sensory neuropathy is the single biggest cause of ________ _______ ______

A

Diabetic foot ulcers

152
Q

Muscle weakness leading to maldistribution of weight

A

Motor neuropathy

153
Q

Increased blood flow causing osteolysis and osteopenia with resultant bone fractures

A

Autonomic neuropathy

154
Q

Wagner DFU Class - superficial ulcer without subcutaneous tissue involvement

155
Q

Wagner DFU Class - penetrates through the subcutaneous tissue; may expose bone, tendon, ligament or joint capsule

156
Q

Wagner DFU Class - extensive ulceration with exposed bone

157
Q

Wagner DFU Class - gangrene of toes or forefoot

158
Q

Wagner DFU Class - gangrene of the whole foot

159
Q

Treatment of DFU

A 
Appropriate wound care
Manage hyperglycemia
Appropriate shoes
Potential casting
Manage infxns with abx
May consider HBOT
160
Q

Ulcerative skin disease of uncertain etiology. About half the patients will have crohn’s disease, ulcerative colitis, rheumatoid arthritis

A

Pyoderma Gangrenosum

161
Q

Treatment for pyoderma gangrenosum

A

Immunosuppression

162
Q

Characterized by medial calcification of the arterials that leads to ischemia and ulceration.

A

Calciphylaxis

163
Q

Most commonly seen in patients on dialysis

A

Calciphylaxis

164
Q

Treatment for calciphylaxis

A

Supportive with wound care

165
Q

Known to occur in diabetics

A

Necrobiosis Lipoidica (diabeticorum)

166
Q

Most likely an inflammatory disorder with collagen degeneration, granulomata formation in the dermis, and microangiopathy

A

Necrobiosis Lipoidica

167
Q

Treatment for necrobiosis lipoidica

A

Best wound care

168
Q

_____ cell carcinomas do not metastasize but _____ cell carcinomas can and do

A

Basal

Squamous

169
Q

SCCa that arises in an area of previously traumatized, chronically inflamed or scarred skin. Diagnosed late with poor prognosis

A

Marjolin’s ulcer

170
Q

Different types of wound care products

A 
Gauze
Tegaderm (transparent films)
Hydrocolloids
Hydrogels
Alginates
Foam
Collagen
Iodine and Silver
171
Q

Disadvantage for hydrocolloid

A

Not absorptive

172
Q

Are heteropolysaccharides derived from the cell walls of brown algae

173
Q

Can absorb up to 300 times its weight in water or wound exudate

174
Q

Can be used with charcoal for malodorous wounds

175
Q

Stimulates fibroblasts and absorbs matrix metalloproteinases

176
Q

Antibiotics preferred for wound care

A

Gentamicin, doxycycline

177
Q

Absolute criteria for blood transfusion

A 
Acute hemorrhage (>1500 mL blood loss) or rapid bleeding with hemodynamic instability
Hgb < 7 g/dL
178
Q

Criteria for blood transfusion when Hgb < 8 g/dL

A

Post operative patient
OR
cardiac disease without signs/symptoms of acute ischemia

179
Q

Criteria for blood transfusion when Hgb < 10 g/dL

A 
Cardiac disease with signs/symptoms of acute ischemia
OR
symptomatic anemia
OR
hemodynamic instability
180
Q

The volume of blood transfused should be just enough to relieve _________ ________. It is not necessary to restore the ________ to normal levels

A

Clinical symptoms

Hemoglobin

181
Q

One unit of PRBCs raises hematocrit _____%

182
Q

WBCs and platelets are removed for this specific type of blood

A

Leukocyte-poor blood

183
Q

3 types of blood transfusion rxns

A

Hemolytic
Leukoagglutinin
Hypersensitivity

184
Q

Due to incompatible matches in the ABO system

A

Hemolytic Acute Rxn

185
Q

Caused by minor red blood cell antigen discrepancies

A

Hemolytic Delayed Rxn

186
Q

May be result of previous red blood cell transfusion containing an immunogenic antigen

A

Hemolytic Delayed Rxn

187
Q

Complications of hemolytic acute rxn that can occur

A

Acute DIC and kidney failure

188
Q

Laboratory findings of acute hemolytic rxn

A 
Hct will fail to rise
Coag studies c/w DIC
Acute renal failure
Hemoglobinuria
Will see helmet cells
189
Q

Reaction to antigens in transfused blood leukocytes by patient previously sensitized to leukocyte antigens from prior transfusions or pregnancy

A

Leukoagglutinin Rxn

190
Q

May see transient pulmonary infiltrates - looks like pneumonia, completely gone in 12 hours

A

Leukoagglutinin Rxn

191
Q

Due to exposure to allogeneic plasma proteins rather than leukocytes

A

Hypersensitivity Rxn

192
Q

Symptoms that may be seen in hypersensitivity rxn to blood transfusion

A

Urticaria or bronchospasm

193
Q

Indicated for thrombocytopenia

A

Platelet transfusions

194
Q

May still be useful in patient with profound neutropenia (<100/mcL) and acutely ill from infection

A

Granulocyte Transfusions

195
Q

Used to correct coagulation factor deficiencies, TTP or HUS

A

Fresh frozen plasma

196
Q

Transplanted between same species

197
Q

Transplanted in the same individual

198
Q

Transplanted between genetically identical individuals

199
Q

Grafts transplanted between different species

A

Xenografts

200
Q

Graft divided between two recipients

A

Split transplant

201
Q

“En bloc” transplant

A

Both pediatric donor kidneys into single adult recipient

202
Q

CDC high risk donors

A

Hep B and Hep C

203
Q

HOPE Act

A

HIV positive donors for transplant in individuals who are already HIV positive

204
Q

Most common transplants

A
  1. Kidney
  2. Liver
  3. Heart
  4. Lung
  5. Kidney/Pancreas
205
Q

NOTA

A

Outlawed the sale of organs
Established OPTN
UNOs runs OPTN

206
Q

SPK

A

Simultaneous pancreas kidney transplant

Second best outcome

207
Q

PTA

A

Pancreas transplant alone

208
Q

PAK

A

Pancreas after kidney transplant

Best outcome

209
Q

MELD

A

Model for end-stage liver disease
Score range 6-40
Calculation based on total bilirubin, INR and cretinine

210
Q

Listing status for heart transplants

A

UNOs status 1A/1B/2/7

211
Q

Underlying diagnoses of lung transplants

A

Emphysema/COPD
Interstitial lung disease
Cystic fibrosis

212
Q

LAS

A

Lung Allocation score
Range 0-100
Incorporates projected survival in next year without a transplant and survival post-transplant

213
Q

Three sets of antigens involved in graft rejection

A

Major histocompatibility complex (MHC)
Minor histocompatibility complex (mHC)
Blood group antigens

214
Q

Immune response mechanisms to transplant

A

Cellular (lymphocyte-mediated)

Humoral (antibody-mediated)

215
Q

Primary antigens associated with graft rejection. In humans, referred to as human leukocyte antigens

A

Major histocompatibility complex

216
Q

Preformed antibodies against donor HLA antigens. Result in hyperacute or accelerated acute antibody-mediated rejection

A

Panel reactive antibodies

217
Q

Sensitization to HLA antigens occurs due to

A

Pregnancies
Blood transfusions
Prior transplants
Prior viral/bacterial infections

218
Q

High level Panel reactive antibodies defined as > ____%

219
Q

Rxn to SOT that occurs within minutes to hours post-transplant. Humorally mediated

A

Hyperacute Rejection

220
Q

Rxn to SOT most common during first 6-months post-transplant.

A

Acute Rejection

221
Q

Rxn to SOT that occurs months to years after rejection episodes have subsided. Both antibody and cell mediated. Appears as fibrosis and scarring in transplanted organs

A

Chronic Rejection

222
Q

Immunosuppressive Classes for Transplants

A 
Corticosteroids
Antiproliferative
Calcineurin inhibitors
mTOR inhibitors
Depleting antibodies (aka anti-lymphocyte antibodies, ALA)
223
Q

Corticosteroids for transplants

A

Prednisone, Methylprednisolone

Inhibit inflammatory response and cytokine expression

224
Q

Antiproliferative meds for transplants

A

Azathioprine, mycophenolate

Inhibit purine/DNA synthesis and prevent differentiation/proliferation of B and T lymphocytes

225
Q

Calcineurin inhibitors for transplants

A

Cyclosporine, tacrolimus

Inhibit calcineurin phosphatase and prevent interleukin-2 medicated T-cell activation and lymphocyte proliferation

226
Q

mTOR inhibitors for transplants

A

Sirolimus

Inhibit IL-2 mediated T-cell activation and lymphocyte proliferation

227
Q

Depleting antibodies for transplants

A 
Monoclonal AB (basiliximab, alemtuzumab), Polyclonal Ab
Deplete T cells (and B cells)
228
Q

Induction agents

A

Poly and monoclonal antibodies

Corticosteroids

229
Q

Maintenance agents

A

Corticosteroids
Antiproliferative agents
Calcineurin inhibitors or mTOR inhibitors

230
Q

Reversal of established rejection

A

Corticosteroids

Poly or monoclonal antibodies

231
Q

Donor sources for HCT

A

Peripheral blood progenitor cells
Bone marrow
Umbilical cord blood

232
Q

Neutropenic phase 14 days, contains more T cells, increased risk for GVHD

A

Peripheral blood progenitor cells

233
Q

Neutropenic phase 21 days

A

Bone marrow

234
Q

Neutropenic phase 30 days, more infections but not infection related death

A

Umbilical cord blood

235
Q

Donor T-lymphocytes recognize foreign HLA antigens. Destruction of lymphopoietic cells, abnormalities in the skin, liver, and gastrointestinal tract of the recipient

A

Graft versus Host Disease

236
Q

Acute GVHD

A

Skin - maculopapular rash, bullae
Liver - elevated LFTs
GI Tract - loss of appetite, dyspepsia, secretory diarrhea

237
Q

Alloreactive T-lymphocytes from the donor immune system recognizes antigenic differences expressed on residual leukemic cells

A

Graft Versus Leukemic Effect (GVL)

238
Q

Removing the ________ eliminates the GVL effect

239
Q

First line treatment of GVHD

A

Methotrexate, cyclosporine, tacrolimus, mycophenolate, sirolimus, prednisone

240
Q

______ is a major cause of morbidity/mortality in SOT

241
Q

CMV replication regardless of symptoms

242
Q

CMV infection + symptoms

243
Q

CMV Syndrome

A

Fever and/or malaise, thrombocytopenia, leukopenia

Tissue invasive disease

244
Q

Options for CMV prophylaxis treatment

A

Ganciclovir

Valganciclovir

245
Q

D+/R-

A

Universal prophylaxis for 6 months post-transplant

Prophylaxis at least 1 month post ALA for rejection

246
Q

D-/R+ or D+/R+

A

Universaal or pre-emptive strategies for at least 3 months post-transplant
Prophylaxis for at least 1 month post ALA for rejection

247
Q

Ubiquitous mold with broad, irregularly branching hyphae with few septations (aseptate)

A

Apophysomyces elegans

248
Q

Gain access via inhalation or direct skin penetration

A

Apophysomyces elegans

249
Q

Actinomycete. Ubiquitous gram-positive, strictly aerobic, filamentous, branching, weakly acid-fast bacilli. Readily disseminates in immunocompromised host.

250
Q

Prevention of Nocardia

A

Avoid gardening, soil, plants while on immunosuppressive therapy.
May use SMX-TMP

251
Q

Most common fungal pathogen in HCT

A

Inversive aspergillosis

252
Q

Pulmonary involvement predominates

A

Invasive aspergillosis

253
Q

Hyaline hyphomycete with septate, narrow hyphae with acute angle (45) branching when visualized in respiratory secretions and tissue specimens

A

Invasive aspergillosis

254
Q

Treatment for invasive aspergillosis

A

Voriconazole, isavuconazole

Surgical Care (2 decks)

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