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Fiser Absite > Fiser Absite. Ch 03-05. Blood Products. Immunology. Infection > Flashcards

Fiser Absite. Ch 03-05. Blood Products. Immunology. Infection Flashcards

1
Q

Which blood products do not carry the risk of HIV and hepatitis because they are heat treated?

A

albumin and serum globulins

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2
Q

Who gets CMV-negative blood?

A

low birth-weight infants, bone marrow transplant pts and other transplant pts

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3
Q

What is the number one cause of death from transfusion reaction?

A

Clerical error leading to ABO incompatibility

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4
Q

Stored blood is low in ____ causing a left-shift

A

2,3 DPG

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5
Q

Back pain, chills, tachycardia, fever, hemoglobinuria in pt that has been transfused. May present as diffuse bleeding in anesthetized patient.

A

acute hemolysis (ABO incompatibility, antibody mediated)

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6
Q

What is the treatment for acute hemolysis (ABO incompatibility)

A

fluids, diruetics, HCO3-, pressors, histamine blockers

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7
Q

What is the most common transfusion reaction and what is the pathophys?

A

febrile nonhemolytic transfusion reaction. recipient antibody reaction against WBCs in donor blood

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8
Q

What is the treatment for febrile nonhemolytic transfusion reaction?

A

stop transfusion and use WBC filters for subsequent transfusions

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9
Q

Anaphylaxis after transfusion. What is usually the pathophys?a and was is the tx?

A

Usually IgG against IgA in IgA-deficient patient. Tx: fluids, Lasix, pressors, steroids, epi, histamin blockers

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10
Q

What is the pathophys of transfusion related acute lung injury (TRALI)?

A

antibodies to recipient’s WBCs, clot in pulmonary capillaries

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11
Q

Dilutional thrombocytopenia occurs after transfusion of ___ units of PRBCs.

A

10

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12
Q

What electrolyte abnormality can occur with massive transfusion?

A

hypocalcemia

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13
Q

Antiplatelet antibodies develop in ___% of pts after 10-20 platelet transfusions

A

20

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14
Q

Hetastarch (Hespan) can be used up to ___ L without the risk of bleeding complications.

A

1

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15
Q

Most common bacterial contaminate of transfused blood?

A

GNRs usually e. coli

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16
Q

Most common blood product source of contamination?

A

platelets (not refrigerated)

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17
Q

What parasitic disease can be transmitted with blood transfusion?

A

chagas disease

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18
Q

What is the most common blood type?

A

O+

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19
Q

Predominant release of proinflammatory cytokines (IL-2, INF-gamma). Involved in cell-mediated responses

A

Th1 helper T cells (CD4)

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20
Q

Predominant release of anti-inflammatory cytokines (IL-4 -> inhibits macrophages). Involved in atopy and allergic responses.

A

Th2 helper T cells (CD4)

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21
Q

IL-___ causes B-cell maturation into plasma cells (antibody secreting).

A

4

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22
Q

IL-___ causes maturation of cytotoxic T cells

A

2

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23
Q

Recognize and attack non-self antigens attached to MHC class I receptors (e.g. viral gene products)

A

Cytotoxic T cells (CD8)

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24
Q

Infections associated with defects in ___ immunity - intracellular pathogens (TB, viruses)

A

cell-mediated

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25
Q

Can increase T-cell mediated immunity.

A

Nucleotides

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26
Q

What are the types of MHC class I

A

A, B and C

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27
Q

What are the types of MHC class II

A

DR, DP and DQ

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28
Q

CD8 cell activation. Present on all nucleated cells. Single chain with 5 domains. Target for cytotoxic T cells.

A

MHC class I

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29
Q

CD4-cell activation. Present on B cells, dendrites, monocytes, and antigen-presenting cells. 2 chains with 4 domains each. Activator for helper T cells. Stimulate antibody formation.

A

MHC class II

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30
Q

___ infection - endogenous viral proteins produce, are bound to class I MHC, go to cell surface, and are recognized by CD8 cytotoxic T cells

A

Viral

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31
Q

___ infection - endocytosis, proteins get bound to MHC class II molecules, go to cell surface, recognized by CD4 helper T cells -> B cells which have already bound to the antigen are then activated by the CD4 helper T cells; they then produce the antibody to that antigen and are transformed to plasma cells and memory B cells.

A

Bacterial

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32
Q

Not restricted by MHC, do not require previous exposure. Not considered T or B cells. Recognize cells that lack self-MHC. Part of the body’s natural immunosurveillance for cancer.

A

Natural killer cells

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33
Q

Initial antibody made after exposure to antigen. Is the largest antibody, having 5 domains (10 binding sites).

A

IgM

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34
Q

Most abundant antibody in body. Responsible for secondary immune response. Can cross the placenta and provides protection in newborn period.

A

IgG

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35
Q

Found in secretions, in Peyer’s patches in gut, and in breast milk; helps prevent microbial adherence and invasion in gut.

A

IgA

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36
Q

Membrane-bound receptor on B-cells (serves as an antigen receptor). Which Ab?

A

IgD

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37
Q

Allergic reactions, parasite infections. Which Ab?

A

IgE

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38
Q

Which antibodies fix complement?

A

IgM and IgG (requires 2 IgGs or 1 IgM)

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39
Q

Immediate hypersensitivity-reaction. IgE mediated; mast and basophils release histamine, serotonin and bradykinin. Example include bee stings, peanuts, hay fever.

A

Type I

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40
Q

Hypersensitivity reaction where IgG or IgM reacts with cell-bound antigen. Examples include ABO blood type incompatibility, Graves disease, MG, ITP.

A

Type II

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41
Q

Hypersensitivity reaction that involves immune complex deposition. Examples include: serum sickness, rheumatoid arthritis and SLE

A

Type III

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42
Q

Delayed-type hypersensitivity. Antigen stimulation of perviously sensitized T-cells. Examples include: TB skin test, contact dermatitis.

A

Type IV

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43
Q

Converts lymphocytes to lymphokine-activated killer cells by enhancing their immune response to tumor. Also converts lymphocytes into tumor-infiltrating lymphocytes. Has been shown to be successful for melanoma.

A

IL-2

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44
Q

What is a tetanus-prone wound?

A

> 6 hrs old; obvious contamination and devitalized tissue; crush; burn; frostbite, or missile injury

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45
Q

When to give tetanus toxoid or tetanus immune globulin

A

Non-tetanus prone wound - give toxoid only if pt has received <3 doses or tetanus status unknown.

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46
Q

Tetanus prone wound

A

always give toxoid unless pt has had >3 doses and it has been <5 years

47
Q

Tetanus immune globulin is for

A

tetanus prone wounds in non-immunized pt or immunization status unknown.

48
Q

What is the most common immune deficiency?

A

malnutrition

49
Q

Which part of the GI tract is virtually sterile; some GPCs, some yeast?

A

stomach

50
Q

Which part of the GI tract has 10^5 bacteria, mostly GPCs?

A

proximal small bowel

51
Q

Which part of the GI tract has 10^7 bacteria, mostly GPCs, GPRs, GNRs?

A

distal small bowel

52
Q

Which part of the GI tract has 10^11 bacteria, almost all anaerobes, some GNRs, GPCs?

A

colon

53
Q

What are the most common organisms in the GI tract?

A

anaerobes

54
Q

What is the most common anaerobe in the colon?

A

bacteroides fragilis

55
Q

What is the most common aerobic bacteria in the colon?

A

E. coli

56
Q

How does e coli trigger the release of TNF-a from macrophages and activate complement and coagulation cascade?

A

endotoxin (lipopolysaccharide lipid A) is released

57
Q

What is the optimal glucose level in a septic patient?

A

100-120

58
Q

How is c diff colitis diagnosed?

A

fecal leukocytes in stool, C. difficile toxin

59
Q

What is tx for c diff?

A

oral vancomycin or flagyl; IV - flagyl; lactobacillus can also help; stop other abx or change them

60
Q

___% of abdominal abscesses have anaerobes; ___% of abdominal abscesses have both anaerobic and aerobic bacteria

A

90, 80

61
Q

Tx for abdominal abscess?

A

drainage

62
Q

Abscesses usually occur how many days after an operation?

A

7/10/2013

63
Q

When do you start abx for an abscess?

A

pts with DM, cellulitis, clinical signs of sepsis, fever, elevated WBC or with bioprosthetic hardware

64
Q

Wound infection percentage for a clean operation (ie hernia)?

A

2%

65
Q

Wound infection percentage for a clean contaminated procedure (ie elective colon resection with prepped bowel)

A

3%-5%

66
Q

Wound infection percentage for a contaminated procedure such as a GSW to colon with repair?

A

5%-10%

67
Q

Most common organism overall in surgical wound infections?

A

s. aureus

68
Q

How to tell the difference between staphlococcus aureus and staphlococcus epidermidis?

A

s aureus is coagulase positive

69
Q

What is the most common GNR in surgical wound infections?

A

E. coli

70
Q

What is the most common anaerobe in surgical wound infections?

A

B. fragilus

71
Q

> ___ bacteria needed for wound infection; less bacteria needed if foreign body present.

A

10^5

72
Q

Recovery from tissue indicates necrosis or abscess (only grows in low redox state). Also implies translocation from gut. Which bacteria in infection?

A

B. fragilis

73
Q

Which two types of bacteria can produce an invasive soft tissue infection that can be present within hours postoperatively (produce exotoxins)

A

Clostridium perfringens and beta hemolytic strep

74
Q

Most common nonsurgical infection?

A

UTI (most commonly E. coli)

75
Q

Leading cause of infectious death after surgery?

A

nosocomial pneumonia

76
Q

2 most common organisms in ICU pneumonia?

A

1 s. aureus, #2 pseudomonas

77
Q

1 class of organismis in ICU pneumonia?

A

GNRs

78
Q

Top three organisms in line infections

A

S. epi, S aureus, yeast

79
Q

Top three causes of necrotizing soft tissue infections

A

Beta-hemolytic streptococcus (group A), C. perfringens and mixed organisms

80
Q

Tx for necrotizing soft tissue infections?

A

early debridement, high dose PCN

81
Q

Myonecrosis, gas gangrene and gram stain showing GPRs without WBCs.

A

C. perfringens

82
Q

Pulmonary sx most common; can cause tortuous abscess in cervical, thoracic and abdominal areas. What type of infection and what is the tx?

A

Actinomyces. Tx: drainage and penicillin G

83
Q

Pulmonary and CNS sx most common. Tx is drainage and Bactrim. What is the organism?

A

Nocardia

84
Q

Pulmonary sx most common. Mississippi and Ohio river valleys. What is the organism and what is the tx?

A

Histoplasmosis. Amphotericin for severe infections

85
Q

Pulmonary sx in the Southwest. What is the diagnosis and what is the tx?

A

Coccidioidomycosis. Amphotericin for severe infections

86
Q

What fungal infection has CNS symptoms most common and what is the tx?

A

Cryptococcus. Amphotericin for severe infections

87
Q

What is the tx for candida infections?

A

fluconazole (some Candida resistant), amphotericin for severe infections

88
Q

What is diagnostic of SBP?

A

PMNs > 500 cells/cc (fluid cultures negative in many cases)

89
Q

SBP is monobacterial, what are the top 3?

A

50% e coli, 30% streptococcus, 10% Klebsiella

90
Q

Tx for SBP?

A

ceftriaxone or other 3rd generation cephalosporin

91
Q

If pt with SBP is not getting better on abx or if cultures are polymicrobial?

A

need to rule out intra-abdominal source (diverticular abscess, perforation)

92
Q

Which abx for short term prophylaxis against SBP?

A

Fluoroquinolone

93
Q

What is the cause of SBP?

A

decreased host defenses (intrahepatic shunting, impaired bactericidal activity in ascites); not due to transmucosal migration

94
Q

What is the cause of secondary bacterial peritonitis?

A

intra-abdominal source (transmucosal migration, perforated viscus)

95
Q

What are the most common organisms in secondary bacterial peritonitis?

A

B. fragilis, E. coli, Enterococcus

96
Q

What is the tx for secondary bacterial peritonitis?

A

Usually need laparotomy to find source

97
Q

Seroconversion after HIV exposure occurs in ___ weeks

A

6 to 12

98
Q

What 2 drugs can help decrease seroconversion of HIV after exposure? Should be given within 1-2 hours of exposure.

A

AZT and lamivudine

99
Q

2 most common reasons for laparotomy in HIV patients?

A

opportunistic infections (CMV most common), neoplastic disease (respectively)

100
Q

Most common intestinal manifestation of AIDS. Can present with pain, bleeding or perforation.

A

CMV colitis

101
Q

Lymphoma in HIV patients occurs most commonly which two locations?

A

stomach, rectum

102
Q

Name two causes of upper GI bleeding in HIV patients?

A

Kaposi’s sarcoma, lymphoma

103
Q

Name three causes of lower GI bleeding in HIV patients?

A

CMV, bacterial, HSV

104
Q

Tx of brown recluse spider bite?

A

dapsone initially, may need resection of area and skin graft for large ulcers later

105
Q

Tx for acute septic arthritis?

A

drainage, 3rd-generation cephalosporin and vancomycin until cultures show organism

106
Q

Tx for diabetic foot infection?

A

broad-sprectrum abx (Unasyn, Zosyn)

107
Q

What bacteria is found only in human bites; can cause permanent joint injury?

A

Eikenella

108
Q

What bacteria is found in cat and dog bites?

A

Paseurella multocida

109
Q

What is the tx for cat/dog/human bites?

A

broad-spectrum abx (Augmentin)

110
Q

What are the 2 bacteria usually found in furuncles (boil)?

A

S. epidermidis or S. aureus

111
Q

What is a carbuncle?

A

A multiloculated furuncle

112
Q

What are the two most common bacteria in peritoneal dialysis catheter infections?

A

s. aureus and s. epidermidis

113
Q

Tx for peritoneal dialysis catheter infection?

A

intraperitoneal vancomycin and gentamicin; increased dwell time and intraperitoneal heparin

114
Q

Need removal of peritoneal dialysis catheter for which type of infections?

A

all fungal, TB and pseudomonas infections

Fiser Absite (4 decks)

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