Immune Dysfunction (Mordecai) Exam III Flashcards
1
Q
What is the primary function of the human immune system?
A) To aid in digestion
B) To repair tissues
C) To protect the host
D) To regulate metabolism
A
C) To protect the host against micro-organisms
Slide 2
2
Q
The human immune system is divided into which of the following types of immunity? (Select 2)
A) Innate immunity
B) Passive immunity
C) Aquired immunity
D) Humoral immunity
A
A) Innate immunity,
C) Acquired immunity aka Adaptive
Slide 2
3
Q
Innate immunity differs from adaptive immunity in which of the following ways?
A) It takes longer to activate and responds specifically
B) It provides long-lasting memory
C) It responds rapidly and non-specifically
D) It requires prior exposure to pathogens
A
C) It responds rapidly and non-specifically
slide 3
4
Q
Innate immunity recognizes ____ pathogens and it does not require a prior exposure.
A) Specific
B) Common
C) Unique
D) Limited
A
B) Common
Slide 3
5
Q
The innate immune system has the following properties: (Select 3)
A) No long-lasting immunity
B) Slow activation
C) No immunological memory
D) Highly specific to pathogens
E) Responds identically to repeated infections
F) Capable of immunological memory
A
A) No long-lasting immunity
C) No immunological memory - No antibodies are formed.
E) Responds identically to repeated infections
slide 3
6
Q
Which of the following is an example of a non-cellular element of innate immunity?
A) Neutrophils
B) Natural Killer (NK) cells
C) Complement proteins
D) Macrophages
A
C) Complement proteins
Mordecai - non-immune cell elements which are more structural things like…complement proteins
slide 4
7
Q
The non-cellular elements of innate immunity include: (Select 3)
A) Acute phase proteins
B) Epithelial membranes
C) Natural Killer (NK) cells
D) Mucous membranes
E) Neutrophils
A
A) Acute phase proteins
B) Epithelial membranes
D) Mucous membranes
Slide 4
8
Q
Which type of cellular element in the innate immunity responds the fastest to infection?
A) Macrophages
B) Monocytes
C) Neutrophils
D) Natural Killer (NK) cells
A
C) Neutrophils
Cells at Work.. great anime.
Slide 4
9
Q
Macrophages are part of the cellular elements of the innate immune system and provide:
A) A fast but short-lived response
B) A slower but sustained response
C) No response unless activated by T-cells
D) Only non-specific responses
A
B) A slower but sustained response
slide 4
10
Q
Which of the following are considered cellular elements of innate immunity? (Select 2)
A) NK Cells
B) Epithelial and mucous membranes
C) Monocytes
D) Microphages
E) Complement
A
A) NK Cells - natural killer
C) Monocytes,
Slide 4
11
Q
What is the common origin of all blood cells, including both myeloid and lymphoid lineages?
A) T-cell progenitor
B) Homeotopoietic stem cell
C) Common myeloid progenitor
D) Granulocyte-monocyte progenitor
E) Hematopoietic stem cell
A
E) Hematopoietic stem cell
Slide 4
12
Q
Which of the following cells are derived from the common myeloid progenitor? (Select 4)
A) Megakaryocyte
B) Cytotoxic T-cells
C) Erythrocytes
D) Eosinophil progenitor
E) B-cells
F) Basophil progenitor
A
A) Megakaryocyte
C) Erythrocytes
D) Eosinophil progenitor
F) Basophil progenitor
and Granulocyte-monocyte progenitor
Slide 4
13
Q
Which of the following cells originate from the common lymphoid progenitor? (Select 3)
A) T-cell progenitor
B) Natural Killer cells
C) Platelets
D) B-cells progenitor
E) Basophils
A
A) T-cell progenitor
B) Natural Killer (NK) cells,
D) B-cells progenitor
Slide 4
14
Q
What is does the granulocyte-monocyte progenitor create? (Select 2)
A) Monocytes
B) Dendritic cells
C) Platelets
D) Eosinophils
E) Mast cells
F) Neutrophils
A
A) Monocytes,
F) Neutrophils
Slide 4
15
Q
Platelets are derived from which of the following?
A) Monocytes
B) Eosinophils
C) Neutrophils
D) Megakaryocytes
A
D) Megakaryocytes
Slide 4
16
Q
Which of the following cells are derived from the Monocytes? (Select 2)
A) Basophils
B) Helper T-cells
C) Dendritic cells
D) Macrophages
E) Natural Killer (NK) cells
A
C) Dendritic Cells
D) Macrophages
Slide 4
17
Q
True or False
Erythrocytes are also known as Red Blood Cells
A
True
slide 4
18
Q
Which of the following cells originate from the Basophil progenitor? (Select 2)
A) Mast cells
B) Eosinophils
C) Helper T-cells
D) Basophils
E) Cytotoxic T-cells
A
A) Mast cells
D) Basophils
Slide 4
19
Q
The complement system plays a role in which of the following types of immunity?
A) Innate immunity only
B) Adaptive immunity only
C) Both innate and adaptive immunity
D) Neither innate nor adaptive immunity
A
C) Both innate and adaptive immunity
Slide 5
20
Q
Which of the following is one of the primary functions of the complement system?
A) Producing antibodies
B) Marking pathogens for destruction
C) Directly killing pathogens without any immune cell involvement
D) Providing long-term memory of pathogens
A
B) Marking pathogens for destruction
Slide 5
21
Q
The complement system consists of over ____ plasma and cell surface proteins, most of which are produced in the ____.
A) 20; bone marrow
B) 50; spleen
C) 30; liver
D) 15; spleen
E) 40; liver
A
C) 30; liver
Slide 5
22
Q
One of the primary functions of the complement system is to augment ____ and ____ to help clear pathogens from the body.
A) phagocytes; antibodies
B) T-cells; natural killer cells
C) enzymes; hormones
D) mast cells; basophils
A
A) phagocytes; antibodies
Slide 5
23
Q
The complement system can be activated by ____ in the classical pathway or by ____ in the alternative pathway.
A) T-cells or B-cells
B) Antigens or antibodies
C) Compliment 1 or compliment 3
D) Neutrophils or macrophages
A
C) C1; C3
Usually Compliment 1 in the classical pathway
Slide 5
24
Q
Which of the following are NOT a characteristic of neutrophils? (Select 3)
A) Most numerous white blood cells
B) Migrate rapidly during bacterial infections
C) Have a half-life of 24 hours
D) Sensitive to acidic environments of infection
E) Become purulent exudate
A
C) Have a half-life of 24 hours
slide 6
25
Neutrophils release ____ and engage in ____ during bacterial infections.
A) cytokines; phagocytosis
B) antibodies; exocytosis
C) histamines; antigen presentation
D) interferons; cytokines
A) cytokines; phagocytosis
## Footnote
Slide 6
26
Neutrophils are the most numerous of the WBCs with a half-life of approximately ____ hours.
A) 6
B) 8
C) 12
D) 16
A) 6
## Footnote
Slide 6
27
Monocytes are known as the largest of which type of cells?
A) Platelets
B) White blood cells
C) Red blood cells
D) Lymphocytes
B) White blood cells
## Footnote
Slide 7
28
# Matching
Match the type of monocyte with where they become macrophages in the body
Langerhans → c) Epidermis (Skin)
Kupffer → a) Liver
Alveolar cells → d) Lung
Microglia → b) Central Nervous System (CNS)
## Footnote
Slide 7
29
After neutrophils mobilize to a site of infection, macrophages follow and **persist at sites** of ____ infection, where they engage in phagocytic destruction and produce ____.
A) chronic; NO and cytokines
B) acute; histamines and cytokines
C) acute; histamines and antibodies
D) chronic; NO and histamines
A) chronic; NO and cytokines
M - *lncrease in NO leads to vasodilation which then further helps the immune system by opening up the blood vessels and help get help getting our immune cells to the target of area where they need to perform their functions. Macrophages persist and have that slow sustained response that can last for days.*
## Footnote
Slide 7
30
Which of the following is true about basophils?
A) They are the most numerous white blood cells
B) They are the least common blood granulocytes
C) They primarily reside in connective tissue
D) They do not play a role in allergies
B) They are the least common blood granulocytes
## Footnote
Slide 8
31
Mast cells are typically found in which location? Select 2
A) Circulating in the bloodstream
B) In connective tissue
C) In lymph nodes
D) Inside the liver
E) Near blood vessels
B) In connective tissue near blood vessels
## Footnote
Slide 8
32
What role do both basophils and mast cells play in the body?
A) They directly attack bacteria
B) They produce antibodies
C) They initiate hypersensitivity reactions
D) They destroy viruses
C) They initiate hypersensitivity reactions
M - *Type 1 hypersensitivity reaction... like asthma or an acute allergic response is a hypersensitivity reaction.*
## Footnote
Slide 8
33
Both basophils and mast cells express high-affinity receptors for ____, which are involved in allergic responses.
A) IgG
B) IgA
C) IgE
D) IgM
C) IgE
## Footnote
Slide 8
34
Which substances are released by mast cells and basophils during an allergic response? (Select 4)
A) Histamine
B) Leukotrienes
C) Cytokines
D) Cortisol
E) Platelets
F) Prostaglandins
A) Histamine
B) Leukotrienes
C) Cytokines
D) Prostaglandins
## Footnote
Slide 8
35
# True or False
Mast Cells and Eosinophils stimulate smooth muscle contraction
False
Mast cells and **Basophils** stimulate smooth muscle contraction
M - *They cause broncoconstriction and that's why we have difficulty breathing with some of these allergic responses.*
## Footnote
Slide 8
36
Which of the following are functions of mast cells? (Select 2)
A) Stimulate skeletal muscle contraction
B) Play a major role in asthma and eczema
C) Act as the first responders to bacterial infections
D) Reside primarily in the bloodstream
E) Release histamine
B) Play a major role in asthma and eczema
E) Release histamine *and other inflammatory mediators*
## Footnote
slide 8
37
Where are eosinophils most heavily concentrated in the body?
A) Central nervous system
B) Lymph nodes
C) Gastrointestinal mucosa
D) Skin
C) Gastrointestinal mucosa
## Footnote
slide 9
38
What is one of the primary roles of eosinophils?
A) Phagocytosis of bacteria
B) Protection against parasites
C) Initiating hypersensitivity reactions
D) Producing antibodies
B) Protection against parasites
## Footnote
Slide 9
39
In addition to protecting against parasites, eosinophils also degrade inflammation caused by ____.
A) neutrophils
B) basophils
C) mast cells
D) lymphocytes
C) mast cells
M - *Eosinophils will degrade mast cell inflammatory mediators... like histamine, leukotrienes, cytokines and prostaglandins.*
## Footnote
Slide 9
40
Adaptive immunity is found in which of the following organisms?
A) Vertebrates only
B) Invertebrates only
C) Arthropods only
D) Plants and fungi
A) Vertebrates only
## Footnote
Slide 10
41
Adaptive immunity is derived from ____ stem cells which then turn into the common _______ progenitor.
A) hematopoietic; lymphoid
B) pluripotent; myeloid
C) mesenchymal; T-cell
D) endothelial; lymphoid
A) hematopoietic; lymphoid
## Footnote
Slide 10
42
What is one of the key characteristics of adaptive immunity compared to innate immunity?
A) Immediate activation upon infection
B) Lack of memory
C) Delayed onset of activation
D) Non-specific response to pathogens
C) Delayed onset of activation
## Footnote
slide 10
43
The adaptive immune system has a delayed onset of activation but is capable of ____ and ____.
A) immediate response; phagocytosis
B) nonspecific response; inflammation
C) cytokine release; mast cell activation
D) memory; specific antigen response
D) memory; specific antigen response
## Footnote
Slide 10
44
# True or False
Vaccinations have active memory like adaptive immunity
True
## Footnote
Slide 10
45
Which of the following are functions of B cells in the **humoral component of adaptive immunity**? (Select 3)
A) Produce antibodies
B) Activate IgE
C) Bind to foreign proteins of bacteria and viruses
D) Release histamines
E) Bind to foreign proteins of tumors
A) Produce antibodies - ***IgA, IgE,IgM***
C) Bind to foreign proteins of bacteria, viruses
E) Bind to foreign proteins of tumors
## Footnote
Slide 11
46
As part of the Cellular component of adaptive ammunity, where do **T cells** (helper and cytotoxic) originate in the body, and where do they mature?
A) Originate in the thymus, mature in the bone marrow
B) Originate and mature in the thymus
C) Originate in the bone marrow, mature in the thymus
D) Originate in the lymph nodes, mature in the spleen
C) Originate in the bone marrow, mature in the thymus
## Footnote
Slide 11
47
Which of the following are produced by T cells as part of the cellular component of adaptive immunity? Select 2
A) Antibodies
B) Interferon
C) Histamines
D) Complement proteins
E) Cytokines
F) Interleukin
B) Interferon
F) Interleukin
## Footnote
Slide 11
48
Which of the following are roles of T cells in the cellular component of adaptive immunity? (Select 3)
A) Activate IgE
B) Respond to infections
C) Initiate allergic reactions
D) Play a role in chronic inflammation
E) Bind directly to viruses and tumors via antibodies
F) Activate IgA
A) Activate IgE
B) Respond to infections
D) Play a role in chronic inflammation
## Footnote
slide 11
49
**Active** immunity involves the deliberate administration of a ____, such as through a vaccine, to initiate an immune response.
A) pathogen
B) antibody
C) cell
D) protein
A) pathogen
*Vaccines can be live, inactivated, recombinant (lab made)*
## Footnote
Slide 12
50
In active immunity, repeated exposure to the same pathogen results in a ____ immune response
A) weaker
B) quicker
C) slower
D) delayed
B) quicker
M - *occurs due to environmental pathogen exposure or pathogens that are deliberately administered to induce antibody formation.*
## Footnote
slide 12
51
Which of the following are examples of passive immunity? (Select 3)
A) Maternal IgA antibodies passed via breast milk
B) Vaccination with a live pathogen
C) Receiving antibodies from another individual
D) Immunity lasting a few weeks to months
E) Production of antibodies after vaccination
F) Someone sneezes in your face
A) Maternal **IgA** antibodies passed via breast milk
C) Receiving antibodies from another individual,
D) Immunity lasting a few weeks to months
## Footnote
Slide 12
52
# True or False
Immunoglobins like IVIG are a type of *passive* immunity given to help patients that are immunocompromised to help fight off infection.
True
M - ***immunoglobins like IVIG** are given to help patients that are immunocompromised fight off infection. They are from donated plasma and the immunoglobins are isolated and then given as a treatment for various autoimmune diseases and other comorbidities.*
## Footnote
Slide 12
53
The immune response, Neutropenia, is characterized by an ____________ number of neutrophils.
A) Excessive
B) Misdirection
C) Inadequate
D) Exaggerated
C) Inadequate
## Footnote
Slide 13
54
# Matching
Match the Category of Immune Response with its Example
1. Inadequate → c) Neutropenia (low white blood cell count)
2. Excessive (exaggerated immune response) → a) Asthma, hives, or anaphylaxis...*Type 1 - overeacting to an antigen*
3. Misdirection → b) Autoimmune disorders - *Antibodies are formed against the body's natural receptors or ligands that aren't necessarily harmful*
## Footnote
Slide 13
55
During a hypersensitivity reaction, the immune system mounts an altered response involving both ____ cells and ____.
A) B; mast cells
B) T; antibodies
C) red blood; B-cells
D) platelets; cytokines
B) T; antibodies
## Footnote
Slide 14
56
What is a necessary condition for hypersensitivity reactions to occur?
A) Direct bacterial infection
B) Excessive neutrophil production
C) Immunosuppression
D) Prior sensitization to an antigen
D) Prior sensitization to an antigen
*Grass, latex, gluten, nuts, medications*
| Yellow guy is Cedar Pollen "antigen"
## Footnote
Slide 14
57
Hypersensitivity reactions can result in a response that ranges from ____ to ____.
A) uncomfortable; moderate
B) comfortable; severe
C) uncomfortable; fatal
D) pleasant; fatal
C) uncomfortable; fatal
## Footnote
Slide 14
58
Which of the following drugs are common triggers for hypersensitivity reactions? (Select 3)
A) NSAIDs
B) Antibiotics
C) Proton pump inhibitors
D) Antihistamines
E) Analgesics
A) NSAIDs
B) Antibiotics
C) Proton pump inhibitors (PPIs)
## Footnote
Slide 14
59
# True or False
Antibiotics are the #1 drug that causes allergic reactions under anesthesia
False
M - *NMBD are the #1 drug that causes allergic reactions under anesthesia.. rocuronium*
## Footnote
Slide 14
60
Which of the following is another name for a Type I allergic response?
A) Delayed hypersensitivity
B) Cytotoxic hypersensitivity
C) Immediate hypersensitivity
D) Immune complex-mediated hypersensitivity
C) Immediate hypersensitivity
## Footnote
Slide 15
61
During a Type I allergic response, ____ cells stimulate ____ cells, leading to the production of **IgE antibodies.**
A) B; T
B) Mast; B
C) Plasma; B
D) T; B
D) T; B
M - *that immediate hypersensitivity response that is mediated by the T cells stimulating the B cells and then Ige antibodies are produced immediately*
## Footnote
Slide 15
62
What happens during the *second exposure* to an antigen in a Type I allergic response?
A) IgG antibodies are produced
B) Antigen releases calcium
C) T cells produce cytokines to kill the antigen
D) Antibodies directly attack the antigen
B) Antigen releases calcium
## Footnote
Slide 15
63
During a Type I allergic response, the release of calcium triggers the release of which of the following substances? (Select 4)
A) Histamine
B) Heparin
C) Interleukins
D) Interferon
E) Prostaglandins
F) Inflammatory mediators
G) Cytokines
A) Histamine
B) Heparin
E) Prostaglandins
F) Inflammatory mediators
## Footnote
Slide 15
64
Histamine released during a Type I allergic response can trigger which of the following effects? (Select 3)
A) Bronchoconstriction
B) Increased vascular permeability
C) Vasodilation
D) Decreased gastric acid production
E) Smooth muscle relaxation
F) Decrease vascular permeability
A) Bronchoconstriction
B) Increased vascular permeability
C) Vasodilation
## Footnote
Slide 15
65
Which of the following are examples of conditions caused by a Type I allergic response? (Select 4)
A) Hemolytic anemia
B) Anaphylaxis
C) Angioedema
D) Conjunctivitis
E) Myasthenia Gravis
F) Asthma
B) **Anaphylaxis** - *the only allergic response that causes this is Type I*
C) Angioedema
D) Conjunctivitis
A) Asthma
***Also Dermatitis***
## Footnote
slide 15
66
Which of the following treatments are used to prevent or manage the effects of histamine during a Type I allergic response? (Select 4)
A) Antihistamines
B) Cromolyn sodium
C) Bronchodilators
D) COX pathway inhibitors
E) Antibiotics
A) Antihistamines
B) Cromolyn sodium
C) Bronchodilators
D) COX pathway inhibitors
**Diagnostic testing**
## Footnote
Slide 16
67
Which of the following treatments might be used for desensitization to allergens in individuals with a Type I allergic response?
A) Small doses of allergen
B) Anti-inflammatories
C) Vaccines
D) Corticosteroids
E) Chromium sodium
A) Small doses of allergen
M - *patients can be desensitized to allergens by receiving very tiny doses of the allergen. It's generally done in a controlled environment **under the supervision of an immunologist**. Obviously, with the **airway expert** present to be prepared for any airway situations that could occur during this process.*
## Footnote
Slide 16
68
What is another name for Type II allergic response?
A) Immediate hypersensitivity
B) Cytotoxic hypersensitivity
C) Delayed hypersensitivity
D) Immune complex-mediated hypersensitivity
B) Cytotoxic hypersensitivity
M - *antibodies are formed against antigens on the cell or the tissue surfaces.*
## Footnote
slide 17
69
Which immune components are involved in a Type II allergic response?
A) IgG, IgM, and complement
B) IgE, IgM and mast cells
C) IgE, T cells and complement
D) Antigen-presenting cells, mast cells and dendritic cells
A) IgG, IgM, and complement *mediated*
* **Activate B cells to produce antibodies**
## Footnote
slide 17
70
# True or False
The presentation and severity vary with Type II allergic response from minutes-hours
True!
## Footnote
Slide 17
71
Treatment options for Type II allergic responses include ____ and ____.
A) antibiotics; antihistamines
B) antivirals; bronchodilators
C) anti-inflammatories; immunosuppressives
D) vaccines; corticosteroids
C) anti-inflammatories; immunosuppressives
## Footnote
slide 17
72
Which of the following is **not** an example of a Type II allergic response?
A) Hemolytic anemia
B) Myasthenia gravis
C) Transfusion reactions
D) Anaphylaxis
D) Anaphylaxis
## Footnote
Slide 17
73
What is another name for a Type III allergic response?
A) Immediate hypersensitivity
B) Cytotoxic hypersensitivity
C) Immune complex hypersensitivity
D) Delayed-type hypersensitivity
C) Immune complex hypersensitivity
## Footnote
Slide 18
74
In a Type III allergic response, immune complexes are most likely to be deposited in which of the following tissues?
A) Brain, heart, muscles
B) Joints, kidneys, skin, eyes
C) Lungs, liver, pancreas
D) Blood vessels, spleen, thymus
B) Joints, kidneys, skin, eyes
M - *antibody has now met with the antigen and it forms this complex, but the body isn't able to effectively eliminate the complex and so it gets deposited into the joints, the skin, the eyes and various areas around the body, and it causes kind of ongoing chronic inflammation.*
## Footnote
Slide 18
75
Which antibodies mediate a Type III allergic response?
A) IgA and IgE
B) IgG and IgM
C) IgE and IgD
D) IgM and IgA
B) IgG and IgM
**Same as Type II**
## Footnote
Slide 18
76
# True or False
The presentation and severity vary with Type III takes hours-weeks to develop
True
## Footnote
Slide 18
77
Which of the following conditions are examples of Type III allergic responses? (Select 3)
A) Systemic lupus erythematosus
B) Rheumatoid arthritis
C) Hemolytic anemia
D) Anaphylaxis
E) Serum sickness
A) Systemic lupus erythematosus (SLE)
B) Rheumatoid arthritis
E) Serum sickness
## Footnote
Slide 18
78
Which treatments are commonly used to manage Type III allergic responses? (Select 2)
A) Anti-inflammatories
B) Immunosuppressives
C) Antivirals
D) Antihistamines
E) Antibiotics
A) Anti-inflammatories
B) Immunosuppressives **(maybe)**
## Footnote
Slide 18
79
What mediates a Type IV allergic response? Select 3
A) IgG antibodies
B) B lymphocytes
C) T lymphocytes
D) IgE antibodies
E) Monocytes
F) Macrophages
C) T lymphocytes
E) Monocytes
F) Macrophages
## Footnote
Slide19
80
# True or false
Type IV allergic response does not involve antibodies
TRUE
## Footnote
Slide 19
81
Which of the following is a common feature of Type IV allergic responses?
A) Immediate reaction
B) Involvement of antibodies
C) Cutaneous symptoms
D) Rapid onset and resolution
C) Cutaneous symptoms
*M - usually more superficial symptoms*
## Footnote
Slide 19
82
Treatments for Type IV allergic responses include which of the following? (Select 2)
A) Anti-inflammatories
B) Immunosuppressives
C) Antivirals
D) Antibiotics
E) Antihistamines
A) Anti-inflammatories
B) Immunosuppressives
## Footnote
Slide 19
83
Which of the following are examples of Type IV allergic responses? (Select 3)
A) Contact dermatitis
B) Tuberculosis
C) Stevens-Johnson syndrome
D) Rheumatoid arthritis
E) Anaphylaxis
A) Contact dermatitis
B) Tuberculosis
C) Stevens-Johnson syndrome - *A allergic reaction to NSAIDs or Tylenol that causes a diffuse rash of blisters on the skin and mucous membranes*
## Footnote
Slide 19
84
Anaphylaxis is a **life-threatening** condition that most commonly occurs within how many minutes of exposure to the triggering agent?
A) 1-2 minutes
B) 3-5 minutes
C) 5-10 minutes
D) 15-20 minutes
C) 5-10 minutes
## Footnote
Slide 21
85
Anaphylaxis is a life-threatening condition that occurs in approximately 1 in ____ to 1 in ____ anesthetics.
A) 1000; 2000
B) 5000; 20,000
C) 10,000; 50,000
D) 20,000; 100,000
B) 5000; 20,000
## Footnote
Slide 21
86
Which of the following are common symptoms of anaphylaxis? (Select 4)
A) Systemic vasodilation
B) Contact dermitis
C) Extravasation of protein and fluid
D) Bronchospasm
E) Vfib with pulse
F) Hypotension
A) Systemic vasodilation
C) Extravasation of protein and fluid,
D) Bronchospasm
F) Hypotension
## Footnote
Slide 21
87
If anaphylaxis is left untreated, which severe outcome may occur?
A) Pulseless electrical activity
B) Bradycardia
C) Atrial fibrillation
D) Hypertension
A) Pulseless electrical activity (PEA)
## Footnote
Slide 21
88
What triggers the antigen-antibody reaction in anaphylaxis?
A) First exposure to an antigen
B) Subsequent exposure to an antigen
C) A bacterial infection
D) A viral infection
B) Subsequent exposure to an antigen
**Antigen-antibody reaction**
## Footnote
Slide 22
89
During anaphylaxis, which cells degranulate and release histamine and other mediators?
A) B cells and T cells
B) Neutrophils and macrophages
C) Mast cells and basophils
D) Dendritic cells and eosinophils
C) Mast cells and basophils
## Footnote
Slide 22
90
Which mediators are released during the degranulation of mast cells and basophils in anaphylaxis? (Select 4)
A) Histamine
B) Leukotrienes
C) Prostaglandins
D) Eosinophils
E) Platelet-activating factor
A) Histamines
B) Leukotrienes
C) Prostaglandins
D) Eosinophil/neutrophils
E) Platelet-activating factor
**and Chemotatic factor**
All of the answers are correct.
91
Anaphylaxis can result in significant fluid loss, with up to ____ of intravascular fluid extravasating into surrounding tissues.
A) 5%
B) 30%
C) 50%
D) 73%
C) 50%
M - ***lifetime prevalence of anaphylaxis is 5%**, but different sources show different numbers. So don't hang your hat on that 5%.
I think that's a very high*
## Footnote
Slide 22
92
Biphasic anaphylaxis occurs in approximately what percentage of patients?
A) 1-2%
B) 3-4%
C) 4-5%
D) 6-7%
C) 4-5%
M - *4 to 5% of those that experience anaphylaxis experience biphasic anaphylaxis. Less than 1% (0.25%)*
## Footnote
Slide 23
93
Biphasic anaphylaxis is characterized by which of the following?
A) A secondary anaphylactic episode following a second exposure
B) A secondary anaphylactic episode occurring without a second exposure
C) A single anaphylactic episode with delayed onset
D) An anaphylactic episode resolved by a single dose of epinephrine
B) A secondary anaphylactic episode occurring without a second exposure
M - *occurs after the patient has already, recovered from their initial anaphylactic response.. **it occurs following an asymptomatic period** and it occurs without a secondary exposure*
## Footnote
Slide 23
94
Biphasic anaphylaxis typically occurs following a asymptomatic period, ____ to ____ hours after the initial episode, without requiring a second exposure to the antigen.
A) 4; 6
B) 6; 12
C) 8; 72
D) 24; 48
C) 8; 72
## Footnote
Slide 23
95
Which of the following are risk factors for biphasic anaphylaxis? (Select 2)
A) Severe initial anaphylactic response
B) Mild initial response with one dose of epinephrine
C) Initial response required multiple doses of epinephrine
D) Prolonged exposure to the allergen
E) Occurrence of an symptomatic period after initial treatment
A) Severe initial anaphylactic response,
C) Initial response required multiple doses of epinephrine
## Footnote
Slide 23
96
Which of the following is NOT a risk factor for perioperative anaphylaxis?
A. Asthma
B. Longer duration of anesthesia
C. Females (not in teen years)
D. Multiple past surgeries
E. Male gender
F. Presence of other allergic conditions
E. Male gender
## Footnote
Slide 24
97
What lab test can verify mast cell activation and release during an anaphylactic reaction? When is it checked?
A. Plasma potassium
B. Plasma glucose
C. Plasma tryptase
D. Plasma sodium
C. Plasma tryptase
*checked 1-2 hours after*
## Footnote
Slide 25
98
Plasma histamine concentration should be at baseline within how many minutes of treatment for anaphylaxis?
A. 30 minutes
B. 45 minutes
C. 60 minutes
D. 90 minutes
C. 60 minutes
Corn: *after treatment you'd see the histamine level go down.*
## Footnote
Slide 25
99
Which of the following statements are true regarding anaphylactic response skin testing after an episode of anaphylaxis? (Select 2 that apply.)
A. Skin testing is typically done 6 weeks after the initial reaction.
B. Skin testing is done immediately after the reaction to confirm diagnosis.
C. The skin test looks for a wheal and flare response.
D. Skin testing is usually done 2 weeks after the initial reaction.
E. Skin testing is done 6 months after the initial reaction.
A. Skin testing is typically done 6 weeks after the initial reaction
C. The skin test looks for a wheal and flare response
## Footnote
Slide 25
100
Which of the following factors can compromise the diagnosis of anaphylaxis in a patient undergoing surgery? (Select 2 that apply.)
A. Hypothermia and bradycardia
B. Communication issues
C. Covered by surgical drapes
D. Preoperative fasting status
B. Communication issues
C. Covered by surgical drapes
## Footnote
Slide 25
101
Which of the following are appropriate initial steps in the management of anaphylaxis during surgery? (Select all that apply.)
A. Call for help
B. Stop blood, drugs, colloids
C. 100% O₂
D. Epinephrine
E. Fluids
A. Call for help
B. Stop blood, drugs, colloids
C. 100% O₂
D. Epinephrine
E. Fluids
## Footnote
Slide 26
102
What is the appropriate dose of epinephrine for *adult* anaphylaxis during surgery?
A. 1 mcg - 10 mcg IVP every 1-2 minutes
B. 10 mcg - 100 mcg IVP every 1-2 minutes
C. 10 mcg - 1000 mcg IVP every 1-2 minutes
D. 100 mcg - 1000 mcg IVP every 1-2 minutes
C. 10 mcg - 1000mcg IVP q 1-2 min
## Footnote
Slide 26
103
What is the appropriate dose of epinephrine for *pediatric* anaphylaxis during surgery?
A. 0.1 - 1 mcg/kg IVP every 1-2 minutes
B. 1 - 10 mcg/kg IVP every 1-2 minutes
C. 10 - 20 mcg/kg IVP every 1-2 minutes
D. 5 - 15 mcg/kg IVP every 1-2 minutes
B. 1-10 mcg/kg IVP q 1-2 min
## Footnote
Slide 26
104
If a patient experiencing anaphylaxis is resistant to epinephrine, what should be administered as the next step in treatment?
A. Dopamine or Dobutamine
B. Norepinephrine or Phenylephrine
C. Vasopressin or Methylene blue
D. Hydrocortisone or Dexamethasone
C. Vasopressin or Methylene blue
*These will inhibit NO production and thus counteract vasodilation*.
## Footnote
Slide 26
105
What is the recommended crystalloid dosage for treating anaphylaxis?
A. 5 - 10 mL/kg over 10 minutes
B. 10 - 25 mL/kg over 20 minutes
C. 20 - 30 mL/kg over 30 minutes
D. 30 - 40 mL/kg over 40 minutes
B.10 - 25 mL/kg over 20 min
*repeat PRN*
## Footnote
Slide 26
106
What is the recommended colloid dosage for treating anaphylaxis?
A. 5 mL/kg over 10 minutes
B. 10 mL/kg over 20 minutes
C. 15 mL/kg over 30 minutes
D. 20 mL/kg over 40 minutes
B.10 mL/kg over 20 min
*repeat PRN*
## Footnote
Slide 26
107
How does epinephrine reduce vasodilation during anaphylaxis?
A. By blocking histamine receptors
B. By decreasing degranulation of mast cells and basophils
C. By reducing fluid volume in the vasculature
D. By inhibiting cytokine production
B. By decreasing degranulation of mast cells and basophils
## Footnote
Slide 27
108
Match the receptor type of Epinephrine with its primary effect during the treatment of anaphylaxis:
Receptor Type
α1
β1
β2
Effect:
A. Bronchodilation
B. Supports blood pressure
C. Inotropy & chronotropy
α1- Supports blood pressure (B)
*increase SVR*
β1-Inotropy & chronotropy (C)
*increase Cardiac Output*
β2 - Bronchodilation (A)
## Footnote
Slide 27
109
Which of the following drug classes are considered secondary treatments for anaphylaxis?
A. Anticholinergics, beta-blockers, diuretics
B. Bronchodilators, antihistamines, corticosteroids
C. Anticoagulants, antiplatelets, fibrinolytics
D. Sedatives, opioids, muscle relaxants
B. Bronchodilators, antihistamines, corticosteroids
## Footnote
Slide 28
110
Which of the following antihistamines and dosages are used as secondary treatments for anaphylaxis? (Select 2 that apply.)
A. H1 → Diphenhydramine 0.5 - 1 mg/kg IV
B. H2 → Ranitidine 50 mg IV
C. H1 → Cetirizine 10 mg IV
D. H2 → Famotidine 20 mg IV
E. H1 → Diphenhydramine 10 mg IV
F. H2 → Ranitidine 100 mg IV
A. H1 → Diphenhydramine 0.5 - 1 mg/kg IV
B. H2 → Ranitidine 50 mg IV
## Footnote
Slide 28
111
Which of the following corticosteroids and dosages are used as secondary treatments for adult anaphylaxis? (Select all that apply.)
A. Hydrocortisone 250 mg IV
B. Methylprednisolone 80 mg IV
C. Hydrocortisone 100 mg IV
D. Methylprednisolone 40 mg IV
E. Hydrocortisone 500 mg IV
F. Methylprednisolone 100 mg IV
A. Hydrocortisone 250 mg IV B. Methylprednisolone 80 mg IV
## Footnote
Slide 28
112
Which of the following corticosteroids and dosages are used as secondary treatments for *pediatric* anaphylaxis? (Select 2 that apply.)
A. Hydrocortisone 50-100 mg IV
B. Methylprednisolone 2 mg/kg IV
C. Hydrocortisone 25 mg IV
D. Methylprednisolone 1 mg/kg IV
E. Hydrocortisone 100-200 mg IV
F. Methylprednisolone 0.5 mg/kg IV
A. Hydrocortisone 50-100 mg IV
B. Methylprednisolone 2 mg/kg IV
## Footnote
Slide 28
113
What steps need to be taken for a patient experiencing a biphasic anaphylactic reaction?
A. Administer sedatives and discharge the patient immediately
B. Watch the patient closely and draw blood samples for further testing
C. Provide hydration and stop monitoring once symptoms subside
D. Give antibiotics and perform a CT scan
B. Watch the patient closely and draw blood samples for further testing
## Footnote
Slide 28
114
Match each blood type with the correct antibodies present in the plasma:
Type A
Type B
Type AB
Type O
A. Anti-A and Anti-B antibodies
B. Anti-A antibodies
C. Anti-B antibodies
D. No antibodies
Type A → C. Anti-B antibodies
(A antigen)
Type B → B. Anti-A antibodies
(B Antigen)
Type AB → D. No antibodies
(A and B antigen)
Type O → A. Anti-A and Anti-B antibodies
(No antigen)
## Footnote
Slide 29
115
What is the most common cause of hyperthyroidism?
A. Hashimoto's thyroiditis
B. Iodine deficiency
C. Graves' disease
D. Thyroid cancer
C. Graves' disease
*Autoantibodies to TSH receptor*
## Footnote
Slide 30
116
Which of the following is NOT affected by the immune response in Systemic Lupus Erythematosus (SLE)?
A. Red blood cells (RBCs)
B. Lymphocytes
C. Nucleic acids
D. Thyroid gland
E. Platelets
F. Coagulation proteins
D. Thyroid gland
Mordecai: *SLE is an autoimmune inflammatory response where antibodies are formed...it affects multiple organ systems. A big famous example is Selena Gomez and her kidney. She needed a kidney transplant because her lupus had affected her kidneys drastically.*
## Footnote
Slide 31
117
Match the blood type with the appropriate transfusion compatibility for red blood cell transfusion:
Type A
Type B
Type AB
Type O
A. Can receive red blood cells from A, AB, B, and O (universal recipient)
B. Can only receive red blood cells from O (universal donor)
C. Can receive red blood cells from B or O
D. Can receive red blood cells from A or O
Type A → D. Can receive red blood cells from A or O
Type B → C. Can receive red blood cells from B or O
Type AB → A. Can receive red blood cells from A, AB, B, and O (universal recipient)
Type O → B. Can only receive red blood cells from O (universal donor)
## Footnote
Slide 29
118
Which of the following are examples of immune reactions? (Select 3 that apply.)
A. Transfusion reactions caused by a response to surface antigens on donor RBCs
B. Transplant rejection due to preexisting antibodies attacking the donor organ
C. Graves' disease caused by autoantibodies targeting the TSH receptor
D. Hyperglycemia caused by excessive carbohydrate intake
E. Dehydration from lack of water intake
A. **Transfusion reactions** caused by a response to surface antigens on donor RBCs
*A, B, and Rh*
B. **Transplant rejection** due to preexisting antibodies attacking the donor organ
*Acute or chronic*
C. **Graves' disease **caused by autoantibodies targeting the TSH receptor
## Footnote
Slide 30
119
Which of the following are examples of immune reactions? (Select 3 that apply.)
A. Multiple sclerosis
B. Rheumatoid arthritis
C. Diabetes mellitus
D. Systemic lupus erythematosus (SLE)
E. Hypertension
A. Multiple sclerosis
B. Rheumatoid arthritis
D. Systemic lupus erythematosus (SLE)
## Footnote
Slide 31
120
Which of the following best describes the immune response involved in multiple sclerosis?
A. Immune-mediated inflammation that destroys myelin and underlying nerve fibers
B. Autoimmune attack on red blood cells and coagulation proteins
C. Abnormal production of proinflammatory factors affecting joints
D. Autoantibodies attacking the thyroid gland
A. Immune-mediated **inflammation that destroys myelin and underlying nerve fibers**
## Footnote
Slide 31
121
What is a key feature of the immune response in rheumatoid arthritis?
A. Autoimmune destruction of myelin
B. Abnormal production of proinflammatory factors affecting joints
C. Antibodies attacking the TSH receptor
D. Autoimmune response targeting the pancreas
B. Abnormal **production of proinflammatory factors** affecting joints
## Footnote
Slide 31
122
Which of the following statements accurately describe angioedema? (Select 4 that apply.)
A. Angioedema involves profound, extreme swelling of tissues.
B. Angioedema can affect the face, airway, and upper respiratory tract.
C. Angioedema is only caused by allergic reactions and never has an idiopathic origin.
D. Angioedema can involve the legs, hands, and other parts of the body.
E. Angioedema can be caused by severe anaphylaxis or occur for idiopathic reasons.
A. Angioedema involves profound, extreme swelling of tissues
B. Angioedema can affect the face, airway, and upper respiratory tract
D. Angioedema can involve the legs, hands, and other parts of the body
E. Angioedema can be caused by severe anaphylaxis or occur for idiopathic reasons
## Footnote
Slide 32
123
What is the primary cause of *hereditary angioedema*?
A. Severe allergic reactions
B. Autoimmune destruction of tissues
C. C1 esterase inhibitor deficiency or dysfunction
D. Excessive histamine release
C. C1 esterase inhibitor deficiency or dysfunction→ excessive bradykinin production.
## Footnote
Slide 33
124
Which of the following factors can cause C1 esterase inhibitor problems, potentially leading to *hereditary angioedema*? (Select 5 that apply.)
A. Menses
B. Infection
C. Stress
D. Trauma
E. Oral contraceptives
F. Excessive sleep
A. Menses
B. Infection
C. Stress
D. Trauma
E. Oral contraceptives
Memory Trick: **MISTO**
## Footnote
Slide 33
125
What typically limits the production of excessive bradykinin of hereditary angioedema?
A. Histamines and corticosteroids
B. Antihistamines and vasodilators
C. C1, which limits kallikrein and Factor XIIa
D. Adrenal hormones and insulin
C. C1, which limits kallikrein and Factor XIIa
## Footnote
Slide 33
126
The excessive production of bradykinin in hereditary angioedema is associated with __ swelling and acts as a potent __, but is not responsive to __.
A. Pulmonary; vasoconstrictor; corticosteroids
B. Laryngeal; vasodilator; antihistamines
C. Abdominal; vasodilator; corticosteroids
D. Laryngeal; vasoconstrictor; antihistamines
B. Laryngeal; vasodilator; antihistamines
The excessive production of bradykinin in hereditary angioedema is associated with **larygneal swelling** and acts as a **potent vasodilator**, but is **not responsive to antihistamines**
## Footnote
Slide 33
127
What dose of antihistamine should be used for the treatment of hereditary angioedema?
A. 25 mg every 4 hours
B. 50 mg every 6 hours
C. 100 mg once daily
D. None of the above
D. None of the above
Trick question!!!
Hereditary Angioedema = excessive bradykinin and is unaffected by antihistamines.
## Footnote
Slide 33
128
# True or False
ACE inhibitors are responsible for degrading bradykinin, which leads to increased vascular permeability and fluid extravasation in acquired angioedema.
**True**
ACE inhibitors are responsible for degrading bradykinin, which leads to increased vascular permeability and fluid extravasation in acquired angioedema.
*also stimulates Substance P and causes vasodilation*
## Footnote
Slide 34
129
What is a common clinical feature of acquired angioedema associated with ACE inhibitors? (Select 2 that apply.)
A. Urticaria and severe itching
B. Lip, tongue, and face swelling
C. Bronchospasm and hives
D. Chest pain and shortness of breath
E. Without urticaria or itching
B. Lip, tongue, and face swelling
E. Without urticaria or itching
Mordercai: *And so these patients will also present with lip, tongue and facial swelling, but they do not have any rash. They don't have itching or IgE to carry out all that stuff is absent. This is **not a histamine reaction**. And so it's not like with a Type I response where you're going to give antihistamines right away. This is more supportive care and get their airway control.*
## Footnote
Slide 34
130
What are the treatments for angioedema? (Select 6 that apply)
A. Fresh Frozen Plasma (FFP)
B. Airway maintenance
C. C1 inhibitor concentrate
D. Epinephrine
E. Glucocorticoids
F. Antihistamines
G. Antibiotics
A. Fresh Frozen Plasma (FFP)
B. Airway maintenance
C. C1 inhibitor concentrate
D. Epinephrine
E. Glucocorticoids
F. Antihistamines
Memory Trick:
**FACE GA**S for Angioedema
**F**FP **A**irway maintenance :**C**1 inhibitor concentrate **E**pinephrine; **G**lucocorticoids **A**ntihistamines *S*econdary
Mordecai: *Now FFP needs to be given to re establish the intravascular volume and then C1 inhibitor concentrate because the issue is a lack of C1 or that compliment one protein and then epinephrine given for cardiovascular support. But then our antihistamines and glucordicoires, as I said, they're not our first line.They're not as helpful, but they definitely don't hurt.You're going to do everything in your power to reduce inflammation.*
## Footnote
Slide 35
131
Which cells are destroyed by the HIV virus?
A. Red blood cells and platelets
B. Monocytes/Macrophages and T-cells
C. Neurons and glial cells
D. Hepatocytes and pancreatic cells
B. Monocytes/Macrophages and T-cells
## Footnote
Slide 36
132
What is one of the most common forms of acquired immune deficiency?
A. Hepatitis B
B. HIV/AIDS
C. Tuberculosis
D. Diabetes Mellitus
**B. HIV/AIDS**
* The virus (HIV) thru reverse transcription makes a double helix DNA with all viral genetic material
* Can change amino acid sequence; new version not recognized
## Footnote
Slide 36
133
# True or False
AIDS is the initial stage of infection caused by HIV.
FALSE
AIDS is the **final stage** of infection caused by HIV
## Footnote
Slide 36
134
How long does seroconversion typically take after inoculation with the HIV virus?
A. 1 week
B. 2-3 weeks
C. 4-6 weeks
D. 6-8 weeks
B. 2-3 weeks
## Footnote
Slide 37
135
What are the initial signs and symptoms of HIV conversion to AIDS?
A. Persistent headaches and dizziness
B. Weight loss and failure to thrive
C. Rapid heartbeat and hypertension
D. Muscle spasms and joint pain
B. Weight loss and failure to thrive
## Footnote
Slide 38
136
Which of the following is NOT a method used to diagnose HIV/AIDS?
A. ELISA testing
B. Viral load measurement
C. CD4/Helper T lymphocytes count
D. Blood glucose testing
E. HAART agent sensitivity testing
D. Blood glucose testing
- ELISA: 4-8 weeks after infection
- Viral Load
- CD4/Helper T lymphocytes < 200k
- HAART agent sensitivity
## Footnote
Slide 38
137
What is typically associated with seroconversion after HIV inoculation?
A. Severe joint pain and rashes
B. Flu-like symptoms
C. Sudden weight gain
D. Persistent dry cough
**B. Flu-like symptoms**
* Fever
* Fatigue
* Night sweats
* Pharyngitis
* Myalgias
* Arthralgias
## Footnote
Slide 37
138
# True or False
Higher basal levels of the HIV virus are associated with a more rapid conversion to AIDS.
TRUE
## Footnote
Slide 38
139
Fill-in-the-Blank Multiple Choice Question
If your patient has a compromised immune system, they are far more likely to be susceptible to __, __, and even certain __.
A. bacterial infections; viruses; cancers
B. allergies; autoimmune diseases; mental disorders
C. dehydration; fractures; muscle spasms
D. hypertension; diabetes; thyroid conditions
A. bacterial infections; viruses; cancers
Mordecai: if your patient has a compromised immune system, they're going to be far more likely to be susceptible to **bacterial infections**, **viruses**, and even certain **cancers**. Herpes is associated.
What else? they're more likely to need airway management and more likely to have complicated Airways because of their repeated respiratory infections.
## Footnote
Slide 39
140
Which of the following cardiovascular conditions should be assessed during an anesthesia evaluation of HIV/AIDs patient? (Select all that apply.)
A. Abnormal EKG
B. LV dilation
C. Pulmonary hypertension
D. MI (Myocardial Infarction)
E. Pericardial effusions
All of the above
A. Abnormal EKG
B. LV dilation
C. Pulmonary hypertension
D. MI (Myocardial Infarction)
E. Pericardial effusions
## Footnote
Slide 40
141
Which of the following neurological conditions should be assessed during an anesthesia evaluation of HIV/AIDs patient? (Select 4 that apply.)
A. Dementia
B. Increased ICP
C. Autonomic nervous dysfunction
D. Peripheral neuropathy
E. Seizure disorder
A. Dementia
B. Increased ICP
C. Autonomic nervous dysfunction
D. Peripheral neuropathy
Mordecai:*Neurological decline is going to be seen as the degree as the disease progresses*
## Footnote
Slide 40
142
Which of the following pulmonary conditions should be assessed during an anesthesia evaluation of HIV/AIDs patient? (Select 3 that apply.)
A. Respiratory failure
B. Pneumothorax
C. COPD
D. Asthma
E. Bronchitis
A. Respiratory failure
B. Pneumothorax
C. COPD
Mordecai: *Pulmonary wise, as I said, they're gonna have frequent respiratory infections.*
## Footnote
Slide 41
143
Which of the following endocrine/hematologic conditions should be assessed during an anesthesia evaluation of HIV/AIDs patient? (Select all that apply.)
A. Adrenal insufficiency
B. Glucose intolerance
C. Anemia
D. Bone marrow suppression
E. Thrombocytopenia
All of the above
* Adrenal insufficiency
* Glucose intolerance
* Anemia
* Bone marrow suppression
* Thrombocytopenia
## Footnote
Slide 41
144
Which of the following renal conditions should be assessed during an anesthesia evaluation of HIV/AIDs patient? (Select 2 that apply.)
A. Acute Tubular Necrosis (ATN)
B. End-Stage Renal Disease (ESRD)
C. Chronic Kidney Disease (CKD)
D. Glomerulonephritis
A. Acute Tubular Necrosis (ATN)
B. End-Stage Renal Disease (ESRD)
Mordecai: *The kidneys are also going to be affected.*
## Footnote
Slide 41
145
Inhibition of the liver's __ has huge implications for anesthetic delivery in HIV/AIDS patients.
A. Glucose metabolism
B. Albumin production
C. CYP 450's
D. Insulin secretion
C. CYP 450's
affects:
* Hormone synthesis
* Cholesterol synthesis
* Vit D metabolism
* Drug metabolism
* Bilirubin metabolism
## Footnote
Slide 42
146
What is a key consideration when positioning malnourished patients during surgical procedures of HIV/AIDs patients?
A. Increased blood pressure management
B. Risk of abnormal fat pad redistribution
C. Enhancing muscle strength
D. Prevention of dehydration
B. Risk of abnormal fat pad redistribution → requiring frequent position checks and padding
Mordecai: *Padding and checking their position frequently is going to be important to keep their bodies safe during their procedures.*
## Footnote
Slide 42
147
Which of the following signs and symptoms characterize scleroderma? (Select 3 that apply.)
A. Inflammation
B. Vascular sclerosis
C. Fibrosis of the skin and viscera
D. Joint pain and fever
E. Abdominal pain and vomiting
A. Inflammation
B. Vascular sclerosis
C. Fibrosis of the skin and viscera
## Footnote
Slide 43
148
Scleroderma typically occurs in individuals between the ages of ___ and is more common in ___.
A. 10-20; males
B. 20-40; females
C. 40-60; both genders
D. Over 60; males
B. 20-40; females
## Footnote
Slide 44
149
What is another name for scleroderma?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Systemic sclerosis
D. Fibromyalgia
C. Systemic sclerosis
## Footnote
Slide 44
150
# True or False
The symptoms of scleroderma can be localized or limited, or more diffuse and widespread.
TRUE
## Footnote
Slide 44
151
Which gastrointestinal (GI) symptoms of scleroderma are particularly pertinent to anesthesia? (Select 2 that apply.)
A. Increased peristalsis
B. GI tract hypomotility
C. Decreased lower esophageal sphincter (LES) tone
D. Hyperactive bowel sounds
B. GI tract hypomotility
C. Decreased lower esophageal sphincter (LES) tone
## Footnote
Slide 45
152
Which of the following complications are commonly seen in patients with scleroderma? (Select 3 that apply.)
A. Cardiac dysrhythmias and conduction abnormalities
B. Pulmonary fibrosis
C. Renal artery stenosis
D. Hyperthyroidism
E. Hepatic cirrhosis
A. Cardiac dysrhythmias and conduction abnormalities
B. Pulmonary fibrosis
C. Renal artery stenosis
## Footnote
Slide 45
153
Which of the following are common symptoms of scleroderma? (Select 3 that apply.)
A. Decreasing mobility of fingers
B. Facial pain
C. Raynaud’s phenomenon
D. Joint hypermobility
A. Decreasing mobility of fingers
B. Facial pain
C. Raynaud’s phenomenon
## Footnote
Slide 45
154
Which of the following is NOT a typical preoperative lab required for patients with scleroderma before surgery?
A. ECG
B. BUN/Creatinine
C. Thyroid panel
D. CBC/Platelets
E. CXR/PFTs
C. Thyroid panel
* ECG
*look and see if they're having any kind of conductive system abnormalities*
* BUN/Creatinine
*see what their kidney function is like*
* CBC/Platelets
* CXR/PFT’s
*in case they have any kind of pulmonary compromised with this disease process*
## Footnote
Slide 46
155
# Hope the question format is not too complicated
Fill in the blanks with the correct terms related to anesthesia implications for scleroderma patients:
__ system dysfunction
A. Respiratory
B. Organ
C. Skeletal
D. Endocrine
__catheter concerns
A. Central
B. Arterial
C. Urinary
D. Dialysis
Contracted __ volume
A. Plasma
B. Intravascular
C. Extracellular
D. Intracellular
__ risk
A. Infection
B. Aspiration
C. Airway obstruction
D. Bleeding
Limited __ mobility/___ compliance
A. Neck, pulmonary
B. Joint, cardiac
C. Spine, digestive
D. Elbow, hepatic
B. Organ system dysfunction
B. Arterial catheter concerns
B. Contracted intravascular volume
B. Aspiration risk
A. Limited neck mobility/pulmonary compliance
## Footnote
Slide 47
156
What effect do inhalation agents have on the immune system? (Select 2 that apply.)
A. Stimulate natural killer (NK) cells
B. Suppress NK cells
C. Enhance phagocyte function
D. Impair phagocyte function
E. Increase the production of red blood cells
B. Suppress NK cells → Induce apoptosis of T-cells
D. Impair phagocyte function
*it's unclear what their impact is on tumor cells, but some studies do show that sevoflurane stimulates renal cell carcinoma but also it inhibits small cell carcinoma and so. Just something to keep in the back of your mind if your patient has renal cell carcinoma*.
## Footnote
Slide 48
157
This benzodiazepine, __ , decreases the migration of neutrophils.
A. Lorazepam
B. Diazepam
C. Midazolam
D. Alprazolam
C. Midazolam
## Footnote
Slide 48
158
This induction agent, __ , will depress natural killer cell activity.
A. Propofol
B. Ketamine
C. Etomidate
D. Thiopental
B. Ketamine
## Footnote
Slide 48
159
This induction agent, __, decreases cytokines but promotes NK cells.
A. Ketamine
B. Propofol
C. Etomidate
D. Midazolam
B. Propofol
## Footnote
Slide 48
160
What drug class will suppress natural killer (NK) cells?
A. Benzodiazepines
B. Opioids
C. Beta-blockers
D. Antihistamines
B. Opioids
*Particularly morphine and fentanyl*.
## Footnote
Slide 48
