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APA/Foundations 2 > Immune System > Flashcards

Immune System Flashcards

1
Q

Protection from infection and disease depends on: (7 things)

A 
leukocytes
phagocytes
lymphocytes
and auxiliary cells:
  - mast cells
  - basophils
  - platelets
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2
Q

soluble mediator molecules secreted by immune cells; a superfamily of peptide molecules that regulate the actions of immune system cells

A

cytokines

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3
Q

2 components of immunity that provide defense against invading pathogens

A

innate immune system

adaptive (acquired) immune system

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4
Q

component of immunity that is nonspecific and provides defense against a very large number of pathogens, rather than being directed at one specific microorganism or type of microorganism

A

innate immunity

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5
Q

6 components of innate immunity

A 
skin
lung alveoli
GI tract
leukocytes
interferons
complement system
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6
Q

primary phagocytes of the immune system

A 
polymorphonuclear neutrophils (PMN)
macrophages
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7
Q

cellular precursors of tissue macrophages

A

monocytes

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8
Q

Location where PMNs and monocytes are generated and stored

A

bone marrow

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9
Q

True or False. PMNs and monocytes (which become macrophages) are continually released into the blood.

A

True

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10
Q

chemical substances that enter the circulation from an area of infection and are transported to the marrow to stimulate production and release of PMNs and monocytes; part of the cytokine superfamily

A

colony-stimulating factors

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11
Q

after release from the bone marrow, how long do the PMNs and monocytes circulate until they move either directly across, through pores between, venue endothelial cells to enter tissues. what is this process called?

A

< 24 hours

diapedesis

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12
Q

primary function of PMNs and macrophages

A

phagocytosis of pathogens such as bacteria and viruses

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13
Q

True or false: macrophages may be mobile and migrate through tissues or may be fixed within the tissues for long periods of time.

A

True

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14
Q

phagocyte whose fx is phagocytosis and destruction of microorganisms; contain bactericidal substances and produce bactericidal reactive O2 molec

A 
Polymorphonuclear neutrophils (PMNs)
[phagocyte]
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15
Q

circulating cells of the mononuclear phagocyte system; after entering issues, they mature into macrophages

A

monocytes

[phagocyte]

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16
Q

mobile and fixed tissue cells of the mononuclear phagocyte system; perform phagocytosis and destruction of microorganisms, present antigen to helper T cells, and secrete cytokines

A

macrophages

[phagocyte]

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17
Q

provide defense against parasitic infections and perform phagocytosis of allergen-antibody complexes formed in an allergic response

A

Eosinophils

[phagocyte]

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18
Q

Lymphocyte whose fx is destruction of virus-infected “self” cells and tumor cells; secrete cytokines

A 
Natural killer (NK) cells (a.k.a. large granular lymphocytes (LGLs))
[lymphocytes]
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19
Q

differentiate into plasma cells that secrete antibodies; present antigen to the TH cells

A

B lymphocytes

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20
Q

secrete cytokines that stimulate the TH cell proliferation and activation of B lymphocytes, cytotoxic T lymphocytes, and macrophages

A

Helper T lymphocytes (TH cells)

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21
Q

engage antigen and secrete pore-forming proteins known as performs into foreign cell membrane; secrete granzymes that destroy the target cell

A

cytotoxic T lymphocytes (CTL)

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22
Q

release histamine and other pro inflammatory mediators responsible for hyperemia, increased vascular permeability, and pain

A

mast cells and basophils

[auxiliary cells]

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23
Q

present antigen to the TH cells

A

Dendritic cells

[auxiliary cells]

24
Q

participate in coagulation and the “walling off” areas of inflammation; secrete pro inflammatory mediators

A

platelets

25
Q

type of immunity that is specific; immune response is directed against a particular antigen, which is usually a component of a microorganism or foreign tissue

A

acquired (adaptive) immunity

26
Q

acquired immunity depends fundamentally on __________, which comprise approximately 30% of circulating leukocytes

A

lymphocytes

27
Q

5 main actions of histamine in humans

A
  1. vasodilation - H1
  2. increased vascular permeability - H1
  3. contraction of most smooth muscle other than that of blood vessels - H1
  4. cardiac stimulation - H2
    stimulation of gastric secretion - H2
28
Q

key mediator of type I hypersensitivity reactions

A

histamine

29
Q

Onset of anaphylaxis s/s may be delayed for an hour or longer. True or False

A

True, although it usually occurs within minutes

30
Q

s/s of anaphylaxis

A

pruritus, urticaria, angioedema (esp laryngeal edema), HoTN, wheezing, bronchospasm, direct cardiac effects including arrhythmias

31
Q

True or false, the bigger the provocative allergenic stimulus, the more severe the reaction

A

true

32
Q

How is tryptase used to determine if an Type I hypersensitivity reaction was an immunologically mediated event

A

High tryptase level strongly suggests an allergic mechanism. Normal tryptase level is inconclusive because not all anaphylactic cases involve an elevated tryptase level

33
Q

examples of type II hypersensitivity reactions

A

transfusion reactions
autoimmune hemolytic anemia
myasthenia gravis
Goodpasture syndrome

34
Q

examples of type III hypersensitivity reactions

A

SLE
RA
glomerulonephritis
other immune complex diseases

35
Q

type IV reactions require at least ___ hrs after contact with antigen

A

12

36
Q

examples of type IV reactions

A 
contact dermatitis
poison ivy
granulomatous hypersensitivity
  - TB
  - sarcoidosis
  - Crohns disease
37
Q

term for increased allergic tendency

A

atopy

38
Q

main cause of hemolytic transfusion reaction

A

human error

39
Q

hallmark symptoms transfusion reaction

A
  1. HoTN
  2. fever
  3. hemoglobinuria
  4. bleeding diathesis (susceptibility to hemorrhage/bleeding; hyaocoagulability)
40
Q

SLE presentation (4 s/s)

A
  1. Polyarthritis (involves 5 or more joints simultaneously)
  2. Dermatitis
  3. Malar rash (Butterfly rash) in 1/3 of pts
  4. Renal dz in >50% of pts
41
Q

most common cause of death in SLE pt

A

renal disease

42
Q

SLE pts are at higher risk of 6 things. What are they?

A
  1. sz
  2. cva
  3. dementia
  4. neuropathy
  5. psychosis
    6 pericardial effusion (in >50% of pts)
43
Q

3 med groups to tx SLE

A
  1. corticosteroids
  2. antimalarials
  3. immunosuppressants
44
Q

things that exacerbate SLE

A
  1. infection
  2. pregnancy
  3. surgical stress
  4. drugs (procainamide, hydrazine, captopril, enalapril, isoniazid, methyldopa, d-penicillamine)
45
Q

anesthesia implications of SLE

A 
prone to:
- PE
- pneumonitis
- alv hemorrhage
- pulm HTN
1/3 of pts have:
- cricoarytendoid arthritis
- RLN palsy
- may require corticosteroids
Cyclophosphamide inhibits plasma cholinesterase --> Ester La and succs last longer
46
Q

anesthesia considerations for pts with rheumatoid arthritis - pharmacologic

A
  1. Pt may be on steroids at home - we need to give them steroid supplements to help them respond to surgical stress
  2. cyclophosphamide (plasma cholinesterase inhibitor) –> increased duration of action for ester La’s and succs
  3. NSAIDS - alter plt function
47
Q

anesthesia considerederations for pts with rheumatoid arthritis - airway

A
  1. neck extension restricted
  2. atlantoaxial subluxation
  3. small mouth opening (tempormandibular joint)
  4. laryngeal joints - generalized edema; laryngeal swelling
  5. use glide scope/fiberoptic
48
Q

most common immunodeficiency syndrome

A

IgA deficiency

it is a primary disorder

49
Q

HIV anesthetic concern r/t medication regimen:

A

NNRTIs induce CYP450 system (Midazolam = enhanced)

50
Q

primary targets of HIV infection

A

CD4+ lymphocytes

51
Q

2 major concerns in HIV pt

A
  1. infection of pt

2. infection of me

52
Q

most common opportunistic pathogen in HIV

A

Pneumocystic carinii

53
Q

responsible for the majority of deaths in HIV pts secondary to opportunistic infection

A

Pneumocystis jiroveci pneumonia

54
Q

most common mechanism of occupational HIV transmission

A

percutaneous injury with a hollow-bore needle

55
Q

4 steps in the progression of scleroderma

A
  1. injury to the vascular endothelium
  2. vascular obliteration and leakage of proteins into the interstitial space
  3. tissue edema and lymphatic obstruction due to protein leakage
  4. tissue fibrosis
56
Q

complications to anesthesia r/t scleroderma

A
  1. periph or cranial nerve neuropathy from nerve compression
  2. MH
  3. fibrous skin –> contractures
  4. decreased pulm compliance
  5. hypo motility of GI tract
  6. decreased LES pressure and increased risk of reflux
  7. myopathies/elevated CK
  8. renal failure and renal artery stenosis
57
Q

Scleroderma anesthetic implications

A
  1. may need fiberoptic intub
  2. bleeding w airway manipulation
  3. chronic HTN (contracted vascular vol)
  4. GERD
  5. corneal abrasion - prone to dry eyes
  6. pulm HTN - avoid acidosis and hypoxemia

APA/Foundations 2 (6 decks)

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