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APA 2 Horvath > immune system > Flashcards

immune system Flashcards

1
Q

when does the rudimentary system develop

A

begins at approx 6 weeks

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2
Q

what is phagocytosis

A

destruction of foreign toxins that are harmful

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3
Q

what do T cells do

A

destroy many virus-infected cells

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4
Q

antibodies (activated T cells) transfused to provide protection are a form of

A

passive immunity

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5
Q

acquired (adaptive) immunity

A

destruction of organisms and toxins by antibodies and specific lymphocytes

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6
Q

humoral branch of acquired immunity includes which cells

A

B lymphocytes (20-50% circulating)

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7
Q

cell mediated branch of acquired immunity includes which cells

A

T lymphocytes (20-50% circulating)

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8
Q

what are the 3 kinds of granulocytes

A

neutrophils, basophils, eosinophils

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9
Q

neutrophils

A

most numerous WBCs, 6h half life, fight bacteria and fungal infection

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10
Q

basophils

A

least common. involved in hypersensitivity. release histamine, leukotrienes, cytokines, and prostaglandins. stimulate smooth muscle contraction (bronchospasm)

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11
Q

eosinophils

A

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

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12
Q

agranulocytes consist of

A

monocytes, lymphocytes

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13
Q

monocytes

A

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

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14
Q

b-lymphocytes is a type of ____ immunity

A

humoral immunity (produce antibodies)

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15
Q

T-lymphocytes is a type of ___ immunity

A

cell mediated immunity (does not produce antibodies)

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16
Q

characteristics of inflammation

A

localized vasodilation, increased blood flow, increased capillary permeability, extravasation of plasma proteins, chemotactic movement of leukocytes to site of injury

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17
Q

histamine is released by which two cells

A

basophils mast

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18
Q

stimulation of gastric secretion is by h

A

2

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19
Q

contraction of most smooth muscle other than that of blood vessels is H

A

1

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20
Q

cardiac stimulation is h

A

2

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21
Q

vasodilation is h

A

1

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22
Q

increased vascular permeability is h

A

1

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23
Q

type 1 hypersensitivity =

A

anaphylaxis

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24
Q

type 2 hypersensitivity =

A

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

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25
Q

type 3

A

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

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26
Q

type 4

A

delayed sensitivity (contact dermatitis, graft rejection)

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27
Q

symptoms of anaphylaxis

A

pruritus, urticarial, angioedema, hypotension, wheezing, bronchospasm, nausea, vomiting, abd pain, diarrhea, uterine contractions, cardiac effects, arrhythmias

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28
Q

what causes hypotension d/t anaphylaxis

A

increased capillary permeability. 50% fluid shift

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29
Q

which reaction can occur with first exposure

A

anaphylactoid

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30
Q

muscle relaxants percentage %

A

60 %

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31
Q

latex percentage %

A

15 %

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32
Q

antibiotics %

A

5-10%

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33
Q

opioids %

A

less than 5%

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34
Q

non-life threatening tx 3 drugs

A

epi, benadryl, corticosteriod

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35
Q

non-life threatening tx epi dose adult

A

100-500 mcg sub-q or IM repeat q10-15min

36
Q

non-life threatening tx epi dose child

A

10mcg/kg - 500 mcg max q15 min x2 then q4h

37
Q

non life threatening benadryl dose

A

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

38
Q

life threatening (anaphylaxis) treatment

A

airway, 100% O2, epi, bronchodilators, H1 antihistamine and H2 receptor agonist, corticosteroid

39
Q

life threatening epi dose

A

50-100mcg IV or more

40
Q

what dose epi do?

A

increases cAMP which restores normal capillary permeability and relaxes smooth muscle

41
Q

which type of patient might you see a poor response from epi

A

beta-blocked

42
Q

what are some bronchodilators you can give during anaphylaxis

A

albuterol, terbutaline, and or anticholinergic agents (atropine, scop, glyco)

43
Q

whats the chance of a mild transfusion reaction

A

1:500

44
Q

whats the chance of a fetal hemolytic reaction

A

1;250,000-600,000

45
Q

What is a fetal hemolytic reaction caused by

A

ABO incompatibility - antibodies destroy donor cells - DIC, renal failure

46
Q

fetal hemolytic reaction is masked with anesthesia but you may see

A

CV instability, hypotension, fever, hemoglobinuria, bleeding diathesis

47
Q

who’s at high risk for a latex allergy

A

health care workers, neural tube defects, multiple surgeries, spina bifida, GU tract defects, banana, kiwi, mango allergy

48
Q

latex Type 4 reaction is ___ while type 1 is ___

A

dermatitis, anaphylaxis

49
Q

how does latex allergy present in the awake patient

A

itchy eyes, generalized pruritus, SOB, feeling of faintness, impending doom, n/v, abd cramping, diarrhea, wheezing

50
Q

how does latex allergy present in the anesthetized patient

A

tachycardia, htn, wheezing, bronchospasm, cardiorespiratory arrest, flushing, facial edema, laryngeal edema, urticaria

51
Q

autoimmune disease pathology

A

insufficient or limited response to antigens superseded by a self-reactive state that is inadequate and dysfunction;

52
Q

which 3 groups of people are commonly affected by autoimmune dz

A

female, child bearing years, working age

53
Q

how does anesthesia interact with the immune system

A

anesthesia and surgery depress non-specific host resistance mechanisms

54
Q

how do epidurals affect immune system

A

significant but transient alteration of lymphocyte and killer T activity

55
Q

how do hypnotics affect immune system

A

decrease ciliary action

56
Q

HIV/AIDS pathology

A

retrovirus invades cell-mediated branch of immune system

57
Q

what kind of drugs do HIV patients take and whats the significance

A

non-nucleoside reverse transcriptase inhibitor (NNRTIs), induce CYP 450 system

58
Q

common CV comorbidities HIV/AIDS

A

abnormal EKG in 50%, pericardial effusions in 25%

59
Q

common comordibities

A

wasting syndrome, demential , peripheral neuropathies, autonomic abnormalities, platelet stability and function impairment, non-hodgkins lymphoma, kaposi’s sarcoma

60
Q

most common opportunistic pathogen with HIV/AIDS

A

pneumocystis carinii (pneumonia responsible for most deaths)

61
Q

highest risk of exposure to a blood borne pathogen is with

A

open bore needle

62
Q

risk % after percutaneous exposure

A

0.3%

63
Q

risk % after mucous membrane exposure

A

0.09%

64
Q

non intact skin to infected fluid other than blood %

A

0.0%

65
Q

what to do after exposure med tx

A

empirical treatment with 2 or more antiretrovirals within 1-2h, 1-2 weeks. periodic testing for 6mo.

66
Q

SLE patho

A

chronic inflammatory dz, production of antinuclear antibodies

67
Q

SLE presentation

A

polyarthritis and dermatitis, molar rash in 1/3 of patients, renal dz in >50%.

68
Q

most common cause of death with SLE

A

renal disease. 10-20% will require dialysis

69
Q

which patient is at a higher risk for sz, stroke, dementia, neuropathy, psychosis

A

SLE

70
Q

pericardial effusion occurs in >___% of SLE patients

A

50

71
Q

tx of SLE

A

corticosteroids, antimalarial, immunosuppresants

72
Q

SLE is exacerbated by

A

infection, pregnancy, surgical stress, drugs

73
Q

which drugs exacerbate SLE

A

procainamide, hydralazine, captoprol, enalapril, isoniazid, methyldopa, d-penicillamine

74
Q

during anesthesia SLE patients are prone to

A

PE, pneumonitis, alveolar hemorrhage, pulm RN, restrictive lung dz

75
Q

1/3 of SLE patients exhibit

A

cricoarytendoid arthritis, RLN palsy

76
Q

cyclophosphamine, used to treat SLE & RA does what

A

inhibits plasma cholinesterase, so LA and succs have prolonged effects

77
Q

scleroderma is what kind of disease , characterized by

A

collagen vascular disease. inflammation, vascular sclerosis, fibrosis of skin and organs.

78
Q

how does scleroderma progress

A
  1. injury to vascular endothelium. 2. vascular obliteration and leakage of proteins into the interstitial space. 3 tissue edema and lymphatic obstruction due to the protein leakage. 4 tissue fibrosis
79
Q

scleroderma anesthetic implications

A

may require fiberoptic intubation, bleeding with airway manipulation, chronic htn (contracted vascular volume) , GERD (hypotonis of lower esophageal sphincter), corneal abrasion (prone to dry eyes), pulm htn (avoid acidosis and hypoxemia)

80
Q

what are advantages of regional anesthesia

A

offers advantage of peripheral vasodilation and post op pain control

81
Q

Rheumatoid Arthritis patho

A

cellular hyperplasia in synovium (infiltration by lymphocytes, plasma cells, and fibroblasts)

82
Q

articular cartilage is eventually destroyed in which dz

A

RA

83
Q

Tx of RA

A

corticosteroids, methotrexate, immunosuppressants, NSAIDs

84
Q

airway considerations for RA - cervical joints

A

neck extension restricted, atlantoaxial subluxation

85
Q

airway considerations for RA - temporomandibular joint

A

small mouth opening

86
Q

airway considerations for RA - laryngeal joints

A

generalized edema, laryngeal swelling

87
Q

5 moments of hand hygiene

A

before patient contact, before aeseptic tase, after patient contact, after contact with patient surroundings

APA 2 Horvath (4 decks)

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