Immune System Flashcards

1
Q

Characteristics of the Innate Immune System:

A

First line of defense (skin)
Inherited
Rapid response
Prior exposure not needed to act

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2
Q

Components of the Innate Immune System

A
Granulocytes
-neutrophils
-eosinophils
-basophils
Agranulocytes
-monocytes
-macrophages
Dendritic cells (DCs)
Cytokines
Complement system
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3
Q

What Components of the Innate Immune System are Phagocytes?

A
Neutrophils
Eosinophils
Monocytes
Macrophages
DCs
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4
Q

Neutrophils have the ____ response time to a pathogen.

A

Fastest

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5
Q

Neutrophils

A

(Granulocyte)
Most numerous of WBCs
Release of cytotoxic cytokines
Dead neutrophils become purulent puss at site of infection

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6
Q

Eosinophils

A
(Granulocyte)
Heavily concentrated in GI mucosa 
Primary defense against parasites
Release cytokines
Responsible for degrading mast-cell inflammatory response
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7
Q

Basophils and Mast Cells

A

(Granulocyte)
IgE
Release histamine, leukotrienes, cytokines, prostaglandins.
Smooth muscle contraction (bronchospasm).
Basophils least common granulocyte.
Mast cells found in peripheral connective tissue close to blood vessels.
Key initiators of immediate hypersensitivity reactions.
Hay fever, asthma, eczema (atopic allergies)

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8
Q

Monocytes and Macrophages

A

(Agranulocyte)
The largest blood cells
Late inflammatory response

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9
Q

Dendritic Cells are mostly located in the…

A

Spleen
Lymph nodes
Skin
Mucous membranes

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10
Q

Dendritic Cells

A

Most potent antigen presenting cells (identifies pathogen and presents to the adaptive immune system)
Contributes to B cell memory
Also can destroy antigen by phagocytosis

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11
Q

Cytokines

A

Small proteins
Interleukins (regulates inflammatory response)
Interferons (destruction of viral antigens)

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12
Q

Complement System

A

Compliments both innate and adaptive systems

Marks pathogens for destruction and recruitment

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13
Q

What are the components of the Adaptive Immune System?

A

B Cells
T Cells
Natural Killer Cells
Natural Killer T Cells

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14
Q

B Cells

A

Production of antibodies (IgG, IgM, IgA, IgD, IgE)

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15
Q

T Cells

A

Originate in bone marrow then mature in thymus.

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16
Q

Destruction of helper CD4T cells is seen with…

A

Human Papilloma Virus (HPV)

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17
Q

A loss of functional CD4 T cells leads to…

A

HIV and AIDS

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18
Q

Natural Killer Cells

A

Secretion of cytokines to destroy virus infected self cells, tumor cells, and other abnormal cells missing the MHC markers required for identification by other T and B cells.

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19
Q

Natural Killer T Cells

A

Can destroy both bacterial and viral pathogens

They can promote or inhibit the development of autoimmune diseases like diabetes type 1.

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20
Q

Active Immunity is to ________ as Passive immunity is to ________.

A

Vaccines, breast feeding (mother to baby) or transfusions.

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21
Q

Type I Hypersensitivity

A

Immediate 15-30 mins (anaphylactic).
IgE binds to mast cells and basophils which release reactive substances (histamine).
Drug allergy, hay fever, asthma.

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22
Q

Type II Hypersensitivity

A

Cytotoxic
IgG, IgM, compliment
Antigen-antibody complex activates complement and destroys target cells.
Blood transfusion, acute autoimmune hemolytic anemia, transplant rejection, myasthenia gravis, type I DM

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23
Q

Type III Hypersensitivity

A

Immune complex
IgG, IgM, neutrophils, compliment
Antigen-antibody complex deposited in tissue stimulates inflammation.
SLE, RA, glomerulonephritis

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24
Q

Type IV Hypersensitivity

A

Delayed (24 hrs-14 days)
T cells, monocytes, macrophages, cytokines
Antigen activates Tc that kills target tissue.
Poison ivy, transplant rejection, contact dermatitis, graft rejection

25
Q

Type V Hypersensitivity

A

Stimulatory
Humoral antibodies
Grave’s disease (> secretion of thyroid hormones)

26
Q

What is the classic sign of an autoimmune disease?

A

Chronic Inflammation

27
Q

What groups of people are at an > risk for an autoimmune disease?

A

Females (especially African and Native americans, hispanic females, and females of childbearing age).

28
Q

What are the 6 most common autoimmune diseases?

A
Grave’s disease
Hashimoto Thyroiditis
Multiple Sclerosis
Rheumatoid Arthritis
Systemic Lupus Erythematosus
Type 1 DM
29
Q

B-Lymphocytes do or do not produce antibodies?

A

Do

30
Q

T-Lymphocytes do or do not produce antibodies?

A

Do not

31
Q

H1 receptors main actions

A
  • Contraction of most smooth muscle other than of blood vessels.
  • Vasodilation
  • Increased vascular permeability
32
Q

H2 receptors main actions

A

Gastric secretion

Cardiac stimulation

33
Q

Difference between anaphylaxis vs anaphylactoid reaction

A

Anaphylaxis is IgE mediated while anaphylactoid is not IgE mediated.

(But response is the same)

34
Q

Most common culprits for anaphylactic reactions:

A
  • NMB (60%)(Rocc) we give it the most (Quaternary Ammonium)(Cosmetics)
  • Latex (15%)
  • Antibiotics (5-10%)
  • Opioids (<5%)
35
Q

Non-life threatening treatment

A

Epi

  • Adults: 100-500mcg sub-q or IM q 15 mins
  • children: 10mcg/kg (500mcg max) q 15mons x2 then q 4 hours

Diphenhydramine
-1-2 mg/kg or 25-50 mg IV

36
Q

Life threatening (Anaphylaxis) Tx

A

Stop administration of antigen
Airway
100% O2
Epi 50-100mcg (or more) IV
- >cAMP (restores norm cap permeability) and (relaxes smooth muscle)
- may get poor response if on BB. (Glucagon can reverse BBs)
H1 and H2

37
Q

Latex Allergy

A

> risk w/ HC workers, neural tube defects, multiple surgeries, spina bifida, genitourinary tract defects. Tropical fruit

Type IV (dermatitis) or Type I (anaphylaxis)

38
Q

Anesthesia can ________ the immune system

A

Depress

39
Q

_______ can alter lymphocyte and killer T activity.

A

Epidurals

40
Q

With HIV/AIDS, ________ invades cell-mediated branch of the immune system.

A

Retrovirus

41
Q

Pts with HIV/AID are usually on Non-nucleoside reverse transcriptase inhibitors (NNRTIs) which > the _________ system. This can do what with other drugs?

A

CYP450.

Metabolize other drugs faster.

42
Q

Patients with HIV/AIDS have a abnormal _____ in 50% and _______ _____ in 25% of patients.

A

EKG, Pericardial Effusions.

43
Q

Some common comorbidities in pts with HIV/AIDS.

A

Wasting syndrome
Dementia, neuropathies
Platelet function impairment
Non-Hodgkin’s and Kaposi’s Sarcoma.

44
Q

Two major concerns in pts with HIV/AIDS

A

Infection of patient
infection of staff

Do not recap needles
PPE
Highest risk with open bore needles
Make sure everyone is aware.

45
Q

What is the most common opportunistic pathogen with HIV/AIDS

A

Pneumocystic carinii

Pneumonia responsible for most deaths

46
Q

Risk and what to do if exposed to HIV/AIDS

A
  1. 3% after percutaneous exposure
  2. 09% after mucous exposure
  3. 0% non-intack skin to fluid other than blood.

Wash and clean area
Get immediate baseline test (you and pt)
Empirical tx with 2 or more antiretrovirals within 1-2 hours / 1-2 weeks
Periodic testing for 6 months

47
Q

SLE presentation

A

Chronic inflammatory disease

  • polyarthritis and dermatitis
  • malar rash in 1/3 of pts
  • renal disease in >50% (most common cause of death) 10-20% require dialysis
48
Q

What are some > risks in pts with SLE?

A

Seizure, stroke, dementia, neuropathy, psychosis

Pericardial effusion in >50% of pts

49
Q

Tx for SLE

A

Corticosteroids
Antimalarial
Immunosuppressants

50
Q

What exacerbates SLE?

A

Infection
Pregnancy
Surgical stress
Drugs (over 80) procainamide, hydralazine, captopril….

51
Q

Anesthesia Implications with SLE

A

Prone to PE, pneumonitis, alveolar hemorrhage, pulmonary HTN, restrictive disease

1/3 of pts exhibit cricoarytendoid arthritis and RLN palsy

May need corticosteroids

Pts are on cyclophosphamide which inhibit plasma cholinesterase (my > lasting effect of ester LAs and Succ)

52
Q

Scleroderma progression

A

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

53
Q

Scleroderma Impact

SLIDE 46

A

Multiple complications

SLIDE 46

54
Q

Anesthetic implications with Scleroderma

A
May require fiberoptic intubation
DIFFICULT INTUBATION
Bleeding with airway manipulation
Chronic HTN
GERD
Corneal Abrasion
Pulmonary HTN (avoid acidosis and hypoxemia)
Regional Anesthesia
55
Q

RA

A

Infiltration of lymphocytes, plasma cells,and fibroblasts in synovium.

Articular cartilage is eventually completely destroyed.

56
Q

RA Tx

A

Corticosteroids
Methotrexate
Immunosuppressants
NSAIDs

57
Q

Anesthetic considerations with RA

A

AIRWAY cervical joints restricted
Fiberoptic? No neck extension (restricted)

Steriod supplement
Cyclophosphamide (plasma cholinesterase inhibitor)
NSAIDS and platelet function

58
Q

Most important infection prevention

A

Hand hygiene

  • frequent
  • effective
5 moment for HH
Before pt contact
Before aseptic task
After body exposure
After pt contact
After pt contact with surroundings