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Apa2 > Immune System > Flashcards

Immune System Flashcards

1
Q

Type 4 hypersensitivity**

A

Delayed
Cell mediated

Caused by activated T cells NOT ANTIBODIES
Th1, Th2, CTL
24-72 hrs
Contact dermatitis/TB lesions/graft rejection/chronic asthma

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2
Q

Innate immunity self-vs-nonself discrimination

A

Based on self-vs-nonself

So it needs to be perfect

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3
Q

What exacerbates SLE?

A

Infection
Pregnancy
Surgical stress
Drugs (procainamide, hydralazine, captopril, enalopril, isoniazid, methyldopa, d-penicillamine)

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4
Q

SLE effects (high risk)

A 
Seizure
Stroke
Dementia
Neuropathy 
Psychosis
Pericardial effusion >50% pts
Tamponade rare
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5
Q

Mast cells**

A

Immediate hypersensitivity responses
Tissue fixed (perivascular spaces of skin/lung/intestine)
IgE receptors on surface (bind to antigens)
Activation=release of mediators important to immediate hypersensitivity rxns

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6
Q

Mononuclear cells**

A

Ingestion and destruction of damages and neoplasticism cells and bacteria

Effector cell-migrates to inflammation areas

Agranulocyte
Phagocytosis
Release cytokines
Present pieces of pathogens to t-lymphocytes

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7
Q

Hypersensitivity acronym

A

A (allergic/anaphylaxic/atopic)
C (cytotoxic)
I (immune complex)
D (delayed)

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8
Q

Adaptive immunity specificity

A

Highly specific! Can discriminate b/t pathogen and non-pathogen structures and minute differences in molec. structures

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9
Q

HIV/AIDS most common opportunistic pathogen

A

Pneumoncystic carinii
Pneumonia responsible for most deaths

Strict aseptic technique

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10
Q

Innate immunity response time

A

Fast (mins-hrs)

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11
Q

Adaptive immunity key components**

A

Antibodies (antigens interact with lymphocytes to form antibodies)

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12
Q

Innate immunity specificity

A

Only specific for molecules and molecular patterns associated with general pathogens or foreign particles

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13
Q

Anaphylaxis treatment**

Standard

A

EARLY!!

Standard (non-life threatening):

  • Epi - 100-500 mcg subq or IM, repeat q 10-15 min for adults, kids 10 mcg/kg q 15min x2 then q 4 hrs
  • Benadryl - 1-2 mg/kg or 25-50 mg IV
  • Corticosteroid - questionable
  • H2 blocker - Pepcid
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14
Q

Adaptive immunity memory

A

Memory good- when used can lead to faster response to recurrent or subsequent infections

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15
Q

Innate immunity diversity and customization

A

Limited- receptors are standard and only recognize antigen patterns. No new receptors are made to adapt the immune response

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16
Q

HIV/AIDS common comorbidities

A

CV - abnormal EKG 50%
Pericardial effusions 25%

Wasting syndrome - malabsorption/metabolism changes, <10% wt loss, eval fluid status

Neurological - dementia, peripheral neuropathy, autonomic abnormalities

Hematologic - platelet stability and f(x) impairment, steroid therapy or splenectomy

Cancer - non-hodgkin lymphoma (space occupying lesions in CNS), Kaposi’s sarcoma (endothelial tissue)

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17
Q

Type 2 hypersensitivity**

A

Cytotoxic
(Autoimmune hemolytic anemia)
Antibodies specific to antigens attach to cell surface

Antibody mediated/ IgG
5-8 hrs
PCN/chronic urticaria/BLOOD TRANSFUSION/ autoimmune hemolytic anemia

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18
Q

HIV/AIDS assessment

A

Current physical exam
Labs
Xrays

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19
Q

Type 3 hypersensitivity**

A

Immune complex
Antibodies bind antigens and release enzymes that cause tissue damage

IgG/ immune complex mediated
2-8 hrs
Serum sickness/arthus/glomerulonephritis/RA/systemic lupus/erythematosus

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20
Q

High risk latex allergy people**

A 
Healthcare workers
Neural tube defects
Multiple surgeries
Spina Bifida
GU tract defects
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21
Q

Innate immunity memory

A

None

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22
Q

HIV/Aids anesthetic concern

A

Non-nucleoside reverse transcriptase inhibitors (NNTIs)

Induce CYP450

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23
Q

Adaptive immunity self-vs-nonself discrimination

A

Worse than innate system
But still pretty good
When it has problems causes autoimmune disease

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24
Q

Allergic Tendency people**

A

Genetic

Large IgE quantity

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25
Q

Innate immunity major cell types

A

Natural killer cells, neutrophils, macrophages, basophils, eosinophils, dendritic cells

26
Q

Anaphylaxis vs. Anaphylactoid**

A

Anaphylaxis= IgE mediated
(Requires prior exposure)

Anaphylactoid= NOT IgE mediated (May occur with 1st exposure)

nearly identical

27
Q

HIV/AIDS = ____ branch

A

Retrovirus invades cell-mediated branch of immune system

28
Q

SLE treatment

A

Corticosteroids
Antimalarial
Immunosuppressants

29
Q

What to do after HIV exposure

A

Wash and clean area
Immediate baseline test you & pt
Empirical treat with 2 or more antiretrovirals (w/in 1-2 hrs/1-2 weeks)
Periodic testing for 6 months

30
Q

Anaphylaxis secondary treatment**

1-7

A
  1. Antihistamines (.5-1 mg/kg Benadryl)
  2. Catecholamines
  3. Bronchodilators
  4. Corticosteroids
  5. NaBicarb
  6. Eval airway before extubation
  7. Vasopressin for refractory shock
31
Q

Antigen activity w/in adaptive immunity**

A

B lymphocytes have millions of distinctive antigen-specific receptors inherent to organism’s DNA

T lymphocytes can only recognize antigens bound to receptor molecules MHC1 and MHC2

32
Q

Natural killer cells**

A

No specific tumor cell and antibody-dependent cytotoxicity

33
Q

Adaptive immunity major cell types**

A 
T cells (cell mediated)
B cells (humoral)
And other antigen-presenting cells
34
Q

Neutrophils**

A

Phagocytosis, cytokine release, secretion of hydrolytic enzymes, secretion of reactive oxygen species

Effector cell-migrates to inflammation areas

Granulocyte (most numerous WBC)
6 hr 1/2 life, 1st on scene in inflamm. rxn.
Fight bacteria/fungus
Contain acid hydrolases, neutral proteases, and lysosomes. After activation produce hydroxyl radicals, superoxide, and hydrogen peroxide

35
Q

RhoGAM**

A

To Rh NEG mom to prevent immune sxs from developing antibodies fetal Rh antigen
-after exposed once mom develops Rh antibodies (next child would cause reaction)

36
Q

Innate immunity key components

A

Antimicrobial peptides and proteins (such as toxic granules)

37
Q

Anaphylaxis initial therapy**

(1-5)

A
  1. Stop drug
  2. Maintain airway/ 100% FiO2
  3. D/C anesthetic agents
  4. Fluids (2-4 L crystalloid / colloid)
  5. Epi (5-10 mcg IV)
38
Q 
HIV occupational exposure**
Most common needle type \_\_\_
Risk after percutaneous exposure \_\_\_
Risk after mucous membrane exposure \_\_\_
Non intact skin to infected fluid other than blood \_\_\_
A

Open bore most common
Perc exposure O.3%
Muc meme exposure 0.09%
Non-intact skin & not blood 0%

39
Q

Macrophages**

A

Process/present antigens to effect inflamm., tumoricidal, and microbicidal functions
Arise from ciculating monocytes-may be confined so specific organ
Recruited/activated in response to microorg. or tissue inj.
Ingest antigens before they interact with lymphocyte receptors

40
Q

HIV/AIDS two major concerns

A

Infection of patient

Infection of staff

-look at regional or laparoscopic options

41
Q

Polymorphonuclear cells**

A

Ingestion or phagocytosis; killing of microorganisms; facilitation is bodily clearance of dead cells

42
Q

Plasma cells**

A

Active in protein synthesis for formation of immunoglobulins

43
Q

Platelets**

A

Facilitation of coagulation, influence tissue reactivity to injury

44
Q

SLE presentation

A

Polyarthritis and dermatitis
Malar rash in 1/3 pts
Renal disease in <50% (most common cause of death, 10-20% require dialysis)

45
Q

HIV/AIDS Prevent exposure

A 
Ensure everyone is aware
Highest risk with open bore needles
DO NOT RECAP
PPE (mask/eye ware/gloves/gowns)
Hand washing 
Clean machines regularly
46
Q

B lymphocytes**

A

Humoral immunity
Transformation into plasma cells which react to foreign substances by producing antibodies and immunoglobulins, active in circulatory system, cytokine release

Agranulocyte
Produces antibodies!!!

47
Q

Basophils and mast cells**

A

Sources of histamine and heparin, which combat insult by increasing vasc. permeability/ smooth musc. contractility (bronchospasm)/ and inflamm responses

Granulocyte (least common type)
Hypersensitivity rxns
Release histamine/leukotrienes/cytokines/prostaglandins
IgE receptors on surface
Increase if given blood causing immune resp.

48
Q

Active immunity diversity and customization

A

Very diverse!

Customized by genetic recombination do epitomes and antigenic determinants

49
Q

Active vs passive immunity

?both types of adaptive/acquired?

A

Active= given pathogen (vaccines)

Passive=given antibodies from someone immune (Immediate but short effect)(fetus, IgA breast milk, RhoGAM)

50
Q

What are antibodies?

A

Immunoglobulins
Each specific for particular antigen
Protect by direct attack or activation of complement system

51
Q

Histidine action

A 
Stimulates gastric secretion (H2)
Contracts smooth muscle (other than blood vessels)
Cardiac stim (H2)
Vasodilation (H1)
Inc vasc perm (H1)
52
Q

High risk for autoimmune**

A 
Female
African Americans 
Native American
Hispanics
Child bearing years
Working age
53
Q

T lymphocytes**

A

Recognize/react to foreign material inside fixed tissues and to harmful organisms like neoplasticism and TB cells
Impt. in transplant rejection
Cytokine release

Agranulocyte
Cell-mediated immunity
Does NOT produce antibodies!!!!

54
Q

Rank Drug reaction culprits**

A
  1. Muscle relaxants (60%)
    • Roc
    • females more
  2. Latex (15%)
  3. ABX (5-10%)

{“4” Hypnotics}

  1. Opioids (<5%)

{“5” colloids}

55
Q

SLE Anesthesia concerns

A

Prone to PE/pneumonitis/alveolar hemorrhage/pulm HTN

1/3 pts cricoarytenoid arthritis & RLN palsy

May require corticosteroids

Cyclophosphamide (inhibits plasma cholinesterase, :. Impacts ester LA & succs)

56
Q

Eosinophils**

A

Phagocytosis, combating parasitic diseases; defense in allergic response

Effector cell-migrates to inflammation areas

Granulocyte 
Heavy in GI, resp, and urinary mucosa
Can cause esophagitis
?f(x)
Collect at site of parasite infect., tumors, and allergic rxns
57
Q

Type 1 hypersensitivity rxn**

A

Anaphylaxis
(Allergic/atopic)

IgE Mediated
20-30 mins
Mast cell activation

58
Q

Anaphylaxis treatment**

Life threatening/Anaphylaxis

A
  • Airway maintenance
  • 100% O2
  • Epi IV (50-100 mcg or more, repeat prn) - restores normal cap perm/relaxes smooth musc
  • CPR, pressors, fluids
  • bronchodilators
  • H1 & H2 blockers
  • corticosteroid
59
Q

Adaptive immunity response time

A

Slow (days)

60
Q

Systemic Lupus Erythmatous (SLE)**

type of disease and what it produces

A

Chronic inflammatory disease

Production of antinuclear antibodies

Apa2 (1 decks)

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