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Final for Critical Care > Immunological > Flashcards

Immunological Flashcards

1
Q

What is a primary immunodeficiency?

A

a group of more than 300 rare, chronic disorders in which part of the bodies immune system is missing or functions improperly.

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2
Q

What are the signs of a primary immune deficiency?

A
  • increased susceptibility to infections
  • more frequent infections
  • longer lasting infections
  • opportunistic infections
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3
Q

what is an opportunistic infection?

A

an infection a person with a healthy immune system likely wouldn’t get

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4
Q

other symptoms of opportunistic infection?

A
  • affects natural immune system
  • cannot initiate -inflammatory response
  • bacterial, fungal, viral infections
  • recurring abscesses, bronchitis and sinusitits.
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5
Q

what type of cells cannot reach the vascular system with a PI?

A

neutrophils unable to reach site of infection, and remain in the vascular system

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6
Q

What is HIV?

A

human immune deficiency virus

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7
Q

What type of infection is HIV classified as?

A

a chronic infection, treated as outpatient

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8
Q

what is AIDS?

A

autoimmune deficiency syndrome

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9
Q

what type of infection is AIDS classified as?

A

Acute, maybe requiring hospitalization

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10
Q

what body fluids can HIV-1 be transmitted through?

A 
blood
seminal fluid
vaginal secretions
amniotic fluid
breastmilk
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11
Q

how soon after exposure to AIDS/HIV should antivirals be started?

A

within 72 hours of exposure

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12
Q

what are stages of HIV based on?

A

stages based on clinical condition and CD4+T cell count

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13
Q

how soon are antibodies produced after infection?

A

antibodies are produced usually within 3-12 weeks after infection

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14
Q

What tests detect antibodies?

A

Blood test, EIA

if EIA is positive; Western blot assay confirms seropositivity

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15
Q

what company uses saliva to perform an EIA?

A

OraSure

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16
Q

what do you do when you are exposed to HIV/AIDS?

A

wash area with soap and water, flush splashes to the nose, mouth, or skin with water
report incident to your supervisor
immediately seek medical treatment

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17
Q

manifestations of HIV?

A

can include any system

infection, malignancy of body tissue

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18
Q

what are the respiratory issues with HIV and AIDS?

A

pneumocystitis pneumonia
Tuberculosis
oral candidiasis

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19
Q

what is the most common respiratory condition with HIV and AIDS?

A

pneumocystis pneumonia

80% without prophylactic treatment

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20
Q

how does pneumocystis pneumonia present?

A

initially vague symptoms, progress to significant pulmonary impairment and respiratory failure

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21
Q

how is pneumocystis pneumonia diagnosed?

A

sputum, bronchial-alveolar lavage, transbronch biopsy

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22
Q

tuberculosis with HIV/AIDS?

A

often latent disease, 10% risk developing active

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23
Q

how common is oral candidiasis with HIV and AIDS?

A

occurs in almost all patients

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24
Q

symptoms of GI problems with HIV/AIDS?

A
  • loss appetite, N/V, oral and esophageal candidiasis, chronic diarrhea
  • related to direct affect of virus or tx protocol
  • weight loss, progressive tissue wasting
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25
Q

oncologic s/s r/t HIV and AIDS?

A

kaposi’s sarcoma
lymphoma
invasive cervical cancer

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26
Q

what is kaposi’s sarcoma?

A
  • endothelial layer blood and lymphatic vessels
  • localized cutaneous lesions to disseminated multi organ
  • prognosis depends on extent of tumor, other HIV infections, CD4+ count
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27
Q

lymphoma with AIDS?

A

b-cell lymphoma 2nd most common malignancy with HIV and AIDS

-often aggressive growth and resistance to tx

28
Q

neurologic r/t HIV and AIDS?

A

Related to action HIV on nervous system tissue, opportunistic infections,
neoplasms, cerebrovascular changes, encephalopathies, treatment complications. Includes inflammation,
atrophy, demyelination, necrosis

29
Q

neuro conditions r/t HIV and AIDS?

A
  • peripheral neuropathy
  • HIV encephalopathy
  • cryptococcus neoformans meningitis
  • progresive multifocal leukoencephalopathy
30
Q

integumentary conditions r/t HIV and AIDS?

A 
kaposi
herpes zoster
molluscum contagiousum
seborrheic dermatitis
generalized folliculitis
31
Q

endocrine conditions r/t HIV and AIDS?

A

infiltration and destruction of endocrine glands

32
Q

gynecologic conditions r/t HIV and AIDS?

A

recurrent candidiasis
ulcerative STDs
HPV

33
Q

what are the s/s of diffuse connective tissue disease?

A
  • chronic

- inflammation and degenerative connective tissue

34
Q

what is the diffuse connective tissue disease?

A

rheumatoid arthritis

35
Q

what is the autoimmune reaction in synovial tissue?

A
  • degenerative changes in muscle fibers

- loss tendon and ligament elasticity and contractile power

36
Q

what gender is RA more common in?

A

females 2:1 versus males 4:1

37
Q

s/s of RA?

A
  • joint pain, swelling, warmth, erythema, lack of function, deformity depending on disease stage and severity
  • joint stiffness in AM
  • deformities in hands and feet
38
Q

where does joint pain begin with RA?

A

small joints, hands, wrists and feet

39
Q

where does RA progress to?

A

knees, shoulders, hips, elbows, ankles, cervical spine, and TMJ

40
Q

How is RA diagnosed?

A
  • rheumatoid nodules
  • exam
  • x-rays
  • presence rheumatoid factor (75%)
  • elevated ESR
  • low RBC and C4 complement
  • positive CRP, antinuclear antibody
41
Q

management of RA?

A

education (balance, rest and exercise)
salicylate and NSAIDS
management in first two years improve outcomes
methotrexate successful preventing joint destruction and long term disability

42
Q

what are the classifications of RA?

A
  • moderate erosive RA
  • Advanced unremitting RA
  • persistent Erosive RA
43
Q

what is the tx for moderate erosive RA?

A

-formal program OT/PT

cyclosporine immunosuppressant may be added to medication regimen, enhances methotrexate

44
Q

what is the tx for advanced unremitting RA?

A

immunosuppressant agents- affect antibody production at cellular level
high dose methotrexate
may cause bone marrow suppression, anemia, GO disturbance, rashes

45
Q

tx of persistent erosive RA?

A

reconstructive surgery, when pain is not controlled, interferes with independence. Synovectomy, tenorrhaphy, arthrodesis, arthroplasty
corticosteroids-low dose use while slower acting meds take effect

46
Q

What is SLE?

A

systemic lupus erythematosus (SLE), an autoimmune disease in which the bodys immune sytem mistakenly attacks healthy tissue in many parts of the body

47
Q

what systems can lupus effect?

A

can affect any system

48
Q

what does lupus do to the skin?

A
  • arthralgia, arthritis
  • papulosquamous or annular lesions
  • chronic rash with erythematous papules or plaques that can scar.
  • butterfly shaped rash on bridge of nose and cheeks
  • oral lesions
49
Q

what does lupus do to the cardio system?

A

pericarditis and artherosclerosis

50
Q

what does lupus do to the renal system?

A

hypertension

51
Q

what does lupus do to the neuro system?

A

varied and frequent, subtle behavior and cognitive changes

52
Q

common symptoms of lupus?

A
  • swollen joints
  • fever
  • chest pain
  • hair loss
  • mouth ulcers
  • swollen lymph nodes, fatigue
  • red rash most commonly on the face
53
Q

how is lupus diagnosed?

A

-exam, H and P, blood tests
-skin assessment rashes, hyper or depigmentation
sensitivity to sunlight or ultraviolet light
alopecia
oral ulcers
-pericardial, pleural infiltrates
-positive ANA
-moderate to severe anemia
-thrombocytopenia, leukocytosis, leukopenia

54
Q

tx for lupus?

A

NSAIDS
corticosteroids
immunosupressives (cyclophosphamide, azathioprine, cyclosporine)

55
Q

what is the most important med for treatment of lupus?

A

corticosteroids
topical for cutaneous
low dose oral for minor disease activity
high dose oral or IV for major disease activity

56
Q

what is scleroderma?

A

excessive accumulation of collagen in tissues

57
Q

what does scleroderma start as?

A

skin involvement

initially inflammation causes edema, taut, smooth, shiny skin appearance

58
Q

how common is scleroderma and what causes it?

A

relatively rare, and the cause is unknown

59
Q

what changes after the initial phase of scleroderma?

A

undergoes fibrotic changes, loss of elasticity and movement

tissue becomes nonfunctional

60
Q

what other body parts does scleroderma occur in?

A

blood vessels
major organs
body systems

61
Q

how does scleroderma begin?

A

with Raynaud’s phenomenon and swelling of hands

62
Q

manifestations of scleroderma?

A
  • increasing hardness and rigidity of skin
  • wrinkle and lines
  • obliterated
  • extremities stiffen, lose
  • mobility
  • mask like face and rigid mouth
  • left ventricular heart failure, hard esophagus, scarred lungs, hardened intestinal mucosa
  • progressive renal failure
63
Q

what is CREST?

A

a calcinosis, raynauds phenomenon, esophageal hardening, sclerodactyly, telangiectasia

64
Q

diagnostics for scleroderma?

A

no definitive test

  • skin biopsy ID cellular changes
  • pulmonary studies show VP abnormalities
  • EKG
  • esophageal study
  • positive ANA
65
Q

management of scleroderma?

A
  • depends on presentation
  • pain management
  • limit disability
  • moderate exercise to avoid contracture
  • avoid extreme temperature
  • lotion
66
Q

treatment of scleroderma?

A

calcium channel blockers to improve raynaud’s

-anti-inflammatory agents control stiffness, arthralgia, general discomfort

Final for Critical Care (3 decks)

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