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Justin Lyle Cards > AP Exam 4 part VI > Flashcards

AP Exam 4 part VI Flashcards

1
Q

which hypersensitivity reaction works by antigen-Ab complexes activating complement and destroying target cell

A

type II (cytotoxic)

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2
Q

transfusion reaction, erythoblastosis fetalis, acute transplant rejection, and MG are what types of hypersensitivity reactiosn

A

type II (cytotoxic)

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3
Q

SLE and RA are examples of what type of hypersensitivity reaction

A

type III (immune complex)

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4
Q

mediators for type III hypersensitivity reaction

A

IgG, IgM, neutrophils, complement

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5
Q

________________ reaction, is when an antigen-antibody complex forms and is deposited in tissues stimulating inflammation

A

type III (immune compelx)

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6
Q

poison ivy and transplant rejections are what type of hypersensitivity reaction

A

IV (delayed)

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7
Q

mediators for type IV hypersensitivity reaction

A

T cells, monocytes, macrophages, and cytokines

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8
Q

graves dz is what type of hypersensitivity reaction

A

V (stimulatory)

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9
Q

tx of anaphylaxis intraoperatively

A
  1. discontinue triggering agent 2. trendelenburg 3. FiO2 = 100% 4. epinephrine 5. fluids (NS/LR 10-30 mL/kg) 6. secondary tx
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10
Q

grade II anaphylactic reaction would require what dose of epi and what route?

A

10-20 mcg; SC/IM/IV

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11
Q

grade III anaphylactic reaction would require wht dose of epi and what route

A

100-200 mcg SC/IM/IV q 1-2 min; 1-4 mcg/min

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12
Q

grade IV anaphylactic reaction would require what dose or epi

A

1 mg IV repeat as needed: 0.05 - 1 mcg/min

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13
Q

secondary tx for intraop anaphylaxis with epinephrine unresponsiveness

A
  1. vasopressin 2-10 units IV 2. norepi: 0.05 - 0.1 mg/kg/min
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14
Q

pt has anaphylaxis intraoperatively, what is your secondary tx if they are having bronchospasm 2/2 that

A
  1. albuterol or ipratropium inhalants 2. terbutaline 0.25 mg SC (repeat in 15-30 min)
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15
Q

if pt is having intraoperative anaphylaxis 2/2 preoperative Beta blockade, what is your 2ndary tx?

A

glucagon 1-5 mg IV q5min

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16
Q

if pt is having anaphylaxis intraoperatively a secondary tx to consider is antihistamines, which ones?

A
  1. diphenhydramine or hydroxyzine 0.5-1.0 mg/kg IV 2 & ranitidine 50 mg IV
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17
Q

pt has intraoperative anaphylaxis, and has airway edema, what is the 2ndary tx?

A

hydrocortisone 100-250 mg IV

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18
Q

surgery and anesthesia are associated with a generalized state of _______________________

A

immunosuppression

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19
Q

factors contributing to the perioperative immune system dysfunction

A
  1. surgery 2. blood transfusion 3. hyperglycemia 4. hypothermia 5. general anesthetics 6. opioids
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20
Q

definition of a surgical site infection

A

one that occurs at or near the surgical incision within 30 days of the procedure, or within 1 year after implantation of prosthetic device

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21
Q

surgical site infections accout for ________% of all hospital acquired or nosocomial infections in hospitalized pts

A

31

22
Q

the ____________ immune system is activated during surgery –> systemic _____________ within hours of procedure

A

innate; inflammation

23
Q

what is the neuroendocrine response to surgery?

A

elevated: epi, NE and cortisol

24
Q

how can we (as anesthesia providers) help in preventing surgical site infections?

A

Abx within 1 hour of cut time and sterile technique

25
Q

surgical excision of tumor may stimulate what?

A

proliferation and metastasis of tumor cells

26
Q

reasons that surgical excision of tumors can lead to proliferation and metastasis of tumor cells

A
  1. excision disrupts vessels supplying tumor –> allowsing them into systemic circ 2. catecholamines (released with surgery) promote angiogenesis 3. angiogenesis increased postop –> tissue repair at surgical site, but contributes to tumor growth and metastasis
27
Q

how do blood transfusions effect on immune system

A
  1. they depress the immune system 2. increase incidence of SSI 3. promote earlier recurrence of cancer
28
Q

what type of blood products are recommended for cancer patients ?

A

irradiated or leukocyte depleted blood products to offset the depression of the immune system by donor leukocytes

29
Q

use of intraoperative cells savers (i.e. recycling blood) contributes to ___________________ in cancer pts

A

recurrence of cancer

30
Q

hyperglycemia effect on the immune system

A
  1. depression of innate and adaptive immune systems 2. increases SSI and poor patient outcomes
31
Q

T/F: even transient episodes of hyperglycemia can depress immune fx

A

TRUE

32
Q

a blood glucose level between ________________ can decrease the effects of hyperglycemia on the immune system

A

140-180

33
Q

effects of hypothermia perioperatively on the immune system

A
  1. increases blood loss 2. impairs wound healing 3. decreases immune function 4. increases need for blood transfusion –> even further decrease in immune system
34
Q

_________________ anesthesia attenuates surgical stress response and preserves normal immune fx

A

regional

35
Q

opioids suppress fx of _______________ cell activity

A

natural killer

36
Q

volatile anesthetics on cancer recurrence

A

conflicting evidence; insufficient evidence to avoid in cancer surgery

37
Q

N2O effect on cancer reccurence?

A

no effect

38
Q

L.A. effect on cancer recurrence

A

decreased cancer recurrence and metastasis

39
Q

neuraxial anesthesia effect on cancer recurrence

A

reduce recurrence and metastasis

40
Q

NSAIDs affect on cancer recurrence

A

acute or chronic use associated with tumor regression (beneficial choice)

41
Q

ASA affect on cancer

A

reduces cancer metastasis

42
Q

opoids effect on cancer recurrence

A

promotes cancer progression and decreased long term survivial

43
Q

supplemental O2 > ___________% postoperatively have shorter cancer free survival period

A

80

44
Q

dexmethasone effect on cancer recurrence

A

no effect on cancer recurrence or survival

45
Q

anesthetic technique on immunocompromised pt

A
  1. strict aseptic technique and maximum barrier precautions 2. GA or RA or combined 3. prophylactic Abx administered 30 min prior to incision 4. active warming measures to avoid hypothermia 5. perioperative management of blood glucose to avoid hyperglycemia 6. leukocyte poor/irradiated blood products should be used when transfusion unavoidable 7. multimodal approach for postop pain control (regional + nonopioids)
46
Q

T/F: the overall risk related to anesthesia has declined

A

TRUE

47
Q

death attributable to anesthesia is ______________

A

rare

48
Q

there is lack of consensus on time frame for “anesthesia-related mortality,” but could be btwn _____-_____ post-anesthesia

A

24h; 30 days

49
Q

________________ hypersensitivity reaction is mediated by IgE, mast cells, and basophils

A

type I

50
Q

_______________ hypersensitivity reaction is mediated by IgG, IgM, compliment

A

type II (cytotoxic)

Justin Lyle Cards (27 decks)

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