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Flashcards in Final Exam Deck (254):
1

How long does it take for an empty stomach after clear liquids?

2 hours

2

How long does it take for an empty stomach after breast milk?

4 hours

3

How long does it take for an empty stomach after infant formula?

< 3 months = 4 hours
> 3 months = 6 hours

4

How long does it take for an empty stomach after nonhuman milk?

6 hours

5

How long does it take for an empty stomach after a light meal?

6 hours

6

What conditions increase aspiration risk by elevating intra-abdominal pressure?

Morbid obesity and pregnancy

7

What conditions increase aspiration risk by delaying gastric emptying?

Gastroparesis
Pregnancy
Abdominal trauma

8

Total body water is ____ intracellular and ______ extracellular. Of extracellular fluid, _____ is intravascular and _____ is extravascular

2/3 intracellular
1/3 intracellular
1/4 intravascular
3/4 extravascular

9

Plasma volume is approximately ______% of TBW

8.3%

10

Daily maintenance fluid requirements

100 ml per kg for first 10 kg
50 ml per kg for second 10 kg
20 ml for remaining

11

Hourly maintenance fluid requirements

4 ml per kg for first 10 kg
2 ml per kg for second 10 kg
1 ml per kg for remaining kg

12

For patients with compromised pulmonary, cardiac, or renal function, fluids should be run at _______ levels to prevent ________ _________

Lower
Fluid overloading

13

Surgical patients require _____ mEq/kg/d of sodium for maintenance

1-2

14

Surgical patients require ______ mEq/kg/d of potassium for maintenace

0.5-1

15

Lactated Ringers contain which electrolytes?

Na
K
Cl
Bicarb
Ca

16

Signs of fluid shifts out of intravascular space

Changes in blood pressure, heart rate, central venous pressure
Decreased urine output

17

Signs of volume excess

Weight gain, pulmonary edema, peripheral edema, S3 gallop

18

Fever < ______ is common after surgery. It is usually due to the _________ stimulus of surgery and will resolve spontaneously

103.5
Inflammatory

19

Post op fever is commonly due to the release of ________ which are a response to tissue trauma

Cytokines

20

Cytokines are produced by _________, ________, and ________ ______.

Monocytes
Macrophages
Endothelial cells

21

Fever-associated cytokines are _____, _____, _____, and ________

IL-1
IL-6
TNF-alpha
IFN - gamma

22

Differential diagnosis of a post op fever

Wind (atelectasis, pneumonia)
Water (UTI, anastomotic leak)
Wound (wound infection, abscess)
Walking (DVT, PE)
Wonder-drug or what did we do

23

What post-op day does atelectasis normally occur?

POD #1

24

What post-op day does pneumonia normally occur?

POD #3

25

What post-op day does a UTI or anastomotic leak normally occur?

POD #3

26

What post-op day does a wound infection or abscess normally occur?

POD #5

27

What post-op day does a DVT or PE normally occur?

POD #7

28

Risk factors for atelectasis

Painful abdominal or thoracic incision
Smoking
Pulmonary disease (asthma, cystic fibrosis)
Obesity
Respiratory muscle weakness

29

How to differentiate pneumonia from atelectasis?

Single sided, sputum production, elevated WBC, and temp curve that progresses upward

30

Risk factors for post-op UTI

Catheter use during surgery
Delays in bladder emptying due to anesthesia
Bladder manipulation during surgery
Female gender
Older age
Diabetes
Immobilization

31

Things to consider with an early fever

Necrotizing fasciitis
Malignant hyperthermia
Anastomotic leak
Pulmonary embolism
MI
Allergic Rxn
EtOH withdrawal

32

Most common bacterial agents of necrotizing fasciitis

Clostridiuim perfringens
Group A B-hemolytic streptococcus

33

Treatment for necrotizing fasciitis

Resuscitation
Pen G
Surgical debridement

34

Treatment for malignant hyperthermia

Resuscitation
Rapid cooling
IV dantrolene

35

Physical assessment for post-op fever

1. Check the wound or surgical site
2. Lung sounds, heart/abd/extremity exam
3. Check IV sites, central line, foley tubes

36

Raise the threshold for CNS toxicity of local anesthetics

Benzodiazepines

37

ADRs of sedation, disorientation

Benzodiazepines

38

Tolerance observed in patients with chronic use of alcohol

Barbiturates

39

Agents pentobarbital and thiopental

Barbiturates

40

ADRs of cardiac and respiratory depression (monitoring is very important)

Barbiturates

41

Avoid in porphyria

Barbiturates

42

Etomidate has hypnotic but not ______ properties. Must follow with ______ and _______ ______ drugs

Analgesic
Analgesic and muscle relaxant

43

ADRs of hypotension, cardiac dioxide retention, suppresses corticosteroid synthesis at adrenal cortex

Etomidate

44

Often included in rapid response or intubation kits, induces sleep for 5 minutes

Etomidate

45

ADRs of respiratory depression, N/V, constipation

Opioids

46

Often used for emergency surgical procedures (ER use with orthopedic indications, use in children)

Ketamine

47

Associated with unconsciousness, analgesia, and amnesia

Ketamine

48

ADRs of hallucinations, bad dreams, increased muscle tone/rigidity

Ketamine

49

Lipophilic anesthetic, cannot see through it

Propofol

50

Used often in neuro ICU

Propofol

51

ADRs of significant respiratory depression, hypotension, and injection site pain

Propofol

52

ADRs of N/V, malignant hyperthermia, caution in patients with renal/hepatic dysfunction

Inhaled anesthetics

53

Agents include nitrous oxide, sevoflurane, isoflurane, desfurane

Inhaled anesthetics

54

Lidocaine, bupivacaine, prilocaine, dibucaine

Amino amides

55

Frequently used in epidurals

Bupivacaine

56

Suppository use for pain relief and analgesia for hemorrhoids

Dibucaine

57

Benzocaine, cocaine, procaine, tetracaine

Amino esters

58

Concentration, max dose, onset, and duration of lidocaine

1-2%
4.5-5 mg/kg
< 2 min
0.5-1 hour

59

Concentration, max dose, onset, and duration of lidocaine with epinephrine

1-2%
7 mg/kg
< 2 min
4-6 hours

60

Concentration, max dose, onset, and duration of bupivacaine

0.25%
2.5 mg/kg
5 min
2-4 hours

61

Concentration, max dose, onset, and duration of bupivacaine with epinephrine

0.25%
max 225 mg
5 min
3-7 hours

62

ADRs of CNS effects (seizures), bradycardia, arrhythmias, respiratory arrest, burning sensation, skin discoloration, tissue necrosis/sloughing, neuritis

Local anesthetics

63

ADRs of hematoma, infection, headache

Spinal anesthesia

64

Risk factors that affect pain control in perioperative settings

Preoperative pain (higher baseline)
Anxiety
Genetics
Female gender
Opioid tolerance

65

Reduce opioid requirements and may contribute to lessened PONV when used

NSAIDs and COX-2 inhibitors

66

Ketorolac, ibuprofen, naproxen

NSAIDs

67

Celecoxib

COX-2

68

Ketorolac has a limit of ____ days for patients

5

69

Used in ICU setting for sedation and in anesthesia for brief procedures

Dexmedetomidine

70

Often times completely locked down by hospitals, has sedative, anxiolytic and analgesic properties

Dexmedetomidine

71

ADRs of monitoring HR, blood pressure, and sedative effects

Dexmedetomidine

72

Risk factors for PONV

Female gender
Motion sickness/previous PONV
Non-smoking status
Post-op use of opioids
Use of inhaled anesthetics

73

Pre operative approach of PONV

Benzodiazepines for anxiolysis
Compassionate interaction with staff
Aprepitant
Dexamethasone
Pre-hydration

74

Intra operative approach to PONV

Use of regional anesthetics
Propofol
Analgesia (non-opioid)
Ketamine
Anti-emetic therapy

75

Pharmacologic treatment for PONV

Serotonin antagonists
Neurokinin inhibitors
Steroids
Antihistamines
Butyrophenones
Benzodiazepines

76

ADRs of HA, diarrhea, constipation, arrhythmias

Serotonin Antagonists
Ondansetron, Granisetron

77

ADRs of HA, diarrhea, weakness, dizziness

Neurokinin Inhibitors
Aprepitant

78

Administered pre-anesthesia reduces nausea and vomiting up to 48 hours after surgery

Neurokinin Inhibitors
Aprepitant

79

ADRs of dizziness, mood change, nervousness

Steroids
Dexamethasone

80

ADRs of sedation, confusion, dry mouth, urinary retention

Antihistamines
Dimenhydrinate, promethazine

81

ADRs of prolonged QT interval (black box), hypotension, tachycardia, extrapyramidal symptoms

Butyrophenones
Droperidol

82

Types of burns

Thermal
Electrical
Chemical
Radiation

83

Four crucial assessment of burns

1. Airway management
2. Evaluation of other injuries
3. Estimation of burn size
4. Diagnosis of CO and cyanide poisoning

84

Consider intubation in burns if:

Suspect airway injury
Full thickness burns to the face/mouth
Circumferential chest burns

85

Steps to take for burn patients

Large-bore IVs and begin fluids ASAP (high risk for intravascular fluid loss)
May need central venous access
Transfer in clean dry blankets
Treat the pain and anxiety (benzodiazepines)

86

In burn patients, there is no need for ___________ but there is need for _________

Prophylactic abx
Tetanus booster

87

__________ is the most common type of burns in pediatrics

Scalding

88

_______ are the most common cause for hospital burn admissions

Flames

89

Burn: only epidermal layer. Dry, red, painful, blanching. Typically heal in 3-6 days. NO blisters.

Superficial (1st degree)

90

Burn: usually very painful and do blister

Partial-thickness (2nd degree)
Superficial vs deep partial thickness

91

Burn: painless, non blanching, do NOT spontaneously heal

Full-thickness (3rd degree)

92

Burn: may extend into tissue, fascia, muscle, bone, organs

4th degree

93

Burns TSA for adults

Chest and back: 18%
Arms: 9%
Legs: 18%
Hands: 1%
Head: 9%

94

Burns TSA for kids

Chest and back: 18%
Arms: 9%
Legs: 14%
Hands: 1%
Head: 18%

95

Parkland formula for burns

LR 4cc x kg x %BSA = amount given in 24 hours
Half over the first 8 hours, over half over the next 16 hours

96

Circumferential burns to the chest or limbs

Check pulses frequently, escharotomy may be needed
Consider intubation

97

IV fluids typically given for burns

LR

98

Burns > ____% BSA get fluids

10%

99

Large amounts of NS could cause ______________

Hyperchloremic acidosis

100

Most widely used as prophylaxis against infection with burns

Silver sulfadiazine

101

Important to know that silver sulfadiazine destroys ____________

Skin grafts

102

Surgery is typically indicated for burns not expected to heal in ____ weeks

2

103

Potential complications of electrical burns

Cardiac arrhythmias, compartment syndrome, and rhabdomyolysis

104

Treatment for inhalational injuries

Oxygen, possible intubation, bronchodilators (albuterol)

105

Symptoms of CO poisoning

Headache, lightheadedness, dizziness, confusion (CHECK NEURO STATUS), tachypnea, hypoxia

106

If you have a patient with symptoms of CO poisoning but COHb is normal

Hydrogen cyanide toxicity

107

ASA Physical Status Classification and Mortality

Normal, healthy pt (0.1%)
Mild sys dz (0.2%)
Severe sys dz (1.8%)
Severe sys dz thrt to life (7.8%)
Moribund pt, won't survive w/o surgery (9.4%)

108

Overall surgical risk dependent on 3 factors

Specific surgical risk
Patient specific clinical variables
Exercise capacity/tolerance

109

Lower risk surgeries

Endoscopic, ophthalmologic, dental, skin/superficial

110

Intermediate risk surgeries

Nonvascular major abdominal, infra-inguinal vascular, carotid, head and neck, orthopedic, prostate

111

Higher risk surgeries

Emergent, major thoracic, aortic or supra-inguinal vascular surgery, procedures expecting major fluid shifts or blood loss

112

Cardiac Risk Raters

RCRI (revised cardiac risk index)
MACE (major adverse coronary events)

113

Goldman's Criteria

High risk surgery?
Hx of ischemic heart dz
Hx of CHF
Hx of CVD (CVA/TIA)
Pre-op insulin treatment
Serum creatinine > 2 mg/mL

More than 2 factors generally yields > 5 % risk of MACE

114

Most important pulmonary complication of surgery

Pneumonia
Significant increase in mortality and length of stay

115

Risk factors for post-op pneumonia

Upper abdominal or cardiothoracic procedures
Prolonged anesthesia (>4 hr)
Age > 60
Tobacco abuse (> 20 pack yrs)
COPD/HF/OSA/Pre-op sepsis
Hypoalbuminemia
Impaired cognition

116

Criteria for preoperative EKG

Asymptomatic women > 50 or men > 45
Known cardiac history

117

How many calories does a surgical patient need?

30 kcal/kg/day

118

How much protein does a surgical patient need?

1 gram protein/kg/day

119

Phase of wound healing that begins immediately and lasts for the first few days

Hemostasis and Inflammation

120

Phase of wound healing that starts after the first few days and lasts for several weeks

Proliferation

121

Phase of wound healing that begins after 2-3 weeks and lasts several months

Maturation

122

Initiates the inflammatory phase with platelet activation and release of cytokines. Initial cells are platelets quickly followed by neutrophils and macrophages.

Hemostasis and Inflammation Phase

123

Fibroblasts are the principal cell involved in this phase. These cells are activated by the many cytokines released by white blood cells. Initially type III collagen is laid down and over time this is replaced by type I collagen. Endothelial cells, leading to new blood vessels (granulation tissue), and epithelial cells, forming new skin, are also activated.

Proliferation Phase

124

During this phase, there is maturation of the wound collagen with collagen breakdown. Scar remodeling continues for up to 12 months during which the wound will reach about 80% of its original strength.

Maturation Phase

125

__________ are a specialized type of fibroblast, contains contractile proteins that contract the wound and make it physically smaller (Secondary intention)

Myofibroblasts

126

If a patient can stop smoking for 4 weeks prior to surgery, it reduces their potential mortality by ____%

50%

127

Prevention of surgical site infxns

Prophylactic abx should be given before incision
Stop abx within 48 hours
Clip, don't shave, hair
Minimize personnel changes intraoperatively

128

Liters of blood in an adult male is approximately __% of their body weight, while an adult female is approximately _____% of their body weight

75%
65%

129

Minimal urine output for an adult on maintenance fluid is:

0.5 cc/kg/hour

130

Wound healing - how to check tissue perfusion

ABI (0.9-1.2)
If abnormal, refer to vascular surgeon

131

Wound healing - if there is edema present

Check tissue perfusion - if normal, consider compression

132

Chronic wounds are usually caused by or are the result of:

Pressure ulcers
Venous and arterial insufficiency
Diabetes and neuropathy

133

P.U. Staging - skin intact but with non-blanchable redness for > 1 hour after relief of pressure

Stage I

134

P.U. Staging - blister or other break in the dermis with partial thickness loss of dermis, with or without infection.

Stage II

135

P.U. Staging - full thickness tissue loss. Subcutaneous fat may be visible; destruction extends into muscle with or without infection. Undermining and tunneling may be present.

Stage III

136

P.U. Staging - full thickness skin loss with involvement of bone, tendon, or joint, with or without infection. Often includes undermining and tunneling.

Stage IV

137

P.U. Staging - full thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar in the wound bed

Unstageable

138

P.U. Staging - purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying tissue from pressure and/or shear

Suspected deep tissue injury

139

Venous ulcers account for ____% of all lower extremity ulcers

80%

140

Venous ulcers are more common in ______ and __________

Women
the elderly

141

Risk factors for venous ulcers

Previous leg injuries
DVT
Phlebitis
Obesity
Older age

142

Present with pain, swelling, and varicosities with an open wound that is generally irregular and shallow

Venous ulcers

143

Characteristics include edema, weeping wound, irregular shape, hemosiderin deposition

Venous ulcers

144

Treatment for venous ulcers

Compression therapy
May need surgery for venous insufficiency

145

Typically associated with moderate to severe pain which is made worse with leg elevation

Arterial Ulcers

146

Present with "punched out" ulcer

Arterial Ulcers

147

Risk factors for arterial ulcers

Smoking
HTN
Hyperlipidemia
Diabetes
(((risk factors for atherosclerosis)

148

Diagnosis testing of arterial ulcers

ABI

149

Treatment for arterial ulcers

Wound care and vascular surgery if possible.
DO NOT COMPRESS

150

Characteristics include painful, well circumscribed, and dry

Arterial ulcer

151

Peripheral sensory neuropathy is the single biggest cause of ________ _______ ______

Diabetic foot ulcers

152

Muscle weakness leading to maldistribution of weight

Motor neuropathy

153

Increased blood flow causing osteolysis and osteopenia with resultant bone fractures

Autonomic neuropathy

154

Wagner DFU Class - superficial ulcer without subcutaneous tissue involvement

Grade 1

155

Wagner DFU Class - penetrates through the subcutaneous tissue; may expose bone, tendon, ligament or joint capsule

Grade 2

156

Wagner DFU Class - extensive ulceration with exposed bone

Grade 3

157

Wagner DFU Class - gangrene of toes or forefoot

Grade 4

158

Wagner DFU Class - gangrene of the whole foot

Grade 5

159

Treatment of DFU

Appropriate wound care
Manage hyperglycemia
Appropriate shoes
Potential casting
Manage infxns with abx
May consider HBOT

160

Ulcerative skin disease of uncertain etiology. About half the patients will have crohn's disease, ulcerative colitis, rheumatoid arthritis

Pyoderma Gangrenosum

161

Treatment for pyoderma gangrenosum

Immunosuppression

162

Characterized by medial calcification of the arterials that leads to ischemia and ulceration.

Calciphylaxis

163

Most commonly seen in patients on dialysis

Calciphylaxis

164

Treatment for calciphylaxis

Supportive with wound care

165

Known to occur in diabetics

Necrobiosis Lipoidica (diabeticorum)

166

Most likely an inflammatory disorder with collagen degeneration, granulomata formation in the dermis, and microangiopathy

Necrobiosis Lipoidica

167

Treatment for necrobiosis lipoidica

Best wound care

168

_____ cell carcinomas do not metastasize but _____ cell carcinomas can and do

Basal
Squamous

169

SCCa that arises in an area of previously traumatized, chronically inflamed or scarred skin. Diagnosed late with poor prognosis

Marjolin's ulcer

170

Different types of wound care products

Gauze
Tegaderm (transparent films)
Hydrocolloids
Hydrogels
Alginates
Foam
Collagen
Iodine and Silver

171

Disadvantage for hydrocolloid

Not absorptive

172

Are heteropolysaccharides derived from the cell walls of brown algae

Alginates

173

Can absorb up to 300 times its weight in water or wound exudate

Alginates

174

Can be used with charcoal for malodorous wounds

Foam

175

Stimulates fibroblasts and absorbs matrix metalloproteinases

Collagen

176

Antibiotics preferred for wound care

Gentamicin, doxycycline

177

Absolute criteria for blood transfusion

Acute hemorrhage (>1500 mL blood loss) or rapid bleeding with hemodynamic instability
Hgb < 7 g/dL

178

Criteria for blood transfusion when Hgb < 8 g/dL

Post operative patient
OR
cardiac disease without signs/symptoms of acute ischemia

179

Criteria for blood transfusion when Hgb < 10 g/dL

Cardiac disease with signs/symptoms of acute ischemia
OR
symptomatic anemia
OR
hemodynamic instability

180

The volume of blood transfused should be just enough to relieve _________ ________. It is not necessary to restore the ________ to normal levels

Clinical symptoms
Hemoglobin

181

One unit of PRBCs raises hematocrit _____%

4%

182

WBCs and platelets are removed for this specific type of blood

Leukocyte-poor blood

183

3 types of blood transfusion rxns

Hemolytic
Leukoagglutinin
Hypersensitivity

184

Due to incompatible matches in the ABO system

Hemolytic Acute Rxn

185

Caused by minor red blood cell antigen discrepancies

Hemolytic Delayed Rxn

186

May be result of previous red blood cell transfusion containing an immunogenic antigen

Hemolytic Delayed Rxn

187

Complications of hemolytic acute rxn that can occur

Acute DIC and kidney failure

188

Laboratory findings of acute hemolytic rxn

Hct will fail to rise
Coag studies c/w DIC
Acute renal failure
Hemoglobinuria
Will see helmet cells

189

Reaction to antigens in transfused blood leukocytes by patient previously sensitized to leukocyte antigens from prior transfusions or pregnancy

Leukoagglutinin Rxn

190

May see transient pulmonary infiltrates - looks like pneumonia, completely gone in 12 hours

Leukoagglutinin Rxn

191

Due to exposure to allogeneic plasma proteins rather than leukocytes

Hypersensitivity Rxn

192

Symptoms that may be seen in hypersensitivity rxn to blood transfusion

Urticaria or bronchospasm

193

Indicated for thrombocytopenia

Platelet transfusions

194

May still be useful in patient with profound neutropenia (<100/mcL) and acutely ill from infection

Granulocyte Transfusions

195

Used to correct coagulation factor deficiencies, TTP or HUS

Fresh frozen plasma

196

Transplanted between same species

Allograft

197

Transplanted in the same individual

Autograft

198

Transplanted between genetically identical individuals

Isografts

199

Grafts transplanted between different species

Xenografts

200

Graft divided between two recipients

Split transplant

201

"En bloc" transplant

Both pediatric donor kidneys into single adult recipient

202

CDC high risk donors

Hep B and Hep C

203

HOPE Act

HIV positive donors for transplant in individuals who are already HIV positive

204

Most common transplants

1. Kidney
2. Liver
3. Heart
4. Lung
5. Kidney/Pancreas

205

NOTA

Outlawed the sale of organs
Established OPTN
UNOs runs OPTN

206

SPK

Simultaneous pancreas kidney transplant
Second best outcome

207

PTA

Pancreas transplant alone

208

PAK

Pancreas after kidney transplant
Best outcome

209

MELD

Model for end-stage liver disease
Score range 6-40
Calculation based on total bilirubin, INR and cretinine

210

Listing status for heart transplants

UNOs status 1A/1B/2/7

211

Underlying diagnoses of lung transplants

Emphysema/COPD
Interstitial lung disease
Cystic fibrosis

212

LAS

Lung Allocation score
Range 0-100
Incorporates projected survival in next year without a transplant and survival post-transplant

213

Three sets of antigens involved in graft rejection

Major histocompatibility complex (MHC)
Minor histocompatibility complex (mHC)
Blood group antigens

214

Immune response mechanisms to transplant

Cellular (lymphocyte-mediated)
Humoral (antibody-mediated)

215

Primary antigens associated with graft rejection. In humans, referred to as human leukocyte antigens

Major histocompatibility complex

216

Preformed antibodies against donor HLA antigens. Result in hyperacute or accelerated acute antibody-mediated rejection

Panel reactive antibodies

217

Sensitization to HLA antigens occurs due to

Pregnancies
Blood transfusions
Prior transplants
Prior viral/bacterial infections

218

High level Panel reactive antibodies defined as > ____%

80%

219

Rxn to SOT that occurs within minutes to hours post-transplant. Humorally mediated

Hyperacute Rejection

220

Rxn to SOT most common during first 6-months post-transplant.

Acute Rejection

221

Rxn to SOT that occurs months to years after rejection episodes have subsided. Both antibody and cell mediated. Appears as fibrosis and scarring in transplanted organs

Chronic Rejection

222

Immunosuppressive Classes for Transplants

Corticosteroids
Antiproliferative
Calcineurin inhibitors
mTOR inhibitors
Depleting antibodies (aka anti-lymphocyte antibodies, ALA)

223

Corticosteroids for transplants

Prednisone, Methylprednisolone
Inhibit inflammatory response and cytokine expression

224

Antiproliferative meds for transplants

Azathioprine, mycophenolate
Inhibit purine/DNA synthesis and prevent differentiation/proliferation of B and T lymphocytes

225

Calcineurin inhibitors for transplants

Cyclosporine, tacrolimus
Inhibit calcineurin phosphatase and prevent interleukin-2 medicated T-cell activation and lymphocyte proliferation

226

mTOR inhibitors for transplants

Sirolimus
Inhibit IL-2 mediated T-cell activation and lymphocyte proliferation

227

Depleting antibodies for transplants

Monoclonal AB (basiliximab, alemtuzumab), Polyclonal Ab
Deplete T cells (and B cells)

228

Induction agents

Poly and monoclonal antibodies
Corticosteroids

229

Maintenance agents

Corticosteroids
Antiproliferative agents
Calcineurin inhibitors or mTOR inhibitors

230

Reversal of established rejection

Corticosteroids
Poly or monoclonal antibodies

231

Donor sources for HCT

Peripheral blood progenitor cells
Bone marrow
Umbilical cord blood

232

Neutropenic phase 14 days, contains more T cells, increased risk for GVHD

Peripheral blood progenitor cells

233

Neutropenic phase 21 days

Bone marrow

234

Neutropenic phase 30 days, more infections but not infection related death

Umbilical cord blood

235

Donor T-lymphocytes recognize foreign HLA antigens. Destruction of lymphopoietic cells, abnormalities in the skin, liver, and gastrointestinal tract of the recipient

Graft versus Host Disease

236

Acute GVHD

Skin - maculopapular rash, bullae
Liver - elevated LFTs
GI Tract - loss of appetite, dyspepsia, secretory diarrhea

237

Alloreactive T-lymphocytes from the donor immune system recognizes antigenic differences expressed on residual leukemic cells

Graft Versus Leukemic Effect (GVL)

238

Removing the ________ eliminates the GVL effect

T cells

239

First line treatment of GVHD

Methotrexate, cyclosporine, tacrolimus, mycophenolate, sirolimus, prednisone

240

______ is a major cause of morbidity/mortality in SOT

CMV

241

CMV replication regardless of symptoms

Infection

242

CMV infection + symptoms

Disease

243

CMV Syndrome

Fever and/or malaise, thrombocytopenia, leukopenia
Tissue invasive disease

244

Options for CMV prophylaxis treatment

Ganciclovir
Valganciclovir

245

D+/R-

Universal prophylaxis for 6 months post-transplant
Prophylaxis at least 1 month post ALA for rejection

246

D-/R+ or D+/R+

Universaal or pre-emptive strategies for at least 3 months post-transplant
Prophylaxis for at least 1 month post ALA for rejection

247

Ubiquitous mold with broad, irregularly branching hyphae with few septations (aseptate)

Apophysomyces elegans

248

Gain access via inhalation or direct skin penetration

Apophysomyces elegans

249

Actinomycete. Ubiquitous gram-positive, strictly aerobic, filamentous, branching, weakly acid-fast bacilli. Readily disseminates in immunocompromised host.

Nocardia

250

Prevention of Nocardia

Avoid gardening, soil, plants while on immunosuppressive therapy.
May use SMX-TMP

251

Most common fungal pathogen in HCT

Inversive aspergillosis

252

Pulmonary involvement predominates

Invasive aspergillosis

253

Hyaline hyphomycete with septate, narrow hyphae with acute angle (45) branching when visualized in respiratory secretions and tissue specimens

Invasive aspergillosis

254

Treatment for invasive aspergillosis

Voriconazole, isavuconazole