Final Exam Flashcards
1
Q
How long does it take for an empty stomach after clear liquids?
A
2 hours
2
Q
How long does it take for an empty stomach after breast milk?
A
4 hours
3
Q
How long does it take for an empty stomach after infant formula?
A
< 3 months = 4 hours
> 3 months = 6 hours
4
Q
How long does it take for an empty stomach after nonhuman milk?
A
6 hours
5
Q
How long does it take for an empty stomach after a light meal?
A
6 hours
6
Q
What conditions increase aspiration risk by elevating intra-abdominal pressure?
A
Morbid obesity and pregnancy
7
Q
What conditions increase aspiration risk by delaying gastric emptying?
A
Gastroparesis
Pregnancy
Abdominal trauma
8
Q
Total body water is ____ intracellular and ______ extracellular. Of extracellular fluid, _____ is intravascular and _____ is extravascular
A
2/3 intracellular
1/3 intracellular
1/4 intravascular
3/4 extravascular
9
Q
Plasma volume is approximately ______% of TBW
A
8.3%
10
Q
Daily maintenance fluid requirements
A
100 ml per kg for first 10 kg
50 ml per kg for second 10 kg
20 ml for remaining
11
Q
Hourly maintenance fluid requirements
A
4 ml per kg for first 10 kg
2 ml per kg for second 10 kg
1 ml per kg for remaining kg
12
Q
For patients with compromised pulmonary, cardiac, or renal function, fluids should be run at _______ levels to prevent ________ _________
A
Lower
Fluid overloading
13
Q
Surgical patients require _____ mEq/kg/d of sodium for maintenance
A
1-2
14
Q
Surgical patients require ______ mEq/kg/d of potassium for maintenace
A
0.5-1
15
Q
Lactated Ringers contain which electrolytes?
A
Na K Cl Bicarb Ca
16
Q
Signs of fluid shifts out of intravascular space
A
Changes in blood pressure, heart rate, central venous pressure
Decreased urine output
17
Q
Signs of volume excess
A
Weight gain, pulmonary edema, peripheral edema, S3 gallop
18
Q
Fever < ______ is common after surgery. It is usually due to the _________ stimulus of surgery and will resolve spontaneously
A
103.5
Inflammatory
19
Q
Post op fever is commonly due to the release of ________ which are a response to tissue trauma
A
Cytokines
20
Q
Cytokines are produced by _________, ________, and ________ ______.
A
Monocytes
Macrophages
Endothelial cells
21
Q
Fever-associated cytokines are _____, _____, _____, and ________
A
IL-1
IL-6
TNF-alpha
IFN - gamma
22
Q
Differential diagnosis of a post op fever
A
Wind (atelectasis, pneumonia) Water (UTI, anastomotic leak) Wound (wound infection, abscess) Walking (DVT, PE) Wonder-drug or what did we do
23
Q
What post-op day does atelectasis normally occur?
A
POD #1
24
Q
What post-op day does pneumonia normally occur?
A
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
