Immune System Dysfunction

Question 1

Molecule capable of inducing an immune response in host organism

Answer 1

Antigen

Question 2

Existing from brith immune system; evolutionarily conserved system acting as a first line defense against invading microbial pathogens and other potential threats to host; mechanism include physical barriers (skin, chemicals in blood, cells that attack foreign cells in body)

Answer 2

Innate immune system

Question 3

Come into play immediately or within hours of antigen’s appearance in body

Answer 3

Innate immune system

Question 4

Antigen specific immunize response; triggered when pathogen evades innate immune system; mor complex

Answer 4

Adaptive immunity

Question 5

Requires days to active with unfamiliar antigen; develops memory that make future response quicker and more effective

Answer 5

Adaptive immunity

Question 6

Major functions of acquired immune system

Answer 6

Recognition of specific “non self” antigens in the presence of “self”, during process of antigen presentation

Question 7

Immune system that enhances ability of antibodies and phagocytic cells to clear microbes and damages cells, promote inflammation, and attach pathogens plasma membrane

Answer 7

Complement system

Question 8

Proteins that act to inhibit the complement system (C1-inhibitor) and can lead to what kind of response, causing hereditary angioedema

Answer 8

Overactive

Question 9

Proteins that act to activate the complement system (C3) that can lead to what response, causing greater susceptibility to infections

Answer 9

Under active

Question 10

Measure of number of neutrophil granulocytes

Answer 10

Absolute neutrophil count (ANC)

Question 11

Abnormal ANC

Answer 11

> 7,700 cells/cubic mm

Question 12

Excessive innate response leads to what?

Answer 12

Higher neutrophilia count

Question 13

Angioedema can be treated with what? (3)

Answer 13

C1inhibitor (25U/kg) or FFP (2-4units)

1. Cinryze
2. Ruconest
3. Berinert

Question 14

What is NOT useful for angioedema (4)

Answer 14

1. Androgens
2. Catecholamines
3. Antihistamines
4. Anti fibrolytics

Question 15

Defects of antibody production and how is it treated?

Answer 15

X-linked treated with IV immunoglobulin /3-4 months

Question 16

Defects in T lymphocytes

Answer 16

DiGeorge syndrome (characteristics facies, congenital heart disease, hypocalcemia)

Question 17

Combined immunodeficiency (SCID), unable to fight off most types of infections, including bacterial, viral and fungal infections

Answer 17

Adenosine deaminase (ADA) deficiency

Question 18

Excessive adaptive immunity with allergic reaction types?

Answer 18

1, 2, 3, 4

Question 19

Life threatening antigen antibody reaction, occurs within 5-10min, up to 50% IV fluid leaks out through capillaries

Answer 19

Antiphylaxis, type 1

Question 20

Most common intraop drug allergies?

Answer 20

Muscle relaxant

Question 21

Intraop drug allergies (4)

Answer 21

1. Muscle relaxant
2. Latex
3. Antibiotics
4. Hypnotics, opioids, X-ray contrast, protamine

Question 22

What are the least cause of anaphylaxis with drug allergies (2)

Answer 22

1. Ketamine

2. Benzodiazepines

Question 23

What is a good consideration with anaphylaxis?

Answer 23

Abrupt drop in BP

Question 24

What can anaphylaxis mimic (4)

Answer 24

PE, acute MI, aspiration, vasovagal

Question 25

Treatment with anaphylaxis? (4)

Answer 25

1. Epi 10-100mcg every 1-2min 2. Benadryl 3. Albuterol inhaler 4. Corticosteroids

Question 26

Misdirected adaptive immunity

Answer 26

Autoimmune disease

Question 27

Who gets autoimmune disease? (4)

Answer 27

1. Women of childbearing age 2. Family history (lupus and MS) 3. Environment triggers (sunlight, solvents, viral and bacteria) 4. Race or ethnicity (DM1=whites, lupus=African&hispanic)

Question 28

Enlargement of thyroid due to lymphocytic infiltration and fibrosis rather than tissue hypertrophy; hypothyroidism with bouts of hyperthyroidism, leading to muscle failure and HF

Answer 28

Hashimoto’s thyroiditis

Question 29

Anesthesia and Hashimoto’s thyroiditis? (5)

Answer 29

Airway compromise (edema and deviation), hypothermia, anemia, hypoglycemia, hyponatremia

Question 30

Leading cause of hyperthyroidism?

Answer 30

Graves’ disease

Question 31

Treatment of Graves’ disease

Answer 31

Propylthiouracil (PTU) or methimazole

Question 32

Anesthesia and Graves’ disease (2)

Answer 32

1. Use anything that DOES NOT simulate SNS | 2. Run DEEP

Question 33

How to handle thyroid storm (5)

Answer 33

1. Cooling pt 2. IV fluids 3. Control BP and HR (propranolol, esmolol, labetalol, NTG) 4. Decadron (2mg/6hr) or cortisol (100-200mg/8hr) 5. PTU (200-400/8hr)

Question 34

Destruction of gastric parietal cells decreases absorption of Vit B12 leading to anemia

Answer 34

Pernicious (Addison’s) anemia

Question 35

Treatment of pernicious (addison’s) anemia

Answer 35

B12 supplements

Question 36

Immune system begins to attack liver cells leading to cirrhosis and even liver failure

Answer 36

Autoimmune hepatitis

Question 37

Treatment for autoimmune hepatitis?

Answer 37

Corticosteroids (if not treated can lead to DM, HTN, psychosis, infxn, osteoporosis)

Question 38

Hyperglycemia (>250), hyperosmolar, dehydration, ketosis, acidosis (<7.25), low K Na Mg PO4

Answer 38

Diabetic ketoacidosis (DKA)

Question 39

Fluid bolus for DKA

Answer 39

Peds: 10ml/kg Adult: 1L Add K if below 5.3

Question 40

Insulin bolus for DKA

Answer 40

Lower glucose to 250-300mg/dL slowly .1unit/kg/hr or .1 unit/kg bolus No bicarb unless pH below 7.0

Question 41

What is used for cerebral edema for DKA (2)

Answer 41

``` Mannitol Hypertonic saline (3%) ```

Question 42

Chronic disease resulting form inability of pancreas to maintain production of insulin necessary to regulate blood sugar levels leading to DKA, HTN, CAD, PVD, CHF, MI, CVA, CRF, infxn, neuropathy

Answer 42

Type 1 DM

Question 43

Stress of surgery can lead to what in DM1?

Answer 43

Hyperglycemia, ketoacidosis, insulin resistance

Question 44

Gluten intolerance, consumption of gluten products and some other proteins in foods like wheat or rye cause damage to small intestines lining

Answer 44

Celiac disease

Question 45

Progressive disease that affects CNS; causes damage to nerves, slowing down or completely disrupting nerve impulses

Answer 45

Multiple sclerosis

Question 46

MS and anesthesia (5)

Answer 46

1. Spinal exacerbate symptoms 2. Caudal, epidural doesn’t 3. Sux may increase k+ 4. NDMR may prolong or resistant 5. Steroids

Question 47

Causes hair loss anywhere on body but is most common on scalp

Answer 47

Alopecia areata

Question 48

Characterized by inflammation of GI tract; can afflict any part of GI tract right from the mouth to anus

Answer 48

Crohn’s disease

Question 49

What should you be careful with for pt on Crohn’s disease

Answer 49

OG