Mod12: Hypersensitivity

Question 1

_{Hypersensitivity allergic reactions}

Which Type of hypersentitivity reaction is immediate?

Answer 1

Type I (immediate)

Question 2

_{Hypersensitivity allergic reactions}

In which type of Hypersensitivity allergic reaction do antigens crosslink with IgE antibodies?

Answer 2

Type I Hypersensitivity allergic reaction

Question 3

_{Hypersensitivity allergic reactions}

In Type I Hypersensitivity allergic reactions, the realease of with substances is triggered by the cross sensitivity of antigens with IgE antibodies?

Answer 3

Inflammatory mediators from mast cells

Question 4

_{Hypersensitivity allergic reactions}

What are examples of Type I Hypersensitivity allergic reactions?

Answer 4

Atopy

^{(Atopy: heightened immune responses to common allergens)}

Urticaria-angioedema

True anaphylaxis!!!

Question 5

_{Hypersensitivity allergic reactions - Type I}

Which two subcategories is Type I hypersensitivity allergic reactions further subdivided into?

Answer 5

Atopic type I

Nonatopic type I

Question 6

_{Hypersensitivity allergic reactions - Type I}

Type I hypersensitivity allergic reactions that are IgE mediated, an that only affect the skin and respiratory tract are categorized as:

Answer 6

Atopic type I hypersensitivity allergic reactions

Include allergic rhinitis, dermatitis, and asthma

Question 7

_{Hypersensitivity allergic reactions - Type I}

Mild, Nonatopic type I hypersensitivity allergic reactions manifest as:

Answer 7

Urticaria

Angioedema

Question 8

_{Hypersensitivity allergic reactions - Type I}

Severe, Nonatopic type I hypersensitivity allergic reactions manifest as:

Answer 8

Anaphylaxis

This is when the IgE antibodies crosslink with the antigens

Massive inflammtory mediators will be released from the mast cells

Question 9

_{Hypersensitivity allergic reactions - Hypersensitivity}

Cytotoxic reactions are classified as which type of Hypersensitivity allergic reactions?

Answer 9

Type II hypersensitivity allergic reactions

Question 10

_{Hypersensitivity allergic reactions - Hypersensitivity}

Which antibodies mediate Type II (cytotoxic) hypersensitivity allergic reactions?

Answer 10

IgG antibodies

IgG bind to antigens on cell surface

Question 11

_{Hypersensitivity allergic reactions - Hypersensitivity}

In Type II (cytotoxic) hypersensitivity allergic reactions, what happens next after the IgG bind to antigens on cell surface

Answer 11

Activate classic complement pathway,

which causes cells Lysis

Question 12

_{Hypersensitivity allergic reactions - Hypersensitivity}

What are examples of Type II (cytotoxic) hypersensitivity allergic reactions?

Answer 12

Hemolytic transfusion reactions

Autoimmune hemolytic anemia

Heparin-induced thrombocytopenia

Question 13

_{Hypersensitivity allergic reactions - Hypersensitivity}

Which type of Hypersensitivity allergic reactions are immune complex hypersensitivity reactions calssified as:

Answer 13

Type III (immune complex) hypersensitivity reactions

Question 14

_{Hypersensitivity allergic reactions - Hypersensitivity}

In Type III (immune complex) hypersensitivity reactions, which complexes deposit in body tissues?

Answer 14

Antigen-antibody (IgG or IgM)

Question 15

_{Hypersensitivity allergic reactions - Hypersensitivity}

Which antibodies comprise the Antigen-antibody complexes responsible for Type III (immune complex) hypersensitivity reactions?

Answer 15

IgG or IgM

Question 16

_{Hypersensitivity allergic reactions - Hypersensitivity}

In Type III (immune complex) hypersensitivity reactions, what happens after antigen-antibody (IgG or IgM) complexes deposit in tissue?

Answer 16

Attract neutrophils to area

Release lysosomal enzymes and toxic products

Question 17

_{Hypersensitivity allergic reactions - Hypersensitivity}

Which are examples of Type III (immune complex) hypersensitivity reactions?

Answer 17

Arthus reaction

Serum sickness

Acute hypersensitivity pneumonitis

Question 18

_{Hypersensitivity allergic reactions - Hypersensitivity}

Delayed, cell mediated Hypersensitivity allergic reactions are classified as:

Answer 18

Type IV (Delayed, cell mediated) hypersensitivity allergic reactions

Question 19

_{Hypersensitivity allergic reactions - Hypersensitivity}

Which cells mediate Type IV (Delayed, cell mediated) hypersensitivity allergic reactions?

Answer 19

CD4+ T lymphocytes

Question 20

_{Hypersensitivity allergic reactions - Hypersensitivity}

How are pt’s sensitized for Type IV hypersensitivity allergic reactions?

Answer 20

Prior exposure

Question 21

_{Hypersensitivity allergic reactions - Hypersensitivity}

What are examples of Type IV (Delayed, cell mediated) hypersensitivity allergic reactions?

Answer 21

Contact dermatitis

Tuberculin-type hypersensitivity

Chronic hypersensitivity pneumonitis

Question 22

_{Hypersensitivity allergic reactions - Four point severity scale}

On the Four point severity scale, in which grade do hypersensitivity allergic reactions manifest as cutaneous signs, generalized erythema, urticaria, angioedema fall?

Answer 22

Grade I

_{(e.g., poision IV, surface hypersensitivity allergic reactions)}

Question 23

_{Hypersensitivity allergic reactions - Four point severity scale}

On the the Four point severity scale, in which grade do hypersensitivity allergic reactions manifest as significant but not life threatening symptoms (e.g., cutaneous signs, hypotension, tachycardia, respiratory difficulty)?

Answer 23

Grade II

Question 24

_{Hypersensitivity allergic reactions - Four point severity scale}

In which grade on the four point severity scale do hypersensitivity allergic reactions manifest as Life threatening symptoms (e.g., arrhythmias, bronchospasm, cardiovascular collapse)

Answer 24

Grade III

(What to do: look for epi pen, call 911. etc.)

Question 25

_{Hypersensitivity allergic reactions - Four point severity scale} In which grade on the four point severity scale do hypersensitivity allergic reactions manifest as cardiac and/or respiratory arrest or DEATH

Answer 25

**Grade IV**

Question 26

_{Anaphylactic vs Anaphylactoid Reactions} True or False: Anaphylactoid are less severe reactions

Answer 26

True

Question 27

_{Anaphylactic vs Anaphylactoid Reactions} What percentage of patients with anaphylactoid reactions will have Grade I reactions?

Answer 27

60%

Question 28

_{Anaphylactic vs Anaphylactoid Reactions} What percentage of patients with anaphylactoid reactions will have Grade II reactions?

Answer 28

26%

Question 29

_{Anaphylactic vs Anaphylactoid Reactions} What percentage of patients with anaphylactoid reactions will have Grade III reactions?

Answer 29

15%

Question 30

_{Anaphylactic vs Anaphylactoid Reactions} True or False: incidence of anaphylactoid reactions decreases as their severity increases

Answer 30

True _{60% of patients have Grade I reactions 26% of patients have Grade II reactions 15% of patients have Grade III reactions}

Question 31

_{Anaphylactic vs Anaphylactoid Reactions} True or False: Anaphylaxis more common as clinical severity increases

Answer 31

True

Question 32

_{Anaphylactic vs Anaphylactoid Reactions} What percentage of patients with _anaphylactic_ reactions will have **Grade I** reactions?

Answer 32

**13%**

Question 33

_{Anaphylactic vs Anaphylactoid Reactions} What percentage of patients with anaphylactic reactions will have Grade II reactions?

Answer 33

**22%**

Question 34

_{Anaphylactic vs Anaphylactoid Reactions} What percentage of patients with anaphylactic reactions will have Grade III reactions?

Answer 34

**60%**

Question 35

_{Anaphylactic vs Anaphylactoid Reactions} What percentage of patients with anaphylactic reactions will have Grade IV reactions?

Answer 35

**2%**

Question 36

_{Anaphylactic vs Anaphylactoid Reactions} What's the severity Grade of most anaphylactic reactions?

Answer 36

Grade III

Question 37

_{Anaphylactic vs Anaphylactoid Reactions} What causes the significant hypotension and the the tachycardia that we see in Anaphylactic and Anaphylactoid Reactions?

Answer 37

Significant Hypotension is from Profound vasodilatation, leading to: * Decreased venous return* * Cardiac output falls* * Increased heart rate (in response)*

Question 38

_{Anaphylactic vs Anaphylactoid Reactions} What causes the edema that we see in Anaphylactic and Anaphylactoid Reactions?

Answer 38

Acute changes in vascular permeability Fluid moves into interstitial spaces

Question 39

_{Anaphylactic vs Anaphylactoid Reactions} Along with the bronchospasm, what other pulmonary manifestation accompany Anaphylactic and Anaphylactoid Reactions?

Answer 39

Bronchial hyperactivity

Question 40

_{Anaphylactic vs Anaphylactoid Reactions} What causes the bronchial edema that we see in Anaphylactic and Anaphylactoid Reactions?

Answer 40

The mediators that are being released throughout the body

Question 41

_{Anaphylactic vs Anaphylactoid Reactions} What causes the alveolar hypoventilation that we see in Anaphylactic and Anaphylactoid Reactions?

Answer 41

Bronchospasm closing the airway Decreased gas exchange

Question 42

_{Anaphylactic vs Anaphylactoid Reactions} What causes the hypoxemia that we see in Anaphylactic and Anaphylactoid Reactions? What does it lead to?

Answer 42

Hypoventilation Decreased gas exchange _{Leads to} Respiratory & metabolic acidosis Decreased mixed venous O2 saturation

Question 43

_{Anaphylactic vs Anaphylactoid Reactions} What causes the **acute respiratory distress** that we see in Anaphylactic and Anaphylactoid Reactions? What does it lead to?

Answer 43

Huge V/Q mismatch Decreased ventilation

Question 44

_{Anaphylactic vs Anaphylactoid Reactions} What's the most frequent causes of death in anaphylactic reactions?

Answer 44

Laryngeal edema _{(Gas exchange becomes so low that it leads to a global hypoxic event)} Cardiovascular collapse

Question 45

_{Anaphylactic vs Anaphylactoid Reactions} What are anesthesia most important interventions to prevent death from an anaphylactic reaction?

Answer 45

Protect the airway Prevents the laryngeal edema Treat cardiovascular collapse