2nd Principles > Immune dysfunction > Flashcards

Immune dysfunction Flashcards

Final exam (69 cards)

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1
Q

What is innate immunity?

A

rapid and non-specific
recognizes common pathogens
short-acting (no memory, no antibodies, response is always identical)

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2
Q

What is adaptive immunity?

A

present in only vertebrates
delayed onset
capable of memory and antigen response (from prior antibodies)

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3
Q

List some of the active immune cells in innate immunity…

A

neutrophils
macrophages
monocytes
NK cells

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4
Q

Which active immune cells have a slower and more sustained response in the innate immunity?

A

macrophages

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5
Q

Which active immune cells mount the fastest response in the innate immunity?

A

neutrophils

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6
Q

The adaptive immune response is derived from what type of cells?

A

lymphoid proginator cells (like T cells and B cells)

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7
Q

What is the complement system?

A

it augments phagocytes and antibody production in the adaptive immunity and compliments the role of immune cells in the innate immunity

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8
Q

how many plasma and surface proteins are in the complement system and where are most of them produced?

A

over 30, produced in the liver

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9
Q

What are neutrophils, what do they release and how do the breakdown?

A

They are the most abundant WBC type. They migrate rapidly to the site of bacterial infections. They release cytokines and breakdown after about 6 hours into purulent exudate.

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10
Q

What are monocytes, give some tissue-specific examples of monocytes…

A

These are the largest blood cell type that circulate to specific tissues and are destined to become macrophages
Langerhans (epidermis)
Kupffer (liver)
Alveolar cells (lungs)
Microglia (brain)

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11
Q

What do macrophages do? What to they produce?

A

They mobilize after activation of neutrophils. They phagocytose bacteria. They produce NO and cytokines. They have a slow and sustained response that lasts multiple days.

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12
Q

What does NO and cytokines produce as a response?

A

vasodilation

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13
Q

What are the least common type of granulocytes?

A

basophils

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14
Q

Which type of immune cells reside in the connective tissue close to blood vessels?

A

mast cells

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15
Q

What do basophils and mast cells do and what do they produce?

A

express high affinity for IgE receptors. They initiate hypersensitivity. They cause the release of histamine, cytokines, prostaglandins and stimulate smooth muscle contraction.

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16
Q

Where are eosinophils located and what do they do? What do they release?

A

they are heavily concentrated in the GI mucosa. They protect against ingested pathogens and parasites via mast cell inflammatory mediators. They release histamine, leukotrienes and prostaglandins.

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17
Q

What are the two components of adaptive immunity?

A

humoral component and the cellular component

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18
Q

The humoral component of adaptive immunity involves what?

A

B cells and production of antibodies. This helps to form an immunity against certain pathogens and cancer

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19
Q

What is the cellular component of adaptive immunity?

A

This involves T cells which play a role in chronic inflammation and respond to infection. These activate IgE antibodies

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20
Q

Where do T cells originate? Where do they mature?

A

originate in bone marrow
mature in the thymus

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21
Q

List some common cell types derived from lymphoid proginator cells…

A

Helper T cells
Cytotoxic T cells
B cells

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22
Q

List some common cell types involved in immunity from the myeloid proginator cells…

A

Eosinophils
Monocytes
Neutrophils
Mast cells
Basophils
Macrophages

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23
Q

What is the difference between active and passive immunity?

A

active immunity occurs from exposure to a pathogen in the environment or by a active pathogen administered to deliberately induce antibody formation. Passive immunity comes from receiving antibodies from another individual.

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24
Q

Give some examples of active immunity…

A

Live, inactivated and recombinant vaccines

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25
Give some examples of passive immunity...
IVIG Maternal IgA antibodies in breast milk
26
How long does passive immunity provide protection?
a few weeks to a few months
27
What is neutropenia?
Low WBC count. Inadequate immune response.
28
Give an example of an exaggerated immune response or hypersensitivity...
asthma or anaphylaxis
29
What are autoimmune disorders?
These are misdirected immune responses the result in antibodies formed against intrinsic receptors or ligands
30
Which anesthesia drugs have the highest incidence of hypersensitivity reactions?
NMBDs, PPIs, Antibiotics, NSAIDS
31
What is a type I allergic response? Give a few examples...
An immediate hypersensitivity reaction mediated by T cells which stimulate B cells. Examples include: anaphylaxis, asthma, angioedema
32
What are some treatments for type I hypersensitivity reactions?
antihistamines, Cromolyn sodium, bronchodilators, COX inhibitors
33
What are type II allergic responses? Give some examples...
A cytotoxic hypersensitivity mediated by IgG and IgM and the complement system. Response can be immediate or delayed weeks or months. Examples include hemolytic anemia, myasthenia gravis, autoimmune diseases and transfusion reactions.
34
What is a Type III allergic response?
An immune-complex hypersensitivity reaction where the immune system fails to eliminate antibody-antigen complexes and they are deposited into the joints, kidneys, skin and eyes.
35
List a few examples of Type III allergic responses...
systemic lupus erythematosus (SLE) and rheumatoid arthritis
36
What are some treatment options for Type II, III and Type IV allergic responses?
anti-inflammatories immunosuppressives
37
What is a type IV allergic response? Give some examples...
T lymphocyte, monocyte and macrophage mediated (does not involve antibodies). Cutaneous symptoms. Examples include contact dermatitis, tuberculosis, Steven-Johnson syndrome (reaction to NSAIDS and Tylenol).
38
List some symptoms of anaphylaxis
systemic vasodilation hypotension vessel permeability bronchospasms
39
How quickly does anaphylaxis take after exposure to an antigen?
5-10 minutes
40
What is biphasic anaphylaxis?
secondary anaphylactic episode that follows an asymptomatic episode (about 8-72 hours later)
41
How common is biphasic anaphylaxis and what are some risk factors?
it occurs in 4-5% of patients that experience anaphylaxis. Risk factors include: severe initial response to antigen or initial anaphylaxis that required multiple doses of epinephrine
42
What are some risk factors of perioperative anaphylaxis?
asthma longer duration of anesthesia drug redosing females multiple past surgeries allergies
43
What are two labs that you can use to officially diagnose anaphylactic response?
plasma tryptase concentration (1 to 2 hours after event) plasma histamine concentration
44
What test can you use to diagnose anaphylactic reaction weeks after the reaction?
Skin (wheal and flare) test
45
What dose of epinephrine do you give adults for anaphylaxis?
10mcg-1mg IVP every 1-2 min
46
What dose of epinephrine do you give pediatric patients with anaphylaxis?
1-10mcg/kg IVP every 1-2 min
47
If your patient is resistant to vasopressin, what can you give them?
Methylene blue *inhibits NO production
48
How does epinephrine help an anaphylactic reaction?
it decreases degranulation of mast cells and basophils and has effects on... alpha 1: increases SVR beta 1: inotropy and chronotropy (increases CO) beta 2: bronchodilation
49
What are some secondary treatments you can do for an anaphylactic reaction?
antihistamines (diphenhydramine, ranitidine) corticosteroids (hydrocortisone) bronchodilators
50
For each blood type what antibodies are present in the plasma (incompatible)? What antigens are in the RBC (compatible)?
A: B antibodies, A antigen B: A antibodies, B antigen AB: no antibodies, A and B antigens (universal recipient) O: A and B antibodies, no antigens (universal donor)
51
What causes transfusion reactions?
a response to surface antigens in donor RBCs
52
Give three examples of autoimmune disorders that are caused by an antigen reaction...
Grave's disease -autoantibodies on TSH receptors MS- AB's against myelination proteins SLE- AB's against RBCs, lymphocytes, nucleic acids, plts, and coagulation proteins
53
What causes hereditary angioedema?
genetic disorder caused by C1 esterase inhibitor deficiency/dysfunction (leads to excess production of bradykinins which cause vasodilation and swelling) triggered by: menses, trauma, stress, oral contraceptives
54
What is often responsible for acquired angioedema?
ACE inhibitors
55
How do you treat angioedema?
airway maintenance (intubate) FFP C1 esterase inhibitor concentrate epi antihistamines, glucocorticoids (not 1st line)
56
Describe how HIV works as an acquired immune deficiency
HIV virus makes DNA with all viral genetic material thru reverse transcriptase. The new amino acid sequence is not recognized which leads to destruction of monocytes, macrophages and T cells
57
What are some of the earlier symptoms of HIV (2-3 weeks after inoculation)
fever, fatigue, night sweats, pharyngitis, myalgias, arthralgias (joint pain/stiffness)
58
What are four test used to diagnose AIDS?
ELISA: 4-8 wk after infection viral load level CD4 T lymphocytes <200,000 HAART agent sensitivity test
59
What is scleroderma?
"systemic sclerosis" characterized by inflammation, vascular sclerosis, and fibrosis of skin and viscera
60
Who does scleroderma usually effect?
women aged 20-40
61
List 8 symptoms of Scleroderma...
1. decreased mobility of fingers 2. facial pain 3. Raynaud's 4. hypo-motility of GI tract 5. decreased tone of LES 6. cardiac dysrhythmias 7. pulmonary fibrosis 8. renal artery stenosis
62
What are some anesthesia implications of scleroderma?
difficult to place A line organ system dysfunction increased aspiration risk reduced pulmonary compliance
63
What drugs should be continued for Scleroderma patients in pre-Op? Why?
calcium channel blockers (for tissue perfusion)
64
What effect do VA have on the immune system?
the suppress NK cells and induce apoptosis of T cells and impair phagocytes
65
What does versed do to the immune system?
it decreases the migration of neutrophils
66
What does Ketamine do to the immune system?
depresses NK cell activity
67
What does Propofol do to the immune system?
It decreases cytokines and promotes NK cells (benefits immune function)
68
What effect does opioids (esp. Fentanyl and morphine) have on the immune system?
They suppress NK cells
69
What effect do NSAIDS have on immune function?
they inhibit prostaglandin synthesis (a beneficial effect)
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