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Questions and Answers
What percentage of the NCE/SEE exam is focused on Basic Sciences?
What percentage of the NCE/SEE exam is focused on Basic Sciences?
Which of the following is NOT a hypersensitivity disorder?
Which of the following is NOT a hypersensitivity disorder?
According to the content, what is the primary focus of 'Anesthesia for special populations' in the NCE/SEE exam?
According to the content, what is the primary focus of 'Anesthesia for special populations' in the NCE/SEE exam?
What is the title of the 2023 textbook authored by Elisha, Heiner, and Nagelhout?
What is the title of the 2023 textbook authored by Elisha, Heiner, and Nagelhout?
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In the context of anesthesia, what is the primary focus of 'Anatomy and physiology' in the NCE/SEE exam?
In the context of anesthesia, what is the primary focus of 'Anatomy and physiology' in the NCE/SEE exam?
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Which of the following is an autoimmune disease?
Which of the following is an autoimmune disease?
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What is the title of the 2020 textbook authored by Gropper?
What is the title of the 2020 textbook authored by Gropper?
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Which of the following is NOT a pathophysiological disorder in the context of the immune system?
Which of the following is NOT a pathophysiological disorder in the context of the immune system?
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What percentage of the NCE/SEE exam is focused on 'Anesthesia for Surgical Procedure and Special Populations'?
What percentage of the NCE/SEE exam is focused on 'Anesthesia for Surgical Procedure and Special Populations'?
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What is the title of the 2022 textbook authored by Hagberg?
What is the title of the 2022 textbook authored by Hagberg?
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What is the primary difference between hereditary and acquired angioedema?
What is the primary difference between hereditary and acquired angioedema?
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What is the main symptom of bradykinin-mediated angioedema?
What is the main symptom of bradykinin-mediated angioedema?
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What triggers laryngeal attacks in patients with hereditary angioedema?
What triggers laryngeal attacks in patients with hereditary angioedema?
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What is the diagnosis of hereditary angioedema based on?
What is the diagnosis of hereditary angioedema based on?
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What is the treatment for mast cell–mediated angioedema?
What is the treatment for mast cell–mediated angioedema?
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What is the treatment for bradykinin-mediated angioedema?
What is the treatment for bradykinin-mediated angioedema?
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What is the management approach for ACE inhibitor–induced angioedema?
What is the management approach for ACE inhibitor–induced angioedema?
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What is the goal of prophylactic management for angioedema?
What is the goal of prophylactic management for angioedema?
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What is the priority in emergent management of angioedema?
What is the priority in emergent management of angioedema?
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What is the indication for intubation in patients with angioedema?
What is the indication for intubation in patients with angioedema?
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What is the term for the immune system's response to nonself antigens from the same species?
What is the term for the immune system's response to nonself antigens from the same species?
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Which of the following autoimmune disorders is characterized by an abnormal response to thyroglobulin and thyroid peroxidase antigens?
Which of the following autoimmune disorders is characterized by an abnormal response to thyroglobulin and thyroid peroxidase antigens?
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What is the primary goal of anesthetic management in patients with Graves Disease?
What is the primary goal of anesthetic management in patients with Graves Disease?
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Which of the following is NOT a characteristic of Alloimmunity?
Which of the following is NOT a characteristic of Alloimmunity?
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What is the term for the ability of the immune system to recognize and avoid destruction of host cells?
What is the term for the ability of the immune system to recognize and avoid destruction of host cells?
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Which of the following autoimmune disorders is characterized by demyelination of the central nervous system?
Which of the following autoimmune disorders is characterized by demyelination of the central nervous system?
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What is the primary mechanism underlying the development of Hashimoto Thyroiditis?
What is the primary mechanism underlying the development of Hashimoto Thyroiditis?
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What is the term for the production of antibodies against the thyroid-stimulating hormone receptor?
What is the term for the production of antibodies against the thyroid-stimulating hormone receptor?
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Which of the following is a characteristic of Graves Disease?
Which of the following is a characteristic of Graves Disease?
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What is the primary treatment for Hashimoto Thyroiditis?
What is the primary treatment for Hashimoto Thyroiditis?
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What is the primary criterion for diagnosing Acquired Immune Deficiency Syndrome (AIDS)?
What is the primary criterion for diagnosing Acquired Immune Deficiency Syndrome (AIDS)?
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Which of the following is NOT a risk factor for developing leukemia?
Which of the following is NOT a risk factor for developing leukemia?
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What is the main mechanism of action of monoclonal antibodies in cancer treatment?
What is the main mechanism of action of monoclonal antibodies in cancer treatment?
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What is the primary treatment for multiple myeloma?
What is the primary treatment for multiple myeloma?
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Which of the following is a characteristic of rheumatoid arthritis?
Which of the following is a characteristic of rheumatoid arthritis?
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What is the primary cause of Acquired Immune Deficiency (AID)?
What is the primary cause of Acquired Immune Deficiency (AID)?
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Which of the following is a feature of Systemic Lupus Erythematosus (SLE)?
Which of the following is a feature of Systemic Lupus Erythematosus (SLE)?
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What is the primary mechanism of action of antiretroviral therapy (ART) for HIV infection?
What is the primary mechanism of action of antiretroviral therapy (ART) for HIV infection?
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Which of the following is NOT a type of leukemia?
Which of the following is NOT a type of leukemia?
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What is the goal of pre-exposure prophylaxis (PrEP) for HIV prevention?
What is the goal of pre-exposure prophylaxis (PrEP) for HIV prevention?
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Study Notes
Immune System and Anesthesia
- The immune system is a critical component of anatomy and physiology, with 20% of the NCE/SEE exam dedicated to it
Anatomy and Physiology of the Immune System
- Review of anatomy and physiology of the immune system is essential for anesthesia for surgical procedures and special populations
Angioedema
- Characterized by episodic, asymmetric subcutaneous and submucosal edema formation, involving the face, extremities, and gastrointestinal tract
- Two types:
- Mast cell-mediated: release of mast cell mediators, causing urticaria, bronchospasm, flushing, and hypotension
- Bradykinin-mediated: does not cause allergic symptoms
- Hereditary vs Acquired:
- Hereditary: deficiency or dysfunction of C1 esterase inhibitor, triggered by menses, trauma, infection, stress, or estrogen-containing oral contraceptives
- Acquired: patients with lymphoproliferative disorders have antibodies to C1 inhibitor, triggered by angiotensin-converting enzyme (ACE) inhibitors
Treatment of Angioedema
- Mast cell-mediated: epinephrine, antihistamines, glucocorticoids
- Bradykinin-mediated: C1 inhibitor concentrate, kallikrein inhibitor, or bradykinin-receptor antagonist
- ACE inhibitor-induced: stop the offending drug, administer supportive care, glucocorticoids, and C1 inhibitor concentrate, kallikrein, or bradykinin-receptor antagonist
Management of Angioedema
- Prophylactic management: before a stimulating procedure, availability of C1 inhibitor concentrate, androgens, and tranexamic acid to prevent attacks
- Emergent management: secure the airway, depending on the severity of swelling, using videolaryngoscope, awake fiberoptic, or surgical airway
Alloimmunity
- Response of the immune system towards nonself antigens of the same species, called alloantigens or isoantigens
- Two major types:
- Blood group alloantigens: thrombocytopenia, transfusion reactions
- Histocompatibility alloantigens: rejection of solid organ transplantations
Autoimmunity
- Abnormal response to self-antigens, resulting in production of self-antibodies or autoantibodies
- Damage to self-tissues due to dysfunction of the innate and/or adaptive immune systems
- Genetic predisposition towards developing an autoimmune disorder
- Over 80 different types of autoimmune disorders, including Graves disease, Hashimoto thyroiditis, multiple sclerosis (MS), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE)
Autoimmune Disorders
- Graves Disease:
- Type V hypersensitivity caused by autoantibodies to the TSH receptor
- Symptoms: tachycardia, palpitations, tremor, heat intolerance, anxiety, and ophthalmopathy changes
- Diagnosis: elevated plasma levels of T3 and T4, low or absent TSH, radioactive iodine (RAI) uptake, and thyroid ultrasound
- Treatment: antithyroid medications, thyroidectomy, and RAI destruction of the thyroid
Anesthetic Management of Graves Disease
- Euthyroidism should be established preoperatively
- Airway evaluation: evidence of tracheal compression or deviation caused by a goiter
- Intraoperative management: adequate anesthetic depth, avoiding drugs that stimulate the sympathetic nervous system
- Postoperative management: continue β-blocker therapy, monitoring for thyrotoxicosis
Hashimoto Thyroiditis
- Most common thyroid disorder
- Females are seven times more likely than males to develop the disorder
- Etiology: thyroglobulin (Tg) and thyroid peroxidase (TPO) antigens stimulate the production of Tg and TPO antibodies
- Symptoms: goiter and hypothyroidism
- Diagnostic tests: low plasma levels of total T4 and elevated TSH levels
- Treatment: thyroid hormone replacement (levothyroxine sodium)
Multiple Sclerosis
- Demyelinating disorder of the CNS
- Immune-mediated inflammatory disease that attacks the myelin, oligodendrocytes, and the underlying nerve fibers
- Symptoms: fatigue, tingling, numbness, muscle weakness, ataxia, vertigo, tremor, spasticity, bladder and bowel dysfunction, pain, and heat intoleranceHere are the study notes for the text:
- Multiple Sclerosis*
- Periods of relapse (new influx of immune cells) and remission (remyelination)
- Diagnosis:
- MS lesions on MRI
- Elevated IgG in CSF
- Decreased conduction velocity on evoked response studies
- Treatment:
- Disease-modifying agents (DMARDS)
- Acute relapses: corticosteroids and plasma exchange
- Severe progressive: antineoplastic agents (cyclophosphamide, mitoxantrone)
- Rheumatoid Arthritis*
- Autoimmune inflammatory disease with widespread effects
- Characterized by:
- Synovial inflammation and hyperplasia
- Cartilage and bone destruction
- Systemic features (cardiovascular, pulmonary, renal, and skeletal disorders)
- Treatment:
- Avoid triggers (viruses, sunlight, smoking)
- NSAIDs, corticosteroids, or immunosuppressants (azathioprine, mycophenolate, MTX)
- Systemic Lupus Erythematosus (SLE)*
- Autoimmune inflammatory disease with widespread effects
- Characterized by:
- Large variety of autoantibodies
- Cardiovascular, hepatic, pulmonary, renal, and skin manifestations
- Diagnosis:
- Antinuclear antibodies (ANA), anti-dsDNA, anti-Smith (anti-Sm), and antiphospholipid antibodies
- Laboratory abnormalities (anemia, leukopenia, thrombocytopenia, and elevated ESR and/or CRP levels)
- Treatment:
- Avoid triggers (sunlight, viral infections, smoking)
- NSAIDs, corticosteroids, or immunosuppressants (azathioprine, mycophenolate, MTX)
- Immunodeficiency Disorders*
- Primary Immunodeficiency Disorders (PIDDs):
- Result of genetic defect in cells of the immune system
- Characterized by:
- Low antibody levels, defective antibodies, or defective immune cells
- Increased susceptibility to infections
- Treatment:
- Largely supportive
- Bone marrow transplantation
- Recent advances in immunobiology, genetics, and biologic modifiers
- Secondary deficiencies:
- Acquired Immune Deficiency (AID)
+[Causes:
- Severe malnutrition
- HTLV-1 infection
- Lymphoid cancers
- Autoimmune diseases
- Splenectomy
- Aging
- Immunosuppressant drugs
- Treatment:
- Treatment of the primary condition usually results in improvement of the associated AID
- Acquired Immune Deficiency (AID)
+[Causes:
- Acquired Immune Deficiency Syndrome (AIDS)*
- Result of HIV infection
- Mechanism:
- Malignant lymphoblasts replace normal marrow elements
- Abnormal lymphoblasts proliferate in lymphoid organs
- HIV is capable of changing amino acid sequences of antigenic regions of their glycoproteins
- Symptoms: +
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Description
A quiz for nurse anesthesia students covering immune system topics, including anatomy, physiology, pathophysiology, and autoimmune diseases.
