NUR 951: Immune System and Anesthesia Quiz
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Questions and Answers

What percentage of the NCE/SEE exam is focused on Basic Sciences?

  • 20% (correct)
  • 30%
  • 35%
  • 25%

    • Which of the following is NOT a hypersensitivity disorder?

  • Asthma
  • HIV (correct)
  • Anaphylaxis
  • Rheumatoid Arthritis

    • According to the content, what is the primary focus of 'Anesthesia for special populations' in the NCE/SEE exam?

  • Geriatric patients
  • Immune compromised and oncology patients (correct)
  • Obstetric patients
  • Pediatric patients

    • What is the title of the 2023 textbook authored by Elisha, Heiner, and Nagelhout?

    <p>Nurse Anesthesia</p> Signup and view all the answers

    In the context of anesthesia, what is the primary focus of 'Anatomy and physiology' in the NCE/SEE exam?

    <p>Immune system anatomy</p> Signup and view all the answers

    Which of the following is an autoimmune disease?

    <p>Rheumatoid Arthritis</p> Signup and view all the answers

    What is the title of the 2020 textbook authored by Gropper?

    <p>Miller's Anesthesia</p> Signup and view all the answers

    Which of the following is NOT a pathophysiological disorder in the context of the immune system?

    <p>Cardiovascular diseases</p> Signup and view all the answers

    What percentage of the NCE/SEE exam is focused on 'Anesthesia for Surgical Procedure and Special Populations'?

    <p>25%</p> Signup and view all the answers

    What is the title of the 2022 textbook authored by Hagberg?

    <p>Benumof and Hagberg's Airway Management</p> Signup and view all the answers

    What is the primary difference between hereditary and acquired angioedema?

    <p>Deficiency of C1 esterase inhibitor</p> Signup and view all the answers

    What is the main symptom of bradykinin-mediated angioedema?

    <p>Absence of allergic symptoms</p> Signup and view all the answers

    What triggers laryngeal attacks in patients with hereditary angioedema?

    <p>All of the above</p> Signup and view all the answers

    What is the diagnosis of hereditary angioedema based on?

    <p>Low C4 level</p> Signup and view all the answers

    What is the treatment for mast cell–mediated angioedema?

    <p>Epinephrine, antihistamines, and glucocorticoids</p> Signup and view all the answers

    What is the treatment for bradykinin-mediated angioedema?

    <p>C1 inhibitor concentrate, kallikrein inhibitor, or bradykinin-receptor antagonist</p> Signup and view all the answers

    What is the management approach for ACE inhibitor–induced angioedema?

    <p>All of the above</p> Signup and view all the answers

    What is the goal of prophylactic management for angioedema?

    <p>To minimize incidental trauma to the oropharynx</p> Signup and view all the answers

    What is the priority in emergent management of angioedema?

    <p>Secure the airway</p> Signup and view all the answers

    What is the indication for intubation in patients with angioedema?

    <p>All of the above</p> Signup and view all the answers

    What is the term for the immune system's response to nonself antigens from the same species?

    <p>Alloimmunity</p> Signup and view all the answers

    Which of the following autoimmune disorders is characterized by an abnormal response to thyroglobulin and thyroid peroxidase antigens?

    <p>Hashimoto Thyroiditis</p> Signup and view all the answers

    What is the primary goal of anesthetic management in patients with Graves Disease?

    <p>Establishing euthyroidism preoperatively</p> Signup and view all the answers

    Which of the following is NOT a characteristic of Alloimmunity?

    <p>Abnormal response to self antigens</p> Signup and view all the answers

    What is the term for the ability of the immune system to recognize and avoid destruction of host cells?

    <p>Self-tolerance</p> Signup and view all the answers

    Which of the following autoimmune disorders is characterized by demyelination of the central nervous system?

    <p>Multiple Sclerosis</p> Signup and view all the answers

    What is the primary mechanism underlying the development of Hashimoto Thyroiditis?

    <p>Stimulation of thyroid peroxidase and thyroglobulin antigens</p> Signup and view all the answers

    What is the term for the production of antibodies against the thyroid-stimulating hormone receptor?

    <p>Thyroid-stimulating antibody</p> Signup and view all the answers

    Which of the following is a characteristic of Graves Disease?

    <p>Goiter and thyroid enlargement</p> Signup and view all the answers

    What is the primary treatment for Hashimoto Thyroiditis?

    <p>Thyroid hormone replacement</p> Signup and view all the answers

    What is the primary criterion for diagnosing Acquired Immune Deficiency Syndrome (AIDS)?

    <p>CD4 T-cell count less than 200 cells/mm</p> Signup and view all the answers

    Which of the following is NOT a risk factor for developing leukemia?

    <p>Vitamin D deficiency</p> Signup and view all the answers

    What is the main mechanism of action of monoclonal antibodies in cancer treatment?

    <p>Marking abnormal cells for destruction</p> Signup and view all the answers

    What is the primary treatment for multiple myeloma?

    <p>Chemotherapy and glucocorticoids</p> Signup and view all the answers

    Which of the following is a characteristic of rheumatoid arthritis?

    <p>Symmetrical polyarthritis</p> Signup and view all the answers

    What is the primary cause of Acquired Immune Deficiency (AID)?

    <p>Malnutrition</p> Signup and view all the answers

    Which of the following is a feature of Systemic Lupus Erythematosus (SLE)?

    <p>Presence of antinuclear antibodies</p> Signup and view all the answers

    What is the primary mechanism of action of antiretroviral therapy (ART) for HIV infection?

    <p>Inhibiting viral replication</p> Signup and view all the answers

    Which of the following is NOT a type of leukemia?

    <p>Myelodysplastic Syndrome (MDS)</p> Signup and view all the answers

    What is the goal of pre-exposure prophylaxis (PrEP) for HIV prevention?

    <p>Reducing the risk of HIV transmission</p> Signup and view all the answers

    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 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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