Fiser Absite. Ch 03-05. Blood Products. Immunology. Infection.

Front 1

Which blood products do not carry the risk of HIV and hepatitis because they are heat treated?

Back 1

albumin and serum globulins

Front 2

Who gets CMV-negative blood?

Back 2

low birth-weight infants, bone marrow transplant pts and other transplant pts

Front 3

What is the number one cause of death from transfusion reaction?

Back 3

Clerical error leading to ABO incompatibility

Front 4

Stored blood is low in ____ causing a left-shift

Back 4

2,3 DPG

Front 5

Back pain, chills, tachycardia, fever, hemoglobinuria in pt that has been transfused. May present as diffuse bleeding in anesthetized patient.

Back 5

acute hemolysis (ABO incompatibility, antibody mediated)

Front 6

What is the treatment for acute hemolysis (ABO incompatibility)

Back 6

fluids, diruetics, HCO3-, pressors, histamine blockers

Front 7

What is the most common transfusion reaction and what is the pathophys?

Back 7

febrile nonhemolytic transfusion reaction. recipient antibody reaction against WBCs in donor blood

Front 8

What is the treatment for febrile nonhemolytic transfusion reaction?

Back 8

stop transfusion and use WBC filters for subsequent transfusions

Front 9

Anaphylaxis after transfusion. What is usually the pathophys?a and was is the tx?

Back 9

Usually IgG against IgA in IgA-deficient patient. Tx: fluids, Lasix, pressors, steroids, epi, histamin blockers

Front 10

What is the pathophys of transfusion related acute lung injury (TRALI)?

Back 10

antibodies to recipient's WBCs, clot in pulmonary capillaries

Front 11

Dilutional thrombocytopenia occurs after transfusion of ___ units of PRBCs.

Back 11

10

Front 12

What electrolyte abnormality can occur with massive transfusion?

Back 12

hypocalcemia

Front 13

Antiplatelet antibodies develop in ___% of pts after 10-20 platelet transfusions

Back 13

20

Front 14

Hetastarch (Hespan) can be used up to ___ L without the risk of bleeding complications.

Back 14

1

Front 15

Most common bacterial contaminate of transfused blood?

Back 15

GNRs usually e. coli

Front 16

Most common blood product source of contamination?

Back 16

platelets (not refrigerated)

Front 17

What parasitic disease can be transmitted with blood transfusion?

Back 17

chagas disease

Front 18

What is the most common blood type?

Back 18

O+

Front 19

Predominant release of proinflammatory cytokines (IL-2, INF-gamma). Involved in cell-mediated responses

Back 19

Th1 helper T cells (CD4)

Front 20

Predominant release of anti-inflammatory cytokines (IL-4 -> inhibits macrophages). Involved in atopy and allergic responses.

Back 20

Th2 helper T cells (CD4)

Front 21

IL-___ causes B-cell maturation into plasma cells (antibody secreting).

Back 21

4

Front 22

IL-___ causes maturation of cytotoxic T cells

Back 22

2

Front 23

Recognize and attack non-self antigens attached to MHC class I receptors (e.g. viral gene products)

Back 23

Cytotoxic T cells (CD8)

Front 24

Infections associated with defects in ___ immunity - intracellular pathogens (TB, viruses)

Back 24

cell-mediated

Front 25

Can increase T-cell mediated immunity.

Back 25

Nucleotides

Front 26

What are the types of MHC class I

Back 26

A, B and C

Front 27

What are the types of MHC class II

Back 27

DR, DP and DQ

Front 28

CD8 cell activation. Present on all nucleated cells. Single chain with 5 domains. Target for cytotoxic T cells.

Back 28

MHC class I

Front 29

CD4-cell activation. Present on B cells, dendrites, monocytes, and antigen-presenting cells. 2 chains with 4 domains each. Activator for helper T cells. Stimulate antibody formation.

Back 29

MHC class II

Front 30

___ infection - endogenous viral proteins produce, are bound to class I MHC, go to cell surface, and are recognized by CD8 cytotoxic T cells

Back 30

Viral

Front 31

___ infection - endocytosis, proteins get bound to MHC class II molecules, go to cell surface, recognized by CD4 helper T cells -> B cells which have already bound to the antigen are then activated by the CD4 helper T cells; they then produce the antibody to that antigen and are transformed to plasma cells and memory B cells.

Back 31

Bacterial

Front 32

Not restricted by MHC, do not require previous exposure. Not considered T or B cells. Recognize cells that lack self-MHC. Part of the body's natural immunosurveillance for cancer.

Back 32

Natural killer cells

Front 33

Initial antibody made after exposure to antigen. Is the largest antibody, having 5 domains (10 binding sites).

Back 33

IgM

Front 34

Most abundant antibody in body. Responsible for secondary immune response. Can cross the placenta and provides protection in newborn period.

Back 34

IgG

Front 35

Found in secretions, in Peyer's patches in gut, and in breast milk; helps prevent microbial adherence and invasion in gut.

Back 35

IgA

Front 36

Membrane-bound receptor on B-cells (serves as an antigen receptor). Which Ab?

Back 36

IgD

Front 37

Allergic reactions, parasite infections. Which Ab?

Back 37

IgE

Front 38

Which antibodies fix complement?

Back 38

IgM and IgG (requires 2 IgGs or 1 IgM)

Front 39

Immediate hypersensitivity-reaction. IgE mediated; mast and basophils release histamine, serotonin and bradykinin. Example include bee stings, peanuts, hay fever.

Back 39

Type I

Front 40

Hypersensitivity reaction where IgG or IgM reacts with cell-bound antigen. Examples include ABO blood type incompatibility, Graves disease, MG, ITP.

Back 40

Type II

Front 41

Hypersensitivity reaction that involves immune complex deposition. Examples include: serum sickness, rheumatoid arthritis and SLE

Back 41

Type III

Front 42

Delayed-type hypersensitivity. Antigen stimulation of perviously sensitized T-cells. Examples include: TB skin test, contact dermatitis.

Back 42

Type IV

Front 43

Converts lymphocytes to lymphokine-activated killer cells by enhancing their immune response to tumor. Also converts lymphocytes into tumor-infiltrating lymphocytes. Has been shown to be successful for melanoma.

Back 43

IL-2

Front 44

What is a tetanus-prone wound?

Back 44

>6 hrs old; obvious contamination and devitalized tissue; crush; burn; frostbite, or missile injury

Front 45

When to give tetanus toxoid or tetanus immune globulin

Back 45

Non-tetanus prone wound - give toxoid only if pt has received <3 doses or tetanus status unknown.

Tetanus prone wound - always give toxoid unless pt has had >3 doses and it has been <5 years

Tetanus immune globulin is for tetanus prone wounds in non-immunized pt or immunization status unknown.

Front 46

What is the most common immune deficiency?

Back 46

malnutrition

Front 47

Which part of the GI tract is virtually sterile; some GPCs, some yeast?

Back 47

stomach

Front 48

Which part of the GI tract has 10^5 bacteria, mostly GPCs?

Back 48

proximal small bowel

Front 49

Which part of the GI tract has 10^7 bacteria, mostly GPCs, GPRs, GNRs?

Back 49

distal small bowel

Front 50

Which part of the GI tract has 10^11 bacteria, almost all anaerobes, some GNRs, GPCs?

Back 50

colon

Front 51

What are the most common organisms in the GI tract?

Back 51

anaerobes

Front 52

What is the most common anaerobe in the colon?

Back 52

bacteroides fragilis

Front 53

What is the most common aerobic bacteria in the colon?

Back 53

E. coli

Front 54

How does e coli trigger the release of TNF-a from macrophages and activate complement and coagulation cascade?

Back 54

endotoxin (lipopolysaccharide lipid A) is released

Front 55

What is the optimal glucose level in a septic patient?

Back 55

100-120

Front 56

How is c diff colitis diagnosed?

Back 56

fecal leukocytes in stool, C. difficile toxin

Front 57

What is tx for c diff?

Back 57

oral vancomycin or flagyl; IV - flagyl; lactobacillus can also help; stop other abx or change them

Front 58

___% of abdominal abscesses have anaerobes; ___% of abdominal abscesses have both anaerobic and aerobic bacteria

Back 58

90, 80

Front 59

Tx for abdominal abscess?

Back 59

drainage

Front 60

Abscesses usually occur how many days after an operation?

Back 60

7-10

Front 61

When do you start abx for an abscess?

Back 61

pts with DM, cellulitis, clinical signs of sepsis, fever, elevated WBC or with bioprosthetic hardware

Front 62

Wound infection percentage for a clean operation (ie hernia)?

Back 62

2%

Front 63

Wound infection percentage for a clean contaminated procedure (ie elective colon resection with prepped bowel)

Back 63

3%-5%

Front 64

Wound infection percentage for a contaminated procedure such as a GSW to colon with repair?

Back 64

5%-10%

Front 65

Most common organism overall in surgical wound infections?

Back 65

s. aureus

Front 66

How to tell the difference between staphlococcus aureus and staphlococcus epidermidis?

Back 66

s aureus is coagulase positive

Front 67

What is the most common GNR in surgical wound infections?

Back 67

E. coli

Front 68

What is the most common anaerobe in surgical wound infections?

Back 68

B. fragilus

Front 69

>___ bacteria needed for wound infection; less bacteria needed if foreign body present.

Back 69

10^5

Front 70

Which bacteria in infection?

Recovery from tissue indicates necrosis or abscess (only grows in low redox state). Also implies translocation from gut.

Back 70

B. fragilis

Front 71

Which two types of bacteria can produce an invasive soft tissue infection that can be present within hours postoperatively (produce exotoxins)

Back 71

Clostridium perfringens and beta hemolytic strep

Front 72

Most common nonsurgical infection?

Back 72

UTI (most commonly E. coli)

Front 73

Leading cause of infectious death after surgery?

Back 73

nosocomial pneumonia

Front 74

2 most common organisms in ICU pneumonia?

Back 74

#1 s. aureus, #2 pseudomonas

Front 75

#1 class of organismis in ICU pneumonia?

Back 75

GNRs

Front 76

Top three organisms in line infections

Back 76

S. epi, S aureus, yeast

Front 77

Top three causes of necrotizing soft tissue infections

Back 77

Beta-hemolytic streptococcus (group A), C. perfringens and mixed organisms

Front 78

What are the following signs and symptoms of:
White blood cell count 20K
Thin, gray drainage
Edema of entire limb
Hyponatremia
Skin blistering/sloughing
crepitus
pain out of proportion to skin findings
sepsis

Back 78

Necrotizing Soft Tissue Infection

Front 79

Tx for necrotizing soft tissue infections?

Back 79

early debridement, high dose PCN

Front 80

Myonecrosis, gas gangrene and gram stain showing GPRs without WBCs.

Back 80

C. perfringens

Front 81

Pulmonary sx most common; can cause tortuous abscess in cervical, thoracic and abdominal areas. What type of infection and what is the tx?

Back 81

Actinomyces. Tx: drainage and penicillin G

Front 82

Pulmonary and CNS sx most common. Tx is drainage and Bactrim. What is the organism?

Back 82

Nocardia

Front 83

Pulmonary sx most common. Mississippi and Ohio river valleys. What is the organism and what is the tx?

Back 83

Histoplasmosis. Amphotericin for severe infections

Front 84

Pulmonary sx in the Southwest. What is the diagnosis and what is the tx?

Back 84

Coccidioidomycosis. Amphotericin for severe infections

Front 85

What fungal infection has CNS symptoms most common and what is the tx?

Back 85

Cryptococcus. Amphotericin for severe infections

Front 86

What is the tx for candida infections?

Back 86

fluconazole (some Candida resistant), amphotericin for severe infections

Front 87

What is diagnostic of SBP?

Back 87

PMNs > 500 cells/cc (fluid cultures negative in many cases)

Front 88

SBP is monobacterial, what are the top 3?

Back 88

50% e coli, 30% streptococcus, 10% Klebsiella

Front 89

Tx for SBP?

Back 89

ceftriaxone or other 3rd generation cephalosporin

Front 90

If pt with SBP is not getting better on abx or if cultures are polymicrobial?

Back 90

need to rule out intra-abdominal source (diverticular abscess, perforation)

Front 91

Which abx for short term prophylaxis against SBP?

Back 91

Fluoroquinolone

Front 92

What is the cause of SBP?

Back 92

decreased host defenses (intrahepatic shunting, impaired bactericidal activity in ascites); not due to transmucosal migration

Front 93

What is the cause of secondary bacterial peritonitis?

Back 93

intra-abdominal source (transmucosal migration, perforated viscus)

Front 94

What are the most common organisms in secondary bacterial peritonitis?

Back 94

B. fragilis, E. coli, Enterococcus

Front 95

What is the tx for secondary bacterial peritonitis?

Back 95

Usually need laparotomy to find source

Front 96

Seroconversion after HIV exposure occurs in ___ weeks

Back 96

6-12

Front 97

What 2 drugs can help decrease seroconversion of HIV after exposure? Should be given within 1-2 hours of exposure.

Back 97

AZT and lamivudine

Front 98

2 most common reasons for laparotomy in HIV patients?

Back 98

opportunistic infections (CMV most common), neoplastic disease (respectively)

Front 99

Most common intestinal manifestation of AIDS. Can present with pain, bleeding or perforation.

Back 99

CMV colitis

Front 100

Lymphoma in HIV patients occurs most commonly which two locations?

Back 100

stomach, rectum

Front 101

Name two causes of upper GI bleeding in HIV patients?

Back 101

Kaposi's sarcoma, lymphoma

Front 102

Name three causes of lower GI bleeding in HIV patients?

Back 102

CMV, bacterial, HSV

Front 103

Tx of brown recluse spider bite?

Back 103

dapsone initially, may need resection of area and skin graft for large ulcers later

Front 104

Tx for acute septic arthritis?

Back 104

drainage, 3rd-generation cephalosporin and vancomycin until cultures show organism

Front 105

Tx for diabetic foot infection?

Back 105

broad-sprectrum abx (Unasyn, Zosyn)

Front 106

What bacteria is found only in human bites; can cause permanent joint injury?

Back 106

Eikenella

Front 107

What bacteria is found in cat and dog bites?

Back 107

Paseurella multocida

Front 108

What is the tx for cat/dog/human bites?

Back 108

broad-spectrum abx (Augmentin)

Front 109

What are the 2 bacteria usually found in furuncles (boil)?

Back 109

S. epidermidis or S. aureus

Front 110

What is a carbuncle?

Back 110

A multiloculated furuncle

Front 111

What are the two most common bacteria in peritoneal dialysis catheter infections?

Back 111

s. aureus and s. epidermidis

Front 112

Tx for peritoneal dialysis catheter infection?

Back 112

intraperitoneal vancomycin and gentamicin; increased dwell time and intraperitoneal heparin

Front 113

Need removal of peritoneal dialysis catheter for which type of infections?

Back 113

all fungal, TB and pseudomonas infections