Problem 5

Study guide 1

1. Discuss the immune defences of the body

 FIRST LINE OF DEFENCE

- PHYSICAL BARRIER: The skin, mucous membrane, tears, ear air wax mucus and stomach acid act as
a physical & ch4emical barrier to prevent invasion by microorganisms. These barriers are the body’s
initial defence against pathogens

o Skin -is the impermeable physical/mechanical barrier that protects many pathogens from
entering the body.
o Mucosa or mucous membranes- that line the immediate internal systems help trap pathogens
by producing mucous.
o Hairs inside the nasal cavity, as well as cerumen (earwax), also trap pathogens and
environmental pollutants

 SECOND LINE OF DEFENCE (NONSPECIFIC INATE RESPONSE

o Involves the immune cells and proteins to non-specifically recognize and eliminate any
pathogen that enters the body
o Phagocytosis-phagocytes(macrophages &neutrophils)found in tissues and blood
o phagocytes recognize and bind pathogens and then use the plasma membrane to
surround and engulf pathogens inside the cell result, a separate internal compartment
(phagosome) is generated, which subsequently fuses with another type of cellular
compartment called the lysosome.
o The digestive enzymes present inside lysosomes finally destroy pathogens by breaking
them into fragments
o Digestion of pathogens inside a phagosome produces indigestible materials and antigenic
fragments; of which, indigestible materials are removed by exocytosis

 THIRD LINE OF DEFENCE (SPECIFIC ADAPTIVE RESPONSE)

o aims at eliminating specific pathogens that have been encountered by the immune system
previously (adaptive or acquired immune response).
o Instead of being restricted to the site of infection, the adaptive immune response occurs
throughout the body.
o The adaptive immune system mainly involves two types of white blood cells
(lymphocytes) – B lymphocytes (B cells) and T lymphocytes (T cells)
o B Cells-antibody-mediated immune response(humoral immunity),T cells- cell
mediated immune response

What are the Three Lines of Defense? (news-medical.net)

2. Compare and contrast the features of cellular and humoral immunity

Difference Between Humoral and Cell Mediated Immunity | Compare the Difference
Between Similar Terms
 3. Discuss hypersensitivity.

Hypersensitivity reactions are abnormal immune responses to antigens, where the immune
system overreacts to substances that are normally harmless. There are four main types of
hypersensitivity reactions, classified based on the immune mechanisms involved:
1. Type I Hypersensitivity: This is an immediate reaction mediated by IgE antibodies, leading
to allergy, anaphylaxis, and atopic diseases. Symptoms can include hives, itching, swelling,
and in severe cases, anaphylactic shock.
2. Type II Hypersensitivity: Mediated by IgG or IgM antibodies, this reaction occurs hours to
days after exposure. Examples include hemolytic disease of the newborn and autoimmune
hemolytic anemia.
3. Type III Hypersensitivity: Involves immune complex-mediated reactions, where antigen-
antibody complexes deposit in tissues, leading to inflammation and tissue damage. Diseases
like serum sickness and rheumatoid arthritis are associated with this type.
4. Type IV Hypersensitivity: This is a delayed reaction involving T cells, occurring 24 to 72
hours after exposure. Contact dermatitis and tuberculin skin tests are examples of type IV
reactions.
 Hypersensitivity reactions can manifest in various ways, from mild allergic symptoms to
severe, life-threatening conditions like anaphylaxis. Understanding the different types of
hypersensitivity reactions is crucial for proper diagnosis and management, as treatments vary
depending on the specific type of reaction a person experiences.

4. Classify hypersensitivity in terms of - antigens that are likely to provoke the four types of
hypersensitivity response - antibody class or lymphocyte class that is responsible for each
hypersensitivity reaction - chemical mediators involved

Classification of Hypersensitivity Reactions

Hypersensitivity reactions are classified based on the antigens that provoke the response, the
antibody or lymphocyte class responsible, and the chemical mediators involved:
1. Antigens Provoking Hypersensitivity Responses:
 Type I Hypersensitivity: Antigens from food products, animal sources (e.g., cats, bee
stings), environmental sources (e.g., mold, latex), and allergic conditions (e.g., allergic
rhinitis, asthma).
 Type II Hypersensitivity: Antigens on cell surfaces or extracellular matrix, leading to
conditions like hemolytic disease of the newborn and autoimmune hemolytic anemia.
 Type III Hypersensitivity: Soluble antigens in the blood forming immune complexes,
causing diseases such as serum sickness and rheumatoid arthritis.
 Type IV Hypersensitivity: T cells responding to antigens, seen in conditions like contact
dermatitis and tuberculin skin tests.
2. Antibody or Lymphocyte Class Responsible:
 Type I Hypersensitivity: Mediated by IgE antibodies.
 Type II Hypersensitivity: Mediated by IgG or IgM antibodies.
 Type III Hypersensitivity: Mediated by IgM and IgG antibodies.
 Type IV Hypersensitivity: Mediated by T cells.
3. Chemical Mediators Involved:
 Type I Hypersensitivity: Involves the release of histamine and other inflammatory
mediators.
 Type II Hypersensitivity: Antibodies activate complement and Fc receptors, leading to
tissue injury.
 Type III Hypersensitivity: Immune complexes activate complement and cause
inflammation.
 Type IV Hypersensitivity: Involves delayed reactions mediated by T cells

Study guide 2

1. Discuss the mechanisms of cell damage in hypersensitivity reaction

 2. Discuss the pathophysiology of the hypersensitivity reaction and relate this to the clinical
manifestations

Pathophysiology of Hypersensitivity Reactions

Hypersensitivity reactions are abnormal immune responses to antigens, where the immune
system overreacts to substances that are normally harmless. The pathophysiology of
hypersensitivity reactions is related to the clinical manifestations through various
mechanisms, depending on the type of hypersensitivity reaction. Here are the key aspects of
the pathophysiology and clinical manifestations:

1. Type I Hypersensitivity:
 Pathophysiology: Involves IgE antibodies binding to mast cells and basophils, leading to
degranulation and release of inflammatory mediators like histamine, leukotrienes, and
prostaglandins.
 Clinical Manifestations: Mild reactions include hives, itching, and urticaria, while severe
reactions can lead to anaphylaxis, a potentially life-threatening condition characterized by
symptoms like difficulty breathing, swelling, and rapid heartbeat.
2. Type II Hypersensitivity:
 Pathophysiology: Mediated by IgG or IgM antibodies targeting cell surface or extracellular
matrix antigens, leading to complement activation and recruitment of inflammatory cells.
 Clinical Manifestations: Examples include hemolytic disease of the newborn, autoimmune
hemolytic anemia, and drug-induced hemolysis, which can cause anemia and other
complications.
3. Type III Hypersensitivity:
 Pathophysiology: Involves immune complex formation between antigens and IgG, IgM, or
IgA antibodies, leading to complement activation and immune cell recruitment.
 Clinical Manifestations: Serum sickness and rheumatoid arthritis are examples of type III
reactions, characterized by fever, rash, arthralgia, and other symptoms.
4. Type IV Hypersensitivity:
 Pathophysiology: T-cell mediated reaction where CD4+ T cells activate tissue antigen-
presenting cells, leading to cytokine-mediated inflammation and direct cell killing by CD8+ T
cells.
 Clinical Manifestations: Contact dermatitis and tuberculin skin tests are examples of type IV
reactions, causing delayed-type hypersensitivity reactions with redness, itching, and
blistering.

3. Discuss the diseases associated with hypersensitivity reactions (eg Asthma, Rheumatic fever,
Glomerulonephritis, SLE, Hay Fever,: Allergic Conjunctivitis, Hashimoto Thyroiditis, TB)
 STUDY GUIDE 3

1. Describe the concept of medical mistakes, their causes, and ways to prevent the

Causes of Medical Errors:

1. Communication Problems: Breakdowns in communication between healthcare
providers, patients, and within healthcare systems can lead to errors.
2. Inadequate Information Flow: Insufficient transfer of critical information during
care transitions can result in errors.
3. Human Problems: Failure to follow established standards of care, policies, or
procedures can contribute to errors.
4. Patient-Related Issues: Inappropriate patient identification, inadequate assessment,
lack of consent, and poor patient education can lead to mistakes.
5. Organizational Transfer of Knowledge: Insufficiencies in training and education for
healthcare providers can impact patient safety.
6. Staffing Patterns and Workflow: Inadequate staffing levels or workflow issues can
create situations conducive to errors.
7. Technical Failures: Complications with medical devices or equipment malfunctions
can result in errors.
8. Inadequate Policies: Poor documentation and lack of clear procedures can
contribute to mistakes.

Ways to Prevent Medical Errors:

1. Active Patient Involvement: Patients should actively participate in their care by
asking questions, understanding their conditions and treatments, and
communicating openly with healthcare providers.
2. Medication Safety: Patients should inform healthcare providers about all
medications they are taking to prevent drug interactions or allergic reactions.
3. Clear Communication: Effective communication among healthcare team members
and with patients is crucial for preventing errors.
4. Continuity of Care: Ensuring seamless transitions between different care settings
and providers can reduce the risk of errors.
5. Standardized Procedures: Implementing standardized protocols and procedures
can help reduce variability and improve patient safety.
6. Training and Education: Healthcare providers should receive ongoing training to
stay updated on best practices and new technologies.
7. Quality Improvement Initiatives: Healthcare organizations should prioritize quality
improvement efforts to identify and address system weaknesses that contribute to
errors.

2. Discuss some of the situations where medical errors can occur

3. Discuss how medical errors are dealt with legally

 Legal Response to Medical Errors:
1. Recognition and Reporting: The legal system typically responds to medical errors that
come to attention through patient complaints or adverse events. However, the majority of
medical errors go unrecognized by the law, with only a minority leading to legal
consideration
2. Goals of Legal Response: The legal response to medical errors often focuses on
compensation, accountability, and retribution. Different legal systems prioritize these goals
to varying degrees, influencing how medical errors are addressed
3. Legislation and Professional Discipline: Medical registration bodies and civil courts play a
significant role in dealing with medical errors through mechanisms related to professional
discipline and accountability. These bodies help regulate healthcare practices and ensure
adherence to standards of care
4. Policy vs. Law: In practice, policy decisions can have a more substantial impact than the law
itself in addressing medical errors. Changes in prosecution policies, for example, can
influence the likelihood of legal action following fatal hospital errors
5. Empirical Data on Medical Errors: Scientific data on iatrogenic harm and medical errors
provide valuable insights into the prevalence and impact of healthcare-related mistakes.
Understanding the root causes of errors is crucial for developing effective strategies to
prevent them
6. Implications of Legal Action: Legal actions such as law suits, disciplinary proceedings, and
internal inquiries can be stressful for healthcare providers involved in errors. Balancing justice
with the emotional toll on individuals is essential in addressing medical mistakes

4. Determine and discuss which circumstances may lead patients to seek legal action

Circumstances that may lead patients to seek legal action in the context of medical errors
can vary but often revolve around situations where patients believe they have experienced
harm or negligence in their healthcare. Based on the provided sources, here are some key
circumstances that may prompt patients to pursue legal challenges:

1. Clinical Negligence: Patients may seek legal action if they believe they have been a victim
of clinical negligence, where the care provided falls below acceptable standards, resulting in
harm or injury. This can include misdiagnosis, surgical errors, medication mistakes, or
inadequate treatment
2. Failure to Provide Informed Consent: Patients have the right to be informed about the
risks, benefits, and alternatives of medical treatments before consenting to them. If
healthcare providers fail to obtain proper informed consent or provide adequate
information, patients may consider legal action
3. Preventable Harm: Instances where patients suffer harm that could have been prevented,
such as medication errors, surgical complications, hospital-acquired infections, or
 mismanagement of conditions, can lead to legal challenges seeking compensation for
damages
4. Lack of Continuity of Care: Breakdowns in continuity of care, such as inadequate follow-
up, poor communication between healthcare providers, or errors in care transitions, can
result in patient dissatisfaction and potential legal action
5. Violation of Patient Rights: Patients may seek legal recourse if they believe their rights as
healthcare consumers have been violated, including issues related to privacy, confidentiality,
dignity, and autonomy in decision-making
6. Delayed Diagnosis or Treatment: Delays in diagnosing or treating a medical condition can
have serious consequences for patients. If a delay leads to worsened outcomes or additional
harm, patients may consider legal action to seek accountability
7. Loss of Trust: When patients lose trust in their healthcare providers due to perceived errors,
lack of transparency, or poor communication, they may turn to legal avenues to address
their concerns and seek redress for any harm experienced

5. Discuss how one should respond in the event of an error to patient management.

Key Steps in Responding to Errors in Patient Management:

1. Transparency and Communication: Transparency is essential when an error occurs.
Healthcare providers should communicate openly with patients and their families, providing
a clear explanation of what happened, expressing empathy, and offering apologies when
appropriate
2. Disclosure and Apology: Prompt disclosure of errors and sincere apologies are vital
components of responding to mistakes in patient management. Apologizing for errors
demonstrates accountability and can help rebuild trust with patient
3. Learning from Errors: It is crucial to view errors as opportunities for learning and
improvement. Healthcare professionals should engage in root cause analysis (RCA) to
identify the factors contributing to the error and implement strategies to prevent similar
incidents in the future
4. Supporting Healthcare Team Members: Errors can have a significant emotional impact on
healthcare providers involved. It is essential to provide support, both emotionally and
professionally, to team members who may be affected by the error. Creating a non-punitive
culture encourages reporting and learning from mistakes
5. Patient Safety Measures: Implementing quality assurance processes, such as RCA following
sentinel events, can help identify system issues contributing to errors and enhance patient
safety. Collaborative efforts among healthcare team members are crucial in preventing
errors and improving care deliver
6. Preventing Recurrence: After addressing an error, it is essential to take proactive steps to
prevent its recurrence. This may involve revising protocols, enhancing communication
channels, providing additional training, or implementing new safety measures within the
healthcare setting
7. Involving Patients in Care: Engaging patients in their care by encouraging questions,
providing clear information about treatments, and involving them in decision-making
processes can help prevent misunderstandings that may lead to errors

STUDY GUIDE 4

1. Classify the clinical features of anaphylaxis according to the system affected

2. Describe the management of anaphylaxis and relate this to its pathophysiological basis.
3. Discuss medications, their mode of action and effects in the treatment of anaphylaxis and
other hypersensitivity reactions
### Medications and Their Role in the Treatment of Anaphylaxis and Hypersensitivity Reactions

The treatment of anaphylaxis and hypersensitivity reactions involves a range of medications that
target different aspects of the immune response to mitigate symptoms and prevent severe
complications. Here is a discussion on medications, their mode of action, and effects in the
treatment of anaphylaxis and other hypersensitivity reactions based on the provided sources:

1. **Epinephrine (Adrenaline)**:

- **Mode of Action**: Epinephrine acts as a potent vasoconstrictor, bronchodilator, and cardiac

stimulant. It counteracts the vasodilation, bronchoconstriction, and cardiovascular collapse seen in
anaphylaxis by increasing blood pressure, opening airways, and improving heart function[5].

- **Effects**: Rapid administration of epinephrine is crucial in managing anaphylaxis as it reverses

severe symptoms like low blood pressure, wheezing, and throat swelling. It helps stabilize the
patient's condition during an acute allergic reaction[5].
2. **Antihistamines**:

- **Mode of Action**: Antihistamines like loratadine or cetirizine block histamine receptors,

reducing symptoms like itching, hives, and rhinorrhea associated with allergic reactions[1].

- **Effects**: Antihistamines are used to alleviate cutaneous symptoms and nasal congestion
during anaphylaxis. They help down-regulate the allergic response and minimize the clinical impact
of histamine release[1].

3. **Corticosteroids**:

- **Mode of Action**: Corticosteroids like prednisone or hydrocortisone have anti-inflammatory

properties that help reduce swelling and inflammation associated with allergic reactions[1][2].

- **Effects**: While corticosteroids may not provide immediate relief during acute anaphylaxis,
they are used to shorten the duration of reactions and manage lingering symptoms like urticaria
over a few days post-reaction[1][2].

4. **Bronchodilators**:

- **Mode of Action**: Bronchodilators such as salbutamol or ipratropium help dilate the airways,
improving breathing in individuals experiencing severe respiratory distress during anaphylaxis[1].

- **Effects**: These medications are considered for people with significant breathing difficulties to
alleviate wheezing and improve respiratory function during allergic reactions[1].

5. **H2-Receptor Antagonists**:

- **Mode of Action**: H2-receptor antagonists like ranitidine are sometimes used in anaphylaxis
to counteract gastric acid secretion but have limited evidence supporting their effectiveness in
managing allergic reactions[1].

- **Effects**: While their role in anaphylaxis treatment is not well-established, they may be
considered in specific cases to address gastric symptoms associated with severe allergic
responses[1].

In summary, medications play a crucial role in managing anaphylaxis and hypersensitivity reactions
by targeting different aspects of the immune response to alleviate symptoms, stabilize patients
during acute episodes, and prevent further complications. Epinephrine remains the cornerstone of
treatment due to its rapid action in reversing life-threatening manifestations of anaphylaxis.
Antihistamines, corticosteroids, bronchodilators, and H2-receptor antagonists complement the
management by addressing specific symptoms and inflammatory processes associated with allergic
reactions.

Citations:
[1] https://bpac.org.nz/BPJ/2008/December/anaphylaxis.aspx

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754021/

[3] https://www.aafp.org/pubs/afp/issues/2020/0915/p355.html

[4] https://www.jacionline.org/article/S0091-6749%2818%2930590-6/fulltext

[5] https://pubmed.ncbi.nlm.nih.gov/29238519/

4. Outline the acute management of anaphylaxis in a primary care setting

5. Describe the preventive measures taken to avoid anaphylactic reactions

 6. Describe the crucial elements in managing emergencies

Crucial Elements in Managing Emergencies

Managing emergencies effectively requires a comprehensive approach that encompasses
various key elements to ensure preparedness, response, recovery, and prevention. Drawing
from the provided sources, here are the crucial elements in managing emergencies:

1. Prevention:
 Risk Assessment: Conducting risk assessments to identify potential hazards and
vulnerabilities that could lead to emergencies is essential for proactive prevention
 Mitigation: Implementing measures to prevent emergencies or minimize their effects, such
as constructing protective barriers or establishing alternative sources of essential services
like electricity or communication systems
2. Preparedness:
 Planning and Training: Developing and testing emergency plans, training personnel, and
educating communities to respond effectively in case of emergencies is crucial for
preparedness
 Establishing Emergency Response Teams: Creating dedicated teams responsible for
managing emergencies, developing response strategies, and coordinating actions during
crises enhances preparedness
3. Response:
 Immediate Action: Responding promptly during emergencies to save lives, protect assets,
and mitigate further damage is a critical element of emergency management
 Activation of Emergency Plans: Putting preparedness plans into action, including
communication protocols, evacuation procedures, and resource mobilization, is essential for
an effective response
4. Recovery:
 Restoration and Reconstruction: Engaging in coordinated efforts to restore physical
infrastructure, support affected communities, and address emotional, social, and economic
impacts post-emergency is vital for recovery
 Long-Term Stabilization: Implementing measures to return affected areas to normalcy,
provide support services, and facilitate reconstruction efforts over an extended period is key
in the recovery phase
5. Continuous Improvement:
 Learning from Incidents: Conducting post-incident reviews, documenting lessons learned,
and implementing improvements based on feedback are essential for enhancing emergency
management practices
 Adapting to New Challenges: Evolving emergency readiness plans to address emerging
risks, changing work environments, and technological advancements ensures preparedness
for diverse emergency scenarios
6. Effective Communication:
 Timely Alerts: Establishing reliable communication systems to quickly alert employees,
stakeholders, and the public about emergencies is crucial for swift response and
coordination
 Information Dissemination: Ensuring clear and effective communication channels during
emergencies, including public announcements, text alerts, and alarm systems, facilitates a
coordinated response
By integrating these crucial elements into emergency management practices,
organizations and communities can enhance their resilience, minimize the impact of
emergencies, and effectively navigate crises to ensure the safety and well-being of
individuals and assets.