Autoimmune, Musculoskeletal (2) Flashcards

Question

Rheumatoid Arthritis, pharmacotherapy: Corticosteroid

Answer 1

Administration during procedure: based on prehospital prescription and severity of surgical procedure ~ Adverse effects: Han, infection, electrolyte imbalance, weight gain, glucose intolerance, adrenal insufficiency, fragile skin

Answer 2

Administration during procedure: Continue ~ Adverse effects: Pulmonary toxicity, bone marrow suppression, hepatotoxicity, infection

Answer 3

Administration during procedure: Continue ~ Adverse effects: Retinal toxicity, cardiotoxicity, blood dyscrasia

Answer 4

Administration during procedure: Continue ~ Adverse effects: Central nervous system symptoms, granulocytopenia, hemolytic anemia

Answer 5

Administration during procedure: Continue ~ Adverse effects: Hepatotoxicity, myleosuppression infection, pulmonary toxicity

Answer 6

~ Preop ROM assessment ~ Consider cervical collar placement, VL or awake FOB ~ Consider flex/ex/odontoid imaging

Answer 7

~ ECG, CXR / ECHO

Answer 8

PFTs: Spirometry and Flow-Volume loops

Answer 9

~ U/A: Elevated Protein and Protein:Creatinine ratio. ~ CBC: Hypoalbuminemia, Pitting edema

Answer 10

CBC: Hypoalbuminemia, H&H, Coags

Answer 11

Continue conventional (non-biologics) D/C Biologics 7-10 days

Answer 12

Document deformities / neuro deficits

Answer 13

~ Central regional techniques when no significant thoracic, lumbar, and sacral spine involvement exists and coagulation studies WNL ~ Peripheral blocks: ok as long as coags WLN, consider ROM limitations ~ Chosen regional technique must outlast procedure!

Answer 14

Inflammation, vascular sclerosis, skin and visceral fibrosis ~ Vascular injury can cause protein leakage into the interstitial space ~ Disease can evolve into CREST syndrome

Answer 15

C = Calcinosis: calcium salt deposits under the skin R = Raynaud's phenomenon: spasm of blood vessels of the fingers and toes when triggered by factors, such as cold, stress or illness E = Esophageal dysmotility: esophageal muscles fail to contract, and the esophagus does not properly deliver food and liquids into your stomach S = Sclerodactyliy: thickening of the skin of the digits, hands and feet T = Telangiectases: lesions formed by collections of dilated blood vessels. occur on the face, upper trunk, hands, mucosal surfaces (eg, lips) and through the GI tract

Answer 16

~ Airway: Microstomia. Cervical extension. STOP-BANG ~ Pulmonary hypertension / ILD: Cor-pulmonale cardiomyopathy (TTE), conduction abnormalities (ECG), DLCO, 6-minute walk ~Esophageal dysfunction: GERD - prophylaxis ~VTE risk: A-fib, CHG - prophylaxis

Answer 17

~ Decreased mouth opening to be anticipated ~ Trauma during intubation may cause excessive bleeding due to telangiectasis ~ IV access may be difficult due to dermal thickening ~ Increased risk of aspiration - esophageal hypomotility

Answer 18

Multi system chronic inflammatory disorder characterized by antinuclear antibody production

Answer 19

~ Usually occurs in young women ~ Exacerbated by stress (infection, pregnancy, surgery) ~ Onset can be drug induced (most commonly by procainamide, hydralazine, isoniazid, D-penicillamine, and methyldopa ~ Drug induced forms most common in people characterized as slow acetylators (slower to metabolize these drugs) ~ Presence of nephritis and hypertension is associated with worse prognosis

Answer 20

~ Classic Butterfly molar rash often exacerbated by sunlight ~ Discoid lesions on the face, scalp, and upper trunk ~ Alopecia is common

Answer 21

Identifying specific organ dysfunctions and the clinical picture will determine the appropriate anesthetic plan

Answer 22

~ Acquired autoimmune disorder ~ Production of antibodies agains phospholipid binding proteins ~ Recurrent venous or arterial thrombosis and/or fetal loss ~ Prevalence of APS in SLE = 30-35%

Answer 23

Antiphospholipid syndrom destroys protein S and protein C which inactivate factor Va. Since factor Va is no longer being inhibited clotting continues (almost like DIC)

Answer 24

Chronic inflammatory disease of th axial spine ~ Hallmark feature is chronic back pain and progressive spine stiffness ~ Extraarticular manifestations of AS include inflammatory bowel disease, psoriasis, and uveitis

Answer 25

Those with <4 METS are at greater cardiac risk

Answer 26

Significant spinal deformity can result in restrictive respiratory physiology. Pleural thickening on CXR. An alternative diagnosis is pulmonary tuberculosis in the setting of immunosuppressant therapy

Answer 27

Thorough ROM physical examination to document any preoperative sensory or motor deficits, especially in patients undergoing spinal surgery. Notation of any motor weakness may affect the plan for intraoperative neruomonitoring and the anesthesia

Answer 28

Long-term NSAID use. Interstitial nephritis, or chronic kidney dysfunction due to amyloidosis, IgA-nephropaty, and tubulointerstitial nephritis

Answer 29

40% - uveitis/ conjunctivitis causing pain, visual disturbance, and photophobia

Answer 30

Predominantly aortic valve insufficiency (40%), thoracic aortic involvement, and RBBB

Answer 31

Hoarseness from cricoarytenoid joint disease does occur however is rarely seen

Answer 32

inflammation of extra-axial tendons and ligaments (40%); most commonly tendoachilles

Answer 33

Decreased compliance due to thoracic joint (spine and costochondral) involvement and fusion with restrictive physiology on pulmonary function tests (PFTs)

Answer 34

Hip involvement (33%) peripheral arthritis; usually monoarticular

Answer 35

Dactylitis (8%) - painful swelling of the fingers and toes heterotrophic ossification after joint surgeries is more common than in the general population

Answer 36

~ Kyphosis: accentuated posterior curvature of the spine ~ Scoliosis: lateral curvature of the spine - Cobb angle more than 10 degrees ~ Kyphoscoliosis: concomitant kyphosis and scoliosis resulting in a lateral bending and rotation of the vertebral column

Answer 37

The Cobb method of measuring scoliosis curves - The most tilted vertebrae above and below the curve are identified. Horizontal lines are drawn parallel with the plane of each vertebrae. Perpendicular lines intersecting those horizontal lines interest at the angle of curvature. (Greater than 50 degrees = Surgery)

Answer 38

~ Idiopathic scoliosis: Diagnosis of exclusion. 80% of all cases

Answer 39

~ Congenital scoliosis: Embryological malformation of one or more vertebrae. The abnormalities cause curvature and other deformities of the spine because on area of the spinal column lengthens at a slower rate than the rest. Because these abnormalities are present at birth, it is usually detected at a younger age and surgical treatment is avoided

Answer 40

~ Neuromuscular scoliosis: Scoliosis secondary to neurological muscular diseases. (cerebral palsy, poliomyelitis, meningomyelocele, syringomyelia spinal cord trauma, muscular dystrophy, spinal muscular atrophy, and spina bifida). Progresses more rapidly than idiopathic scoliosis and often requires surgical treatment

Answer 41

*** Curvature > 60 degrees (severe). Cardiac and respiratory likely

Answer 42

Anticipate substantial blood loss with spinal procedures: From surgical field, but occasionally from laceration of the great vessels. Large bore PIVs, fluid infusion devices and have banked PRBCs immediately available.

Answer 43

Inherited connective-tissue (collagen) disorder that can affect the skin, joints, and blood vessels ~ Characterized by joint hyper mobility, cutaneous fragility, and hyperextensibility

Answer 44

Due to abnormal production of pro collagen and collagen: there are 9 types but only one form (Type IV) is associated with an increased risk of death due to. the vascular component of the disease.

Answer 45

Most common issues with type IV is rupture of large blood vessels or disruption of the bowel

Answer 46

~ Joint hypermobility ~ Skin fragility or hyperplasticity ~ Spontaneous rupture of bowel, uterus, or major arteries ~ Premature labor and/or excessive bleeding with child delivery ~ Will often require tracheal dilation ~ Increased risk of pneumothorax ~ Occasionally MR and cardiac conduction abnormalities are seen

Answer 47

Thin translucent skin, arterial/intestinal/uterine fragility or rupture, extensive bruising, characteristic facial appearance. Sudden death of a close relative(s).

Answer 48

Only form associated with increased risk of death due to vascular syndrome ~ GI tract, uterus, and vasculature are particularly well endowed with type IV collagen, which accounts for complications such as spontaneous rupture of the bowel, uterus, or major arteries

Answer 49

~ Increased Cardiac conduction abnormalities ~ Increased bleeding (minimize DL trauma) ~ Avoid instrumentation of nose and esophagus and IM injections ~ Arterial or central venous lines may lead to extensive hematomas ~ IV infiltration may be difficult to recognize due to skin laxity ~ Regional Anestesia is relatively contraindicated

Answer 50

Hereditary progressive genetic disease affecting connective tissues ~ Those with syndrome have long arms, legs, fingers and toes

Answer 51

affects eyes, blood vessels, and skeleton

Answer 52

Mutation or change in fibrillar-1 gene causes marfans syndrome ~ Fibrillin 1 a critical growth factor affecting growth and proliferation of cells

Answer 53

~ Existence of thoracic aneurysm? ~ Hyperextensible joints (possible positioning implications) ~ High arched palate (airway implications) ~ Kyphoscoliosis (difficulties with neuraxial anesthesia)