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Adv Principles A > Exam 1 (part 1) > Flashcards

Exam 1 (part 1) Flashcards

1
Q

what does the sedentary lifestyle of older ortho patients put them at risk for?

A

thrombotic events

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2
Q

is parathyroid hormone increased or decreased in osteoporosis?

A

increased

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3
Q

what 3 hormones/vitamins are decreased when PTH is elevated?

A

vitamin D, growth hormone, and insulin like growth factors

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4
Q

which areas of the spine are at risk of compression fracture in osteoporosis?

A

thoracic and lumbar

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5
Q

what are 3 common areas for fracture in patients with osteoporosis, other than the spine?

A

proximal femur and humerus, wrist

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6
Q

what is the basic patho of osteoarthritis?

A

loss of articular cartilage leading to inflammation
*typically in weight bearing joints

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7
Q

with osteoarthritis there is joint deformity and pain that is worse ______

A

at the end of the day

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8
Q

what are herberden nodes?

A

swollen/spurred distal interphalangeal joints

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9
Q

what are bouchard nodes?

A

swollen/spurred proximal interphalangeal joints

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10
Q

what are 2 common drug classes used for the management of osteoarthritis?

A

NSAIDs (meloxicam) and COX-2 inhibitors (celebrex)

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11
Q

what is the patho of RA?

A

joint synovial tissue/connective tissue inflammation leads to bone erosion, cartilage destruction and impaired joint integrity

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12
Q

which 2 joints are mainly affected by RA?

A

wrists and metacarpophalangeal joints

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13
Q

with RA, pain/stiffness ______ throughout the day

A

improves

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14
Q

what are 3 places that subcutaneous nodules are found in patients with RA?

A

around joints, extensor surfaces (skin around joint), and bony prominences

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15
Q

what 4 lab values are elevated in pts with RA?

A

CRP
rheumatoid factor
anti-immunoglobulin antibody
ESR

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16
Q

what is an anesthetic consideration for pts on glucocorticoids?

A

will most likely need a stress dose of steroids in order to avoid CV instability intraop

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17
Q

what drug class is methotrexate?

A

antineoplastic

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18
Q

what drug class is hydroxychloroquine?

A

antimalarial/antirheumatic

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19
Q

what drug class do sulfasalazine and leflunomide belong to?

A

DMARDs
*disease-modifying anti-rheumatic drugs

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20
Q

what drug class do infliximab and etanercept belong to?

A

TNF inhibitors

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21
Q

what are 3 airway concerns for pts with RA?

A

limited TMJ movement
narrowed glottic opening
cricoarytenoid arthritis

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22
Q

which part of the cervical spine is particularly fragile in RA patients?

A

Alantoaxial joint

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23
Q

what is the odontoid process?

A

part of the axis that sticks up into the atlas lol

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24
Q

what can happen if the odontoid process is displaced with neck flexion in RA patients?

A

impingement on c-spine and medulla–>vertebral artery compression

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25
Q

what are 4 symptoms of alantoaxial subluxation?

A

headache, neck pain, upper and lower extremity paresthesia with movement, bowel/bladder dysfunction

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26
Q

what do you do if you suspect alantoaxial subluxation?

A

evaluate c-spine flexion/extension x-rays

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27
Q

what are 4 symptoms of vertebral artery occlusion?

A

N/V, dysphagia, blurred vision, transient LOC

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28
Q

what is sjogren’s syndrome?

A

immune system attacks the glands that make tears and saliva

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29
Q

what type of ventilation pattern is seen in RA?

A

restrictive due to diffuse interstitial fibrosis

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30
Q

why is there an increased incidence of gastric ulcers in RA patients?

A

NSAID use

31
Q

what does RA do to the kidneys?

A

leads to renal insufficiency

32
Q

what are 2 cardiac conditions common in pts with RA?

A

pericarditis and cardiac tamponade

33
Q

what are the 4 major anesthetic concerns for ortho cases according to lecture?

A

1.hemorrhage/shock
2.full stomach (if emergent)
3. pelvic fracture–>illiac artery–>retroperitoneal bleeding
4.long bone fracture–>fat from bone marrow–> venous–> thromboembolic

34
Q

what complication can occur from the hammering of long bones in surgery?

A

fat embolism

35
Q

what does MILS stand for?

A

Manual in line stabilization

36
Q

what 3 body parts are in line for MILS?

A

head, neck, torso

37
Q

how many providers are required to intubate a patient while maintaining MILS?

A

3
1 for head, 1 for shoulders, 1 to intubate

38
Q

what are 10 things that can trigger post op delirium :-)

A

hypoxemia
hypotension
hypercarbia
sleep deprevation
hypervolemia
infection
abnormal electrolytes
pain
benzos
anticholinergics

39
Q

what are 3 age related respiratory changes according to lecture?

A

progressive decreased PaO2
increased closing volume
FEV1 decrease of 10%/decade

40
Q

what are the 3 symptoms of fat embolism syndrome and when do the typically present?

A

dyspnea, confusion, petechiae
12-72 hours

41
Q

what are 3 lab findings in fat embolism syndrome?

A

fat macroglobulinemia
anemia + thrombocytopenia
elevated SED rate

42
Q

what is the normal SED rate for a male and female

A

male 0-22 mm/Hr
female 0-29 mm/Hr

43
Q

what is the patho of fat embolism syndrome?

A

end organ capillaries obstructed by fat/bone marrow particulate–> fat metabolized by fatty acids–>SIRS (cytokine release, pulmonary endothelial injury, pulm edema, ARDS)

44
Q

what are neurological changes seen in fat embolism syndrome?

A

drowsiness, confusion, obtundation, coma

45
Q

what kind of rash is seen in patients with fat embolism syndrome?

A

petechial rash

46
Q

what are 4 minor changes seen in fat embolism syndrome?

A

fever, tachycardia, jaundice, renal changes

47
Q

how should heparin be administered in a patient with fat embolism syndrome?

A

IV

48
Q

which inhalation agent must be avoided in pts with fat embolism syndrome?

A

N2O

49
Q

what is the % risk of a DVT/PE without prophalaxis?

A

40-80%

50
Q

which 3 surgeries run the greatest risk of DVT or PE?

A

hip surgery, TKA, lower extremity trauma

51
Q

when should LMWH be initiated?

A

12 hr before or 12 hr after procedure

52
Q

when is it safe to perform a neuraxial on pt that received LMWH?

A

10-12 hr since last dose
**next dose should be delayed for 4 hours after neuraxial procedure

53
Q

can a pt be on LMWH and have a neuraxial catheter?

A

No. the catheter should be removed 2 hours before LMWH admin

54
Q

neuraxial procedures are safe for pts on warfarin if their INR is ______

A

less than or = to 1.5

55
Q

when can a neuraxial be performed safely after admin of aspirin or NSAIDs?

A

anytime. no restrictions

56
Q

when can a neuraxial be performed safely after admin of clopidogrel or ticagrelor?

A

5-7 days

57
Q

when can a neuraxial be performed safely after admin of prasugrel?

A

7-10 days

58
Q

when can a neuraxial be performed safely after admin of ticlopidine?

A

10 days

59
Q

when can a neuraxial be performed safely after admin of cangrelor?

A

3 hours

60
Q

when can a neuraxial be performed safely after admin of abiciximab?

A

24-48 hours

61
Q

when can a neuraxial be performed safely after admin of tirofiban or eptifibatide?

A

4-8 hours

62
Q

with neuraxial anesthesia, lower extremity blood flow is _____ due to the sympathectomy

A

increased

63
Q

what does neuraxial anesthesia do to the systemic inflammatory response?

A

decreases, so some anti-inflammatory effects

64
Q

neuraxial anesthesia causes ______ platelet reactivity

A

decreased

65
Q

what medication typically given before incision is linked to a decreased need for blood transfusion?

A

TXA

66
Q

what are 3 common doses for TXA? what is the max dose?

A

10 mg/kg
15 mg/kg
30 mg/kg
Max 2.5 G total

67
Q

when does pain from a tourniquet begin?

A

45 min

68
Q

what is the tourniquet inflation for thigh? arm?

A

~ 100 mmHg> SBP
~ 50 mmHg> SBP

69
Q

what is the max time of tourniquet inflation?

A

max 3 hours, typically no more than 2

70
Q

what are 3 things to document with tourniquet use in surgery?

A

inflation time
deflation time
total inflated pressure + adjustments

71
Q

when is the risk of ischemia, rhabdo, and mechanical trauma increased in tourniquet use?

A

after 2 hours

72
Q

what are 4 systemic complications from tourniquet use?

A

metabolic acidosis
hypercarbic
hyperkalemia
tachycardia/HTN

73
Q

why would a transient increase in minute ventilation be seen after tourniquet release?

A

d/t transient hypercarbia

Adv Principles A (5 decks)

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