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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
what are 4 symptoms of alantoaxial subluxation?
headache, neck pain, upper and lower extremity paresthesia with movement, bowel/bladder dysfunction
26
what do you do if you suspect alantoaxial subluxation?
evaluate c-spine flexion/extension x-rays
27
what are 4 symptoms of vertebral artery occlusion?
N/V, dysphagia, blurred vision, transient LOC
28
what is sjogren's syndrome?
immune system attacks the glands that make tears and saliva
29
what type of ventilation pattern is seen in RA?
restrictive due to diffuse interstitial fibrosis
30
why is there an increased incidence of gastric ulcers in RA patients?
NSAID use
31
what does RA do to the kidneys?
leads to renal insufficiency
32
what are 2 cardiac conditions common in pts with RA?
pericarditis and cardiac tamponade
33
what are the 4 major anesthetic concerns for ortho cases according to lecture?
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
what complication can occur from the hammering of long bones in surgery?
fat embolism
35
what does MILS stand for?
Manual in line stabilization
36
what 3 body parts are in line for MILS?
head, neck, torso
37
how many providers are required to intubate a patient while maintaining MILS?
3 1 for head, 1 for shoulders, 1 to intubate
38
what are 10 things that can trigger post op delirium :-)
hypoxemia hypotension hypercarbia sleep deprevation hypervolemia infection abnormal electrolytes pain benzos anticholinergics
39
what are 3 age related respiratory changes according to lecture?
progressive decreased PaO2 increased closing volume FEV1 decrease of 10%/decade
40
what are the 3 symptoms of fat embolism syndrome and when do the typically present?
dyspnea, confusion, petechiae 12-72 hours
41
what are 3 lab findings in fat embolism syndrome?
fat macroglobulinemia anemia + thrombocytopenia elevated SED rate
42
what is the normal SED rate for a male and female
male 0-22 mm/Hr female 0-29 mm/Hr
43
what is the patho of fat embolism syndrome?
end organ capillaries obstructed by fat/bone marrow particulate--> fat metabolized by fatty acids-->SIRS (cytokine release, pulmonary endothelial injury, pulm edema, ARDS)
44
what are neurological changes seen in fat embolism syndrome?
drowsiness, confusion, obtundation, coma
45
what kind of rash is seen in patients with fat embolism syndrome?
petechial rash
46
what are 4 minor changes seen in fat embolism syndrome?
fever, tachycardia, jaundice, renal changes
47
how should heparin be administered in a patient with fat embolism syndrome?
IV
48
which inhalation agent must be avoided in pts with fat embolism syndrome?
N2O
49
what is the % risk of a DVT/PE without prophalaxis?
40-80%
50
which 3 surgeries run the greatest risk of DVT or PE?
hip surgery, TKA, lower extremity trauma
51
when should LMWH be initiated?
12 hr before or 12 hr after procedure
52
when is it safe to perform a neuraxial on pt that received LMWH?
10-12 hr since last dose **next dose should be delayed for 4 hours after neuraxial procedure
53
can a pt be on LMWH and have a neuraxial catheter?
No. the catheter should be removed 2 hours before LMWH admin
54
neuraxial procedures are safe for pts on warfarin if their INR is ______
less than or = to 1.5
55
when can a neuraxial be performed safely after admin of aspirin or NSAIDs?
anytime. no restrictions
56
when can a neuraxial be performed safely after admin of clopidogrel or ticagrelor?
5-7 days
57
when can a neuraxial be performed safely after admin of prasugrel?
7-10 days
58
when can a neuraxial be performed safely after admin of ticlopidine?
10 days
59
when can a neuraxial be performed safely after admin of cangrelor?
3 hours
60
when can a neuraxial be performed safely after admin of abiciximab?
24-48 hours
61
when can a neuraxial be performed safely after admin of tirofiban or eptifibatide?
4-8 hours
62
with neuraxial anesthesia, lower extremity blood flow is _____ due to the sympathectomy
increased
63
what does neuraxial anesthesia do to the systemic inflammatory response?
decreases, so some anti-inflammatory effects
64
neuraxial anesthesia causes ______ platelet reactivity
decreased
65
what medication typically given before incision is linked to a decreased need for blood transfusion?
TXA
66
what are 3 common doses for TXA? what is the max dose?
10 mg/kg 15 mg/kg 30 mg/kg Max 2.5 G total
67
when does pain from a tourniquet begin?
45 min
68
what is the tourniquet inflation for thigh? arm?
~ 100 mmHg> SBP ~ 50 mmHg> SBP
69
what is the max time of tourniquet inflation?
max 3 hours, typically no more than 2
70
what are 3 things to document with tourniquet use in surgery?
inflation time deflation time total inflated pressure + adjustments
71
when is the risk of ischemia, rhabdo, and mechanical trauma increased in tourniquet use?
after 2 hours
72
what are 4 systemic complications from tourniquet use?
metabolic acidosis hypercarbic hyperkalemia tachycardia/HTN
73
why would a transient increase in minute ventilation be seen after tourniquet release?
d/t transient hypercarbia

Adv Principles A (5 decks)

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