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HA > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Nasal intubation passes tube through which meatus

A

inferior turbinate/ meatus

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2
Q

What is the pharynx responsible for, location

A

Airway patency
obstruction

musclar tube from the back of skull to the border of the cricoid cart

join nasal and oral cavities down to the esophagus

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3
Q

Primary cause of airway obstruction in anesthesia

A

loss of phayngeal muscle tone

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4
Q

Nasopharynx

A

nose to soft pallet

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5
Q

oropharynx

A

soft pallet to epiglottis

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6
Q

Hypopharynx

A

Epiglottis to cricoid cart

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7
Q

Larynx

A

Epiglottis to lower end of cricoid cartilage (6th cervical vertebrae)

Responsible for; Inlet to trachea
Phonation
Airway protection

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8
Q

Unpaired Laryngeal cartilages

A

Thyroid- largest (support soft tissue)
Cricoid
Epiglottis

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9
Q

Paired Laryngeal cartilages

A

Arytenoid
Corniculate
Cuneiform

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10
Q

Where does the vocal ligament attach

A

artenoid cartilage and the thyroid cart at the thyroid notch

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11
Q

Trachea extends, length, shape, closed by, bound to?

A

Extends from inferior cricoid membrane to carina

10 to 15 cm - adult

C-shaped cartilage

Closed posteriorly by longitudinal trachealis muscle

Anteriorly bounded by tracheal rings

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12
Q

Reasons for receiving difficult airway notice

A

difficult mask ventilation
difficult laryngoscopy
difficult intubation or failed intubation

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13
Q

Inter-incisor distance

A

Mouth opening
Prefer > 6 cm (3 finger breadths)

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14
Q

Large tongue name

A

Macroglossia

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15
Q

Edentulousness meaning

A

lack of teeth – lack of teeth = hard to ventilate

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16
Q

Sniffing position

A

Cervical flexion and atlanto-occipital extension
Aligns oral, pharyngeal, and laryngeal axis

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17
Q

sternomental distance

A

Distance between sternal notch and chin

Head in full extension
Mouth closed
>12.5 cm preferred

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18
Q

Thyromental distance

A

Submandibular compliance
Prefer > 6.5 cm (3 finger breadths)
Tip of chin to thyroid notch

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19
Q

Prognathic ability

A

Extension of lower incisors beyond upper incisors
Upper lip bite test

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20
Q

Mallampati Test

A

The patient is seated upright with head neutral
Mouth open
Tongue protruded
No phonation

Visibility of oropharyngeal structures
Class I - IV

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21
Q

Mallampati class I

A

Fauces (arch), pillars (tonsils), entire uvula, and soft palate

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22
Q

Mallampati class ii

A

Fauces, portion of the uvula, and soft palate

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23
Q

Mallampati class iii

A

Base of the uvula and soft palate

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24
Q

Mallampati class iv

A

Only hard palate

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25
Q

BURP

A

External manipulation and backward, upward, rightward pressure

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26
Q

Optimal external laryngeal manipulation (OELM)

A

Move the larynx to align up glottis

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27
Q

Cormack-lehane classification

A

Classification of laryngeal view/ view of the glottis
Grade I-IV

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28
Q

CL- Grade 1

A

Entire full glottis

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29
Q

CL- Grade 2

A

Only the posterior portion of the glottis

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30
Q

CL- Grade 3

A

No part of the glottis and only epiglottis

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31
Q

CL- Grade 4

A

Epiglottis cannot be seen

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32
Q

Criteria associated with difficult mask ventilation (OBESE)

A

Obesity, BMI > 30kg/m2
Beard
Edentulous
Snorer, OSA
Elderly, male Age > 55

Mallampati 3 or 4

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33
Q

Reasons to do an awake intubation

A

Suspected difficult laryngoscopy

Suspected difficult ventilation with face mask/supraglottic airway

Significant increased risk of aspiration

Increased risk of rapid desaturation

Suspected difficult emergency invasive airway

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34
Q

Achalasia

A

Esophageal outflow obstruction d/t inadequate relaxation of the LES
Dilated hypomotile esophagusLES hypertension and reduced peristalsis

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35
Q

LES normal resting tone

A

29 mmHg
> 29 hypertensive

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36
Q

s/s of Achalasia and risk

A

dysphagia (solids/liquids),
regurgitation,
heartburn,
chest pain

RISK;
Aspiration (sleep sitting up)
Esophageal CA

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37
Q

TX for achalasia

A

relieves obstruction… not peristalsis.

Nitrates, CCB, - low dose
Botox, - relax LES
pneumatic dilation, - balloon inflates in the distal esophagus to dilate and inflate.
Heller myotomy, - cutting smm at LES (distal to esoph and fundus of stomach)
per oral endoscopic myotomy (POEM)

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38
Q

Anesthesia Concerns for Achalasia and npo

A

aspiration➔ RSI or awake intubation
POEM – NPO up to 48 hours(decreased peristalsis)
Heller still should be NPO for 24-48 hr

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39
Q

Distal Esophageal Spasm, dx and tx

A

Spastic distal esophagus
Mimics anginal pain
DX; Esophagram-Cork screw or rosary bead appearance
TX: Nitroglycerin, trazodone, and imipramine (antidepressants), and sildenafil (PDI)

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40
Q

Esophageal diverticula tx

A

Esophageal wall outpouching
tx; removal

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41
Q

Esophageal diverticula Locations/ names

A

Pharyngoesophageal (Zenker’s diverticulum)
Mid-esophageal
Epiphrenic (supradiaphragmatic diverticulum)

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42
Q

Esophageal diverticula s/s

A

Bad breath
Dysphagia

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43
Q

Esophageal diverticula anesthesia

A

Aspiration risk
No cricoid pressure
Intubate w/ head elevated
Avoid NGT or OGT- risk perforating

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44
Q

Odynophagia

A

pain w/ swallowing. Hx of esophagitis. Or esophageal ulcers

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45
Q

Globus sensation

A

lump in throat. “psych problem”.

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46
Q

Hiatal hernia

A

Part of the stomachentersthe thoracic cavity through esophagealhiatus (diaphragm)

Not generally repaired

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47
Q

Sliding hiatal hernia

A

GE junction and fundus slideupward

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48
Q

Paraesophagealhernia

A

GE junction doesn’t move
Pouch ofstomach herniates next to the GE junctionthrough esophageal hiatus

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49
Q

Esophageal Tumors location and type

A

Progressive dysphagia and weight loss
Squamous cell- mid esophagus
adenocarcinomas- distal (most common)

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50
Q

Esophageal Tumors s/s

A

Pancytopenia
Dehydration
Lung injury (post-chemo and radiation)
Malnourishment

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51
Q

Esophageal Tumors tx

A

Esophagectomy, chemotherapy, or radiation

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52
Q

GERD

A

Reflux causing esophageal mucosal injury or at extraesophageal sites (and upward)
<29 mmhg usually 13 mmhg

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53
Q

Anti-reflux mechanisms

A

LES,
crural diaphragm- sit where LES is
GE junction location- lower than crural
LES pressure- (gerd = hypotesive)

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54
Q

GE junction/LES incompetence

A

Transient LES relaxation
LES hypotension
Anatomic distortion of GE junction (hernia)

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55
Q

GERD s/s

A

Heartburn
Regurgitation
Dysphagia
Chest pain
chronic cough

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56
Q

GERD complications

A

Esophagitis
Laryngopharyngeal reflux variant (chronic cough)
Recurrent pulmonary aspiration

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57
Q

GERD tx

A

Lifestyle modification- avoid high fat/ acidic food, avoid drinking, peppermint.

PPIs > H2 antagonists

Nissen fundoplication- wrap fundus and illeus to make stronger.

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58
Q

GERD Anesthesia concerns and meds to give pre op

A

Aspiration risk
Cimetidine and ranitidine (works better)
Famotidine (longer duration of action)> cimetidine
PPIs- day or or day before sx.
Sodium citrate + metoclopramide - DM, MO, and pregnant pts

RSI + cricoid pressure

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59
Q

PH of stomach acid

A

2.5

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60
Q

Peptic Ulcer Disease where and s/s

A

Ulcers in the mucosal lining ofstomach or duodenum
Burning epigastric pain- usually w/ worsening ulcers/ with fasting

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61
Q

Primary cause of peptic ulcer disease

A

Helicobacter pylori - protinflammatory cytokines = effect parietal cells = reduce duodenal muscousa bicarb

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62
Q

Gastric ulcer and causes

A

usually in body of the stomach
Form of PUD
NSAIDs – common cause
H. pylori + NSAIDs use

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63
Q

Peptic Ulcer Disease risk factors for death

A

Bleeding
Peritonitis- from perforation
Dehydration
Perforation
Sepsis

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64
Q

Peptic Ulcer diseasepopulation it effects

A

etoh
elderly

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65
Q

Peptic Ulcer disease Complications

A

Bleeding -Mortality 10% to 20%

Perforation- Untreated duodenalulceration- 10% risk, Sudden and severe epigastric pain

Gastric outlet obstruction

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66
Q

Gastric outlet obstruction s/s and anesthesia concerns

A

Acute or slow development
S/S: vomiting, dehydration, andhypochloremicalkalosis

Anesthesia Consideration
Full stomach (RSI), NGT, hydration, IVantisecretory drugs (ex: PPIs)

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67
Q

PEPTIC ULCER DISEASETreatment

A

Antacids,
H2 Receptor Antagonists
PPIs
Prostaglandin Analogues
Cytoprotective agents

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68
Q

H2 Receptor Antagonists

A

Inhibits basal and stimulated HCL secretion
Cimetidine, ranitidine, famotidine, and nizatidine–more potenta and longer duration of action- tx for 4-6 weeks

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69
Q

PPIs

A

Inhibits all phases of gastric acid secretion
Omeprazole, pantoprazole

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70
Q

Prostaglandin Analogues

A

Maintains mucosal integrity
Misoprostol

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71
Q

Cytoprotective agents

A

Creates physicochemical barrier
Sucralfate
peptobismol

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72
Q

Antacids

A

OTC for symptomatic relief of dyspepsia
Aluminum/magnesium hydroxide
Calcium carbonate

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73
Q

Peptic Ulcer DiseaseTreatment for H pylori

A

Triple combination therapy – 14 days
PPI (2 x strength) + 2 ABXs - Clarithromycin and amoxicillin or metronidazole, tetracycline

74
Q

Peptic Ulcer Diseasesurgical Treatment

A

Correcting immediate problem
Hemorrhage, perforation, and obstruction

remove source and fix anatomy, prevent long term complications/ SE.

75
Q

Peptic Ulcer Diseasesurgical Treatment

A

Correcting immediate problem
Hemorrhage, perforation, and obstruction

remove source and fix anatomy, prevent long term complications/ SE.

76
Q

Peptic Ulcer Diseasesurgical Treatment

A

Correcting immediate problem
Hemorrhage, perforation, and obstruction

remove source and fix anatomy, prevent long term complications/ SE.

77
Q

Dumping Syndrome

A

Emptying hyperosmolar gastric contents into proximal small bowel
Release of vasoactive GI hormones(histamin, ang 2, NO, bradykinin)

78
Q

Dumping Syndrome

A

Emptying hyperosmolar gastric contents into proximal small bowel
Release of vasoactive GI hormones(histamin, ang 2, NO, bradykinin)

79
Q

Dumping Syndrome tx

A

Dietary modifications- more glucose or carbs with meal
Octreotide therapy

80
Q

Dumping sydrome late and early s/s

A

Early – 15-30 mins post-prandial
Nausea, epigastric discomfort, diaphoresis, crampy abd pain, diarrhea, tachycardia, palpitations, dizziness or syncope
Late – 1-3 hours post-prandial
Vasomotor symptoms secondary to hypoglycemia d/t excessive insulin release

81
Q

Ulcerative colitis s/s

A

Diarrhea, rectal bleeding, tenesmus, passage of mucous, crampy abdominal pain,anorexia, N/V, fever, and weight loss

82
Q

tenesmus

A

constant urge to go to the bathroom

83
Q

Inflammatory bowel diseaseUlcerative colitis

A

Mucosal disease…. All or most of the colon to rectum
severe- hemm

84
Q

Ulcerative colitis Complications

A

Massive hemorrhage
Toxic megacolon- dilated transverse colon, loss of segments.
Obstruction
Perforation

85
Q

Ulcerative colitis tx

A

Total proctocolectomy- curative
removing colon and rectum.

86
Q

crohn’s diesease

A

Acute or chronic bowel inflammationat terminal ileum/cecal valve- connection of small bowel and large bowel

87
Q

Crohns disease s/s

A

Weightloss,
inflammatorymass,
bowelspasm,
postprandialpain
Malnutrition,
steatorrhea,
stricture formation- narrowing -> obstruction

88
Q

crohn’s diseasecomplications

A

Stricture, obstruction, abscess, or fistula

89
Q

crohn’s disease tx/ sx

A

Small bowel resection d/t fistula or obstruction
Total protocolectomy w/ end ileostomy- not curative

90
Q

Inflammatory bowel diseaseMedical treatment

A

5-Acetylsalicylic acid (5-ASA)- Anti-inflammatory
Glucocorticoids- UC and Crohn’s
ABX – Ciprofloxacin or metronidazole
Azathioprine and 6-mercaptopurine- Purine analogues
Methotrexate and cyclosporine
Immunosuppressive

91
Q

Carcinoid tumors og,secretes

A

Originate from the GI tract
<25% in lung tissue
Secrete GI peptides and/or vasoactive substances
Insulin, histamine, serotonin

92
Q

foregut

A

Thymus,
esophagus
lung
stomach
duodenum
pancreas

93
Q

Midgut

A

appendix
ileum
ascending colon

94
Q

Midgut

A

appendix
ileum
ascending colon

95
Q

hindgut

A

distal large bowel
rectum

96
Q

Seretonin secreted location

A

high in midgut
low in forgut and rare in hindgut

97
Q

Carcinoid sydrome location

A

atypical in foregut
typical in midgut
rare in hindgut

98
Q

CARCINOID TUMORS WITHOUT CARCINOIDSyndrome

A

found with appendecomy- may or may not remove.

99
Q

CARCINOID TUMORS W/ SYSTEMIC SYMPTOMS D/T SECRETED PRODUCTS

A

GI peptides and /or vasoactive substances- found in midgut over the foregut

Midgut carcinoids (produce more mediators) > foregut carcinoids

Non-producing tumors- present as mass or bowel obstruction.

100
Q

Small intestine carcinoid presentation w/ %

A

abd pain (51%), intestinal obstruction (31%), tumor (17%), GI bleed (11%)

101
Q

Rectrum carcinoid presentation

A

Bleeding (39%), constipation (17%), Diarrhea (17%)

102
Q

Bronchus Carcinoid presentation

A

Asymtomatic (31%)

103
Q

Carcinoid tumorscarcinoid syndrome s/s

A

Serotonin and vasoactive substances released in systemic circulation
Serotonin- diarrhea
Histamine- responsible for puriting flushing
Both for bronchoconstriction

Signs and symptoms
Flushing, diarrhea, hypotension,HTN, bronchoconstriction, wheezing

104
Q

Carcinoid tumorsCarcinoid crisis

A

Intense flushing, diarrhea, abdominal pain, tachycardia, HTN or hypotension
Fatalw/o treatment

Spontaneous or provoked by stress, chemotherapy, or biopsy

105
Q

Drugs that may provoke mediator release

A

sux, mivacurium, atracurium, tubocurarine, epi, ne , dop , isoprterenol, thiopental

106
Q

Carcinoid tumorstreatment

A

Serotonin blockers
Histamine blockers
Somatostatin analogues (>80% patients)
Octreotide, histamine blockers, and ipratropium

107
Q

Serotonin blockers

A

5HT1/2 - diarrhea
5HT3(ondansetron) – diarrhea and nausea;occasionally relieve flushing

108
Q

Histamine blockers

A

prevent Flushing

109
Q

Somatostatin analogues

A

(>80% patients)
Prevents crisis development
Lanreotide (most common, SUBq x 4wks)
Octreotide (24-28 before sx)

110
Q

Octreotide, histamine blockers, and ipratropiumprevent…..

A

prevent Bronchoconstriction

111
Q

Autodigestion prevented by protective mechanisms for pancrease

A

Packaging of proteases in precursor form
Synthesis of protease inhibitors
Low intra-pancreatic concentration of calcium

112
Q

Causes of pancreatitis

A

Gallstones and ETOH abuse - 60% to 80%
AIDS, hyperparathyroidism, and trauma

113
Q

Acute Pancreatitissigns and symptoms

A

Mid-epigastric pain,N/V, abd distention (ileus)
Dyspnea, low-gradefever, tachycardia, hypotension
Shock d/t hypovolemia
Increased serum amylase and lipase

114
Q

Acute pancreatitisranson criteria

A

> 55 years
WBC count > 16,000 cells/mm3
BUN >16 mmol/L
Aspartate transaminase > 250 units/L
Arterial PaO2 < 60 mmHg
Fluid deficit > 6 L
Blood glucose > 200 mg/dL w/oahistoryof DM
Lactate dehydrogenase > 350 IU/L
Corrected calciumconcentration < 8 mg/dL
Fall in Hct >10%
Metabolicacidosis with a base deficit > 4 mmol/L

Mortality r/t number of criteria present
0-2 criteria <5% mortality
3-4 criteria 20% mortality
5-6 criteria 40% mortality
7-8 criteria 100% mortality

115
Q

Acute pancreatitiscomplications

A

DIC
ARDS
SHOCK
Renal Failure
Hypotension
Arterial hypoxemia
infection of the necrotic panc material or abscess formation
25% of pts experience complications

116
Q

Acute pancreatitisTreatment

A

Aggressive IVF administration
Colloid replacement
NPO
Enteral/TPN
NGT suction
Pain management
Removal of gallstones

117
Q

Chronic pancreatitis how and causes

A

Persistent inflammation w/ irreversible damage
Loss of exocrine and endocrine function

Chronic ETOH abuse, CF, and hyperparathyroidism

118
Q

Signs and symptoms of Chronic pancreatitis

A

Post-prandial, epigastric pain
Thin, emaciated,steatorrhea
DM

119
Q

Treatment of Chronic pancreatitis

A

Management of pain,DM, and malabsorption

120
Q

Gi bleedingUpper acute s/s

A

Hypotension and tachycardia w/ blood loss >25% of total blood volume
Hct - normal
Anemia
Orthostatic hypotension – Hct <30%
BUN >40 mg/dL

121
Q

Causes of Gi bleedingUpper acute

A

Esophageal variceal bleeding, malignancy

122
Q

Gi bleedingUpper tx

A

Upper endoscopy
Active bleeding
——Endoscopic coagulation(burn, clips)

123
Q

Gi bleedingUpper Anesthetic Considerations

A

Aspiration risk – ETT… RSI

124
Q

GI bleedingLower and causes

A

Abrupt passage of bright red blood and clots via the rectum
Diverticulosis, tumors, ischemic colitis, infectious colitis

125
Q

GI bleedingLower tx

A

Sigmoidoscopy/colonoscopy
Angiography and embolic therapy
Surgery

126
Q

Part of properly assessing Mallampati includes:

A
  • NO phonation
127
Q
  1. What is the LEAST LIKELY cause of dental injury during anesthesia?
A
  • Aggressive mask ventilation
128
Q
  1. Prognathic ability is a measurement of:
A
  • The extension of the lower incisors beyond the upper incisors.
  • The ability of the lower incisors to bite the upper lip.
129
Q
  1. What information regarding the patient’s anesthetic history would indicate a potential airway concern?
A
  • Report of cut lips and broken teeth.
  • Report of excessive sore throat.
130
Q
  1. Which airway assessment finding is more predictive of difficult intubation than a high BMI>
A
  • Cervical traction.
131
Q
  1. A 34-year-old patient diagnosed with acute pancreatitis is scheduled for surgery in the morning. The patient has the following laboratory values:
    WBC: 18,000
    Platelets: 150,000
    AST: 376
    BUN: 22
    What is the patient’s risk for mortality?
A
  • 40%
132
Q
  1. An adenocarcinoma esophageal tumor is located at:
A
  • At the mid-esophagus
133
Q
  1. Which medication will induce remission in patient with Ulcerative Colitis and Crohn’s disease?
A
  • 5-Acetylsalicylic acid
134
Q
  1. For patients with a history of esophageal diverticula, what are the anesthetic concerns?
A
  • Increased risk of aspiration
  • Apply cortical pressure during induction.
135
Q

. In a patent with carcinoid tumors, how early should octreotide be administered to prevent crisis during surgery:

A
  • 24 hours!
136
Q

1.Which statement BEST describes acromegaly?

A
  • Decreased amount of neuromuscular blockers is recommended.
137
Q

2.Which anesthetic plan is ideal for a patient with systemic lupus erythematosus?

A
  • Order pre-operative CBC and ECG.
138
Q

3.Preoperative findings of Duchenne muscular dystrophy include:

A
  • Kyphoscoliosis
139
Q

4.Signs and symptoms of scleroderma include:

A

Small bowel hypomotility.
* Decreased pulmonary compliance.

140
Q

5.Anesthetic considerations for syndrome of inappropriate anti-diuretic hormone (SIADH) include:

A
  • Measurement of urine osmolality.
  • Titrating intravenous fluid.
141
Q

6.A diagnosis of Grave’s disease is consistent with:

A
  • Weight loss.
142
Q

7.In patients with carcinoid tumors, how early should octreotide be administered to prevent crisis during surgery:

A
  • 24 hours.
143
Q

8.All of the anesthetic considerations are indicated in a patient with hyperparathyroidism EXCEPT:

A
  • Administration of 40 mg of rocuronium.
    o Pre-operative ECG.
    o Avoiding the use of midazolam pre-operatively.
    o IV fluid administration.
144
Q

9.Which statement BEST characterizes myasthenia gravis?

A
  • Fatiguability of skeletal muscle with repetitive use.
145
Q

10.What are treatments indicated for a patient with rheumatoid arthritis?

A
  • Corticosteroids and DMARDS.
146
Q

Scleroderma

A

Inflammation and autoimmunity
Vascular injury with vascular obliteration
Tissue fibrosis and organ sclerosis

147
Q

Xerostomia

A

dry mouth

148
Q

CREST syndrome

s/s of scleroderma

A

calcinosis
Raynauds
Esophageal dysfunction
sclerodactyly- thick and tight skin
Telangiectasis- cap dilation

Skin: Taut skin
MS: Limited mobility/contractures, skeletal muscle myopathy
Nervous System: Nerve compression
CV: Systemic and pulmonary HTN, dysrhythmias, vasospasm in small arteries of fingers, CHF
Pulmonary: Diffuse interstitial pulmonary fibrosis, decreased pulmonary compliance
Renal: Decreased renal blood flow and systemic HTN
GI: Xerostomia, poor dentition, fibrosis of GI tract, reflux

149
Q

Scleroderma Treatment

A

Alleviating symptoms…
ACE-I

150
Q

SclerodermaAnesthesia Management

A

Airway: Mandibular motion, small mouth opening, neck ROM, oral bleeding

hard stick

Decreased pulmonary compliance and reserve, avoid increasing PVR

GI: Aspiration
Eyes: corneal abrasions
Regional anesthesia
Keep warm
VTE prophylaxis
Positioning
Pulse ox difficulties

151
Q

Pseudohypertrophy Muscular DystrophyDuchenne Muscular Dystrophy (DMD)
what and who

A

Mutation in the dystrophin gene
Fatty infiltration =pseudohypertrophic
2-5 y/o boys

152
Q

Duchenne Muscular Dystrophy (DMD) initial s/s

A

waddling gait, frequent falling, difficulty climbing stairs

153
Q

Pseudohypertrophy Muscular DystrophyS/S

A

CNS: Intellectual disability
MS: Kyphoscoliosis, skeletal muscle atrophy, serum CK 20-100x normal
CV: Sinus tachycardia, cardiomyopathy, EKG abnormalities
Pulmonary: weakened respiratory muscles and cough, OSA
GI: Hypomotility, gastroparesis

154
Q

Pseudohypertrophy Muscular DystrophyAnesthesia Management

A

Airway: weak laryngeal reflexes and cough
Pulmonary: weakened muscles
CV: Pre-op EKG and/or echo based on the severity
GI: Delayed gastric emptying
Avoid succinylcholine
Pharyngeal and respiratory muscle weakness
Rhabdomyolysis
MH – increased incidence; Dantrolene
Regional > GA

155
Q

Myasthenia Gravis

A

Chronic autoimmune disorder
NMJ - Decreased functional post-synaptic AChreceptors

Muscle weakness w/ rapid exhaustion of voluntary muscles

Partial recovery with rest
ACh receptor-bindingantibodies andthymusabnormalities

156
Q

Myasthenia GravisS/S

A

Ptosis, diplopia, and dysphagia
Dysarthria and difficulty handling saliva
Isolated respiratory failure
Arm, leg, or trunk muscle weakness
Myocarditis
Autoimmune diseases associated
-RA, SLE, pernicious anemia, hyperthyroidism

157
Q

Myasthenic crisis w/ s&s

A

Drug resistance or insufficient drug therapy
S/S: severe muscle weakness and respiratory failure

158
Q

Cholinergic crisis w/ s&s

A

Excessive anticholinesterase treatment
S/S: muscarinic side effects – profound muscle weakness, salivation, miosis, bradycardia, diarrhea, abdominal pain

159
Q

Edrophonium/Tensilon Test

A

1-2 mg IVP
Improves myasthenic crisis, makes cholinergic crisis worse

160
Q

Myasthenia GravisTreatment

A

Anticholinesterases
-First line of treatment
-Pyridostigmine > neostigmine

Thymectomy
-Induces remission
-Reduced use of immunosuppressives
-Reduces ACh receptor antibody levels
-Full benefit delayed

Immunosuppression
-Corticosteroids, azathioprine, cyclosporine,mycophenolate

Immunotherapy
-Plasmapheresis
–Removes antibodies from circulation
-Immunoglobulin
–Temporary effect

161
Q

Myasthenia GravisAnesthesia Management

A

Aspiration risk
Weakened pulmonary effort
Marked sensitivity to nondepolarizing muscle relaxants
Resistance to succinylcholine
Intermediate-acting muscle relaxant
Intubate without NMBD

162
Q

Osteoarthritis complications and OG

A

Degenerative process affecting articular cartilage
Minimal inflammation
Joint trauma
Pain present with motion,relieved by rest
Weight-bearing and distal interphalangeal joints
Heberden nodes
Degenerative disease – vertebral bodies and intervertebral disks
Protrusion of the nucleus pulposus
Compression of nerve roots
Middle to lower c-spine andl-spine

163
Q

OsteoarthritisTreatment

A

PT and exercise
Maintaining muscle function
Pain relief
Joint replacement surgery

164
Q

OsteoarthritisAnesthesia Management

A

Airway
Limited ROM

165
Q

Rheumatoid Arthritis

A

Autoimmune-mediated, systemic inflammatory disease
Proximal interphalangeal and metacarpophalangeal joints
Rheumatoid nodules at pressure points
Rheumatoid factor
Single or multiple joints
Painful synovial inflammation, swelling, and increased fluid
Morning stiffness
Symmetrical distribution of several joints
Fusiform swelling
Synovitis of temporomandibular joint
Affects nearly all joints
Except t-spine and lumbosacral spine

166
Q

Rheumatoid ArthritisS/S Atlantoaxial subluxation

A

Atlantoaxial subluxation
Odontoid process protrudes into the foramen magnum
Pressure on the spinal cord or impairs vertebral artery blood flow

167
Q

Rheumatoid ArthritisS/S Cricoarytenoid arthritis

A

Acute – hoarseness, dyspnea, and stridor w/ tenderness over the larynx; swelling and redness of arytenoids
Chronic – asymptomatic or variable degrees of hoarseness, dyspnea, and upper airway obstruction

168
Q

Rheumatoid ArthritisS/S

A

Atlantoaxial subluxation
Cricoarytenoid arthritis
Osteoporosis
NM: Weakened skeletal muscles
-Peripheral neuropathies
CV: Pericarditis, accelerated coronary atherosclerosis
Pulmonary: Restrictive lung changes
Hematology: anemia, neutropenia, elevated platelets
Keratoconjunctivitis sicca and xerostomia

169
Q

Rheumatoid ArthritisTreatment

A

NSAIDS
Decrease joint swelling, relieve stiffness, provide analgesia
COX-1 inhibitors, COX-2 inhibitors

Corticosteroids
Decrease joint swelling, pain, and morning stiffness

DMARDs (Disease-modifying antirheumatic drugs)- methotrexate

Tumor necrosis factor (TNF-alpha) inhibitors and interleukin(IL-1) inhibitors

Surgery

170
Q

Rheumatoid ArthritisAnesthesia Management

A

Airway
-Atlantoaxial subluxation
-TMJ limitation
-Cricoarytenoid joints
Severe rheumatoid lung disease
Protect eyes
Stress dose

171
Q

Systemic Lupus Erythematosus

A

Multisystem chronic inflammatory
Antinuclear antibody production

172
Q

Systemic Lupus Erythematosus Typical manifestations:

A

Antinuclear antibodies
Characteristic malarrash
Thrombocytopenia
Serositis
Nephritis

173
Q

Systemic Lupus ErythematosusS/S

A

Polyarthritis and dermatitis
Symmetrical arthritis
-No spinal involvement
-Avascular necrosis of femoral head or condyle
CNS: Cognitive dysfunction, psychological changes
CV: Pericarditis, coronary atherosclerosis, Raynaud’s
Pulmonary: Lupus pneumonia, restrictive lung disease, vanishing lung syndrome
Renal: Glomerulonephritis, decreased GFR
GI/Liver: ABD pain, pancreatitis, elevated liver enzymes
NM: Skeletal muscle weakness
Hematology: Thromboembolism, thrombocytopenia, hemolytic anemia,
Skin: Butterfly-shaped malar rash, discoid lesions, alopecia

174
Q

Systemic Lupus ErythematosusTreatment

A

NSAIDs or ASA
Anti-malarial; Hydroxychloroquine and quinacrine
Corticosteroids
Immunosuppressants; Methotrexate, azathioprine

175
Q

Systemic Lupus ErythematosusAnesthesia Management

A

Based upon manifestations and organ dysfunction
Airway: recurrent laryngeal nerve palsy, cricoarytenoid arthritis
Stress dose of corticosteroids

176
Q

Malignant Hyperthermia

A

Hypermetabolic syndrome
Genetic mutation
-Ryanodine receptor - RYR1 gene
-Dihydropyridine receptor
Exposure to inhaled VA and succinylcholine
50% mortality
Family history

Uncontrolled elevation of sarcoplasmic calcium
Sustained activation of muscle contraction
Rhabdomyolysis

177
Q

Malignant HyperthermiaS/S Early

A

hypercarbia
tachypnea (if respiration is spontaneous
sinus tachycardia
masseter muscle spasm
generalized muscle rigidity
Peaked T waves
metabolic and respiratory acidosis

178
Q

Malignant HyperthermiaS/S Late

A

Hyperthermia
cola-colored urine/ rhabdo
elevated CPK
cardiac dysrhythmia
acute renal failure
cardiovascular collapse
DIC.

179
Q

Malignant HyperthermiaTreatment

A

D/C all triggering gas/drugs
Hyperventilate with 100% O2 at 10 L/min
Change breathing circuit and soda lime
Dantrolene; 20 mg + 3 G mannitol, Mix with 60 mL sterile water
-Initial dose 2.5 mg/kg
-Max upper limit 10 mg/kg

Treat arrythmias
Monitor urine output

180
Q

Malignant HyperthermiaPost-Op

A

Transfer to ICU 24-48 hours
Report to MH registry
MH testing for pt and family members
-Muscle biopsy contracture testing
–Halothane plus caffeine contracture test

HA (15 decks)

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