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Nur 943 OB > FINAL 2 > Flashcards

FINAL 2 Flashcards

1
Q

Lateral and rotational deformity of the thoracolumbar spine

A

Scoliosis

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2
Q

Scoliosis: Spinous processes rotate toward the _____ side of the curve

A

Concave

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3
Q

Scoliosis: Ribs on convex side push ______ (gibbous deformity) while ribs on the concave side push _____

A

posteriorly

anteriorly

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4
Q

Scoliosis may have _____ (humpback) and _____(bent backwards).

A

Kyphosis

Lordosis

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5
Q

Scoliosis is measured by the ____ angle, where angle of the curve (____ surface of the top vertebra to ____surface of the bottom vertebra is measured using perpendicular lines from _____points to _____of the curve

A 
Cobb
Upper
Lower
end
center
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6
Q

The angle is formed by the _______

A

intersection

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7
Q 
Angle of the Curve and significance
<10
>25
>40
>65
>100
>120
A

<10=Normal
>25= Echo shows evidence of increased PAP
>40=Need for Surgical Intervention
>65=Restrictive Lung Disease
>100=Symptomatic Lung Disease, Dyspnea on Exertion
>120=Alveolar Hypoventilation

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8
Q

Which orthopedic surgical corrections have a high anesthetic risk for respiratory complications and vent support, with high expected blood loss? According to that dumbass chart on slide 5-6

A

Cerebral Palsy
DMD
Spinal muscular atrophy
and infantile < 3 years

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9
Q

What preoperative test should be performed prior to Scoliosis Surgery?

A 
Chest Xray
ECG
Echo
PFTs
Coags
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10
Q

Scoliosis is listed among the highest risk for pediatric surgeries. This is due to

A

Hypotension and CV collapse d/t high blood loss

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11
Q

Other risk factors associated with Scoliosis surgery

A 
Anaphylaxis
Anesthetic overdose
Pneumothorax
Hemothorax
Impaired venous return from prone positioning
Surgical manipulation
VAE
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12
Q 
She says know these vertebral arteries  From top to bottom on the slide...
=
=
=------A
=------B
=
=
=------C
=
=\_\_\_D
=
=
=
A

Vertebral Artery
Cervical Radicular Artery
Thoracic Radicular Artery (T7)
Radicularis Magna (Artery of Adamkiwicz) (L1)

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13
Q

What monitors cortical and subcortical responses to peripheral nerve stimulation and compares it to a baseline value?

A

SSEPs

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14
Q

SSEPs monitor the ____ columns of the spinal cord

A

Dorsal (monitors sensory, not motor)

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15
Q

Things that effect SSEPs (3)

A

Anesthesia
BP
Temp

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16
Q

Inhalational agents effect motor evoked potentials _____ SSEPs.

A

greater than

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17
Q

Doses < _____MAC for Sevo and Des have minimal effect on SSEPs

A

<1.5 Mac

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18
Q

N2O potentiates volitiles and ___ amplitude of SSEPs by itself

A

decreases

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19
Q

IV agents have _______ effect on SSEPS

A

little

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20
Q

Maintain ETCO2 ______, Map _____ and _____thermia during SSEPS

A

All normal
ETCO2 35-45mmHg
MAP > 60mmHg
Normothermia

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21
Q

With motor evoked potentials keep MAP ___

A

> 65 mmHg

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22
Q

During Motor Evoked Potentials, use _____ for maintenance anestheisa

A

Propofol and Remi Gtts (TIVA)

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23
Q

Hypotension during Scoliosis surgery…assume it is due to

A

Blood loss…until proven otherwise

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24
Q

Some potential intraop complications during scoliosis surgery

A

ETT malposition- d/t prone positioning
Altered pulm compliance- d/t prone positioning
Bleeding
Excessive Heat loss
Neurologic injuries- d/t positioning and surgery
electrolyte abnormalities

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25
Q

Static Encephalopathy defined as a nonprogressive posture and movement disorder with poor muscle control, weakness, and increased muscle tone.

A

Cerebral Palsy

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26
Q

Cerebral Palsy is due to

A

Injury or abnormal development of immature brain

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27
Q

Cerebral Palsy is a defined as a posture and movement disorder with (3 characteristics)

A

poor muscle control
weakness
Increased muscle tone

28
Q 
Cerebral Palsy paresis types
Single limb=
Both limbs on same side=
Both lower limbs=
3 limbs=
All 4 limbs=
A 
Single limb=monoparesis
Both limbs on same side=hemiparesis
Both lower limbs=diparesis
3 limbs=triparesis
All 4 limbs=tetraparesis, or quadraparesis
29
Q

Motor deficits of cerebral palsy may manifest as (3 things)

A

Hypotonia
Spasticity
Extrapyramidal features like choreoathetoid/dystonic movements or ataxia.

30
Q 
Functional Capacity Classification for Cerebral Palsy
Class 1
Class 2
Class 3
Class 4
A

Class 1- No limitation of activity
Class 2- Slight to moderate limitation
Class 3- Moderate to great limitation
Class 4- No useful physical activity

31
Q

4 Classification systems for Cerebral Palsy

A

Physiology (type of muscle tone)
Topography (Area affected, like mono or quadriplegia)
Etiology (like prenatal, perinatal or postnatal)
Functional Capacity (Type 1,2,3,4)

32
Q

Comorbidities with CP and anesthetic concerns (3)

A

Pulmonary- frequent respiratory infections
GI- Gerd- prone to aspiration
Neurologic- SCZ disorders, so avoid etomidate, ketamine, methohexital, EMLA, normeperidine.

33
Q

CP: These patients are often on baclofen or dantrolene for spasicity, should you discontinue it?

A

nope, may need a decreased dose of NMBAs

34
Q

CP: Can you give these patients Succs?

A

Yup- b/c these muscles are not denervated

35
Q

CP: Avoid _______ in presence of VP shunt

A

caudal/epidural

36
Q

CP: can these patients communicate pain

A

may not

37
Q

This is a dwarfing syndrome that manifests as bone fragility and risk for multiple fractures

A

Osteogenesis Imperfecta (Mr. Glass from “unbreakable”)

38
Q

4 types of Osteogenesis Imperfecta

A

Type 1- mildest form
Type 2 - most severe form (lethal)
Type 3- Progressively deforming form
Type 4- mild to moderate bone fragility

39
Q

Main anesthetic consideration with Osteogenesis Inperfecta

A

Handle Gently

40
Q

What is the most common progressive muscular dystrophy?

A

DMD

41
Q

DMD have a waddling gait and ______ _______ (location and type of spinal curvature).

A

Lumbar Lordosis

42
Q

DMD Pts have difficulty climbing _____

A

stairs

43
Q

Avoid ____ with DMD d/t risk of hyperkalemia

A

Sux

44
Q

DMD have _____ and _____ compromise

A

respiratory and CV

45
Q

DMD have ______ of the tongue, leading to difficult intubations

A

hypertrophy

46
Q

DMD have ____ blood loss during surgery

A

greater

47
Q

NMBAs have ____ onset and ____duration of action with DMD patients.

A

slow

prolonged

48
Q

____ is contraindicated with DMD d/t hyperkalemia, muscle rigidity rhabdomyolysis, myoglobinuria, arrhythmias and cardiac arrest.

A

Succs

49
Q

DMD, best to ____ inhalational agents, d/t association with ____

A

avoid

MH

50
Q

Cystic Fibrosis is a autosomal _______ disorder

A

recessive

51
Q

What is the most common life-limiting inherited disorder among Caucasians?

A

Cystic Fibrosis

52
Q

Patho of Cystic Fibrosis

A

Disruption of electrolyte transport in epithelial cells of sweat glands, airways, pancreatic ducts, intestine, biliary tree and vas deferens.

53
Q

Sx of Cystic Fibrosis

A

Increased sweat chloride concentraiton (>60mEq/L) viscous mucus production, lung disease, intestinal obstruction, pancreatic insufficiency, biliary cirrhosis, and congenital absence of vas deferens.

54
Q

Normal sweat chloride levels =

Dx for Cystic Fibrosis =

A 
Normal = 40mEq/L
CF= > 60 mEq/L
55
Q

What is the most common cause of death and morbidity for CF patients?

A

Pulmonary disease

56
Q

CF: enhanced absorption of ____ in the airway epithelium and failure to secrete ____ and ____

A

Na+

Cl- and fluid

57
Q

CF: ______ leads to thickening of mucus, inflammation and infection

A

dehydration

58
Q

CF: early signs of pulmonary dysfunction
____ in max expiatory flow rates at low lung volumes
___ in ratio of RV to TLC

A

Decreased

Increased

59
Q

CF: Neonatal surgical indications (Hint* all GI related)

A

Meconium ileus
Meconium peritonitis
Intestinal Atresia

60
Q

CF: Children/Teenager surgical indications (hint ENT and IV)

A

Nasal polypectomy
IV access
ENT surgery

61
Q

CF: Adult surgical indications

A

Esophageal Varices
Recurrent pneumothorax
Cholecystecomy
Liver or Lung transplant

62
Q

CF anesthetic management. Schedule surgery _____

A

later in the day. allows pt to be up moving to loosen secretions

63
Q

CF: avoid _____ventilation

A

hyper

64
Q

Avoid this induction agent with CF

A

Ketamine- due to increased secretions

65
Q

____ and ______ anesthetic gases with CF

A

heat and humidify

66
Q

Disadvantage of LMA in CF

A

inability to suction secretions

risk of laryngospasm and aspiration

Nur 943 OB (11 decks)

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