Final_Skin & Musculoskeletal Dx

Question 1

MS - anesthetic management

Answer 1

• tight temperature control (normothermia)

- Avoid: spinal, Sux

Question 2

EB - anesthetic management

Answer 2

• Avoid skin trauma/mucous membranes
• Corticosteroids if on long-term management
• Bullae formation from: Tape, BP cuff, Tourniquets, Adhesives, ECG leads, Scrubbing skin with alcohol
• Pad EVERYTHING
• Sheepskin pad
• Silicone gel pillow
• IV, A-line suturing
• Minimize airway instrumentation (Difficult intubation possible)
• Spinal/epidural OK

Question 3

EB - ruptured bullae tx

Answer 3

epi-soaked gauze

Question 4

CREST Syndrome - associated with?

Answer 4

Scleroderma
C:calcinosis in skin
R: raynauds
E: esophageal dysfxn
S: Sclerodactyly (thickening/tightening of skin on fingers/hands)
T: Telangiectasis (dilation of capillaries causing red marks on surface of skin)

Question 5

Scleroderma - anesthetic implications

Answer 5

• Difficult airway?
• IV access may be difficult
• Cardiac evaluation
• Pulmonary evaluation
• Risk for aspiration
• Degree of renal dysfunction
• Minimize peripheral vasoconstriction

Question 6

Muscular dystrophy

Answer 6

• Group of hereditary diseases
• Painless degeneration and atrophy of skeletal muscle fibers
• Progressive, symmetrical weakness and wasting
• No skeletal muscle denervation
• Sensation and reflexes are intact

Question 7

DMD - anesthetic implications

Answer 7

Sux C/I

-have dantrolene available

Question 8

Myotonic Dystrophy

Answer 8

aka Steinert Disease

-avoid Sux, etomidate

Question 9

Mitochondrial dystrophies

Answer 9

avoid propofol based anesthetic techniques

Question 10

Myasthenia Gravis

Answer 10

• Most common disease affecting neuromuscular junction

- chronic autoimmune disorder caused by decrease in functional acetylcholine receptors at neuromuscular jxn

Question 11

Myasthenia Gravis: S/S

Answer 11

Hallmark: weakness + rapid exhaustion of voluntary muscle strength with repetitive use followed by partial recovery with rest

Question 12

Most vulnerable muscles (myasthenia gravis)

Answer 12

skeletel muscles innervated by cranial nerves (ocular, pharyngeal, laryngeal)
-ptosis, diplopia, dysphagia

Question 13

Anesthetic Management of MG

Answer 13

Regional/LA
If GA: usually need GETA
Pharyngeal/laryngeal muscle weakness
*resistant to sux
*sensitive to NDNMR

Question 14

MG: majority of morbidity/mortality d/t

Answer 14

swallowing + respiratory muscle dysfunction

Question 15

Most common joint disease in U.S.

Answer 15

osteoarthritis

Question 16

Osteoarthritis

Answer 16

degenerative process that affects cartilage
-pathogenesis: r/t joint trauma
-stiff, pain = common
Hips/knees often affected

Question 17

Kyphoscoliosis s/s

Answer 17

Depends on curvature (>40% = severe)

*restrictive lung dx, pHTN (leading to Cor pulmonale)

Question 18

Kyphoscoliosis pre-op

Answer 18

• baseline ET
• recent URI?
• GERD? (aspiration risk)

Question 19

Kyphoscoliosis - anesthetic management

Answer 19

• potential for: large blood loss, surgically induced spinal cord damage, intra-op wake-up test
• caution with HOTN
• special attention to: I+Os, pain management

Question 20

RA

Answer 20

• immune system attacks lining of joints
• W>M
• exacerbations + remissions
• Rheumatoid factor present 90% of time

Question 21

RA - late physical findings (hands)

Answer 21

• Boutonniere deformity (thumb)
• Ulnar deviation of metacarpophalangeal joints
• Swan-neck deformity of fingers

Question 22

Hallmark symptom of RA

Answer 22

Morning stiffness

Question 23

Severe RA

Answer 23

Nearly every joint affected except thoracic + lumbar

Question 24

+ cervical spine involvement in RA s/s

Answer 24

may have pressure on spinal cord

-parasthesias, weakness

Question 25

RA Tx

Answer 25

NSAIDs
Corticosteroids
DMARDS
◦Disease-Modifying Antirheumatic Drugs
◦Slow or halt the disease
◦Methotrexate
Cytokines 
◦Tumor necrosis factor (TNF)-α
◦Interleukin (IL)-1
Gold

Question 26

SLE

Answer 26

Multisystem chronic inflammatory disease characterized by antinuclear antibody production
-stress/Rx implicated at onset (surgery, pregnancy, infxn—Procainamide, hydralazine, isoniazid)

Question 27

SLE Tx

Answer 27

ASA, NSAIDs, Antimalarial drugs, corticosteroids

Question 28

SLE anesthetic management

Answer 28

Geared toward comorbid conditions