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AFN Assessment > Highlights from Dr. Gegel's MS Lecture > Flashcards

Highlights from Dr. Gegel's MS Lecture Flashcards

1
Q

Primary presentation of RA

A

Pain and disability

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2
Q

Role of cytokines in RA

A

TNF, IL-1, IL-6 are released and accelerates the inflammatory cascade

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3
Q

Role of B lymphocytes in RA

A

Produce antibodies (Rheumatoid factor) that enhances cytokine production

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4
Q

RA and C-spine relationship

A

The upper cervical spine is affected in 85% of patients which can result in Atlanto-axial subluxation and spinal cord compression

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5
Q

NSAIDs for RA

A

Tx of inflammation

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6
Q

Corticosteroids for RA

A

Blunt the immune response, but unable to slow the progression

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7
Q

What type of medications are used to slow down the progression of RA?

A

DMARDS

Disease-modifying antirheumatic drugs

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8
Q

What type of cells does DMARDS target

A

B and T cells

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9
Q

Give an example of a DMARD

A

Methotrexate

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10
Q

What labs should be checked preoperatively for a pt taking Methotrexate?

A

CBC and LFTs

Methotrexate (DMARD) is associated with pancytopenia and decreased liver fxn

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11
Q

What are examples of TNF inhibitors used with RA?

A

Infliximab (Remicade)
Adalimumab (Humira)
Certolizumad pegol (Cimzia)

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12
Q

The inhibition of TNF is a achieved by?

A

Monoclonal antibodies

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13
Q

What is another option for RA tx?

A

Fusion protein such as Etanercept (Enbrel)

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14
Q

T/F: Degree of cord compression may not correlate with pt’s symptoms.

A

True

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15
Q

What type of radiograph is appropriate for pt’s with RA?

A

C-spine (lateral flexion and extension)

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16
Q

Which type of anesthesia can be challenging for pts with RA?

A

Regional anesthesia

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17
Q

What MS d/o is associated with “bamboo spine”?

A

Ankylosing Spondylitis

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18
Q

What cardiac change can you expect in 40% of Anky Spond pts?

A

Aortic Valve Insufficiency

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19
Q

What are renal effects seen with systemic lupus erythematosus?

A

Dialysis and renal transplant in 20% of pts

Renal involvement suggests poor prognosis

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20
Q

Medications utilized in drug-induced lupus disease?

A

ACEI
Hydralazine
Procainamide
Methyldopa
Isoniazid (INH)

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21
Q

What type of consult could you consider ordering for SLE (lupus) diagnostic testing?

A

Cardiology consult

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22
Q

T/F: Acute renal failure occurs in about >50% of systemic sclerosis pts.

A

True.

ARF occurs in about 5% of pts characterized by fulminant acute-onset kidney injury, severe hypertension, and normal sediment.

Steroid therapy and pregnancy are associated w/ higher incidence of AFR

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23
Q

Sclerosis lab exams are based on what?

A

H&P and preop medications

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24
Q

Anesthesia implications of Sclerosis

A

Keep patient warm
Difficult IV access
Potential for airway difficulty
A-line placement carries higher risk d/t poor circ
VTE is 3x more common

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25
Q

List airway considerations regarding sclerosis anesthetic implications

A

Thorough airway exam
Potential airway difficulty
Consider video laryngoscope or FOB
Inc risk asp -> GI prophylaxis

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26
Q

What is the leading cause of lower extremity disability?

A

Osteoarthritis

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27
Q

Review OA &RA skeleton

A
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28
Q

With Kyphoscoliosis ________ cases are iodiopathic >80%

A

Most

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29
Q

What test measures to severity of Kyphoscoliosis?

A

Cobb angle

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30
Q

Cobb angle scale

A

15-20 degrees: no specific treatment
20-40 degrees: back brace
40-50 degrees of more: May require corrective sx (spinal fusion)

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31
Q

Airway consideration for pts with Kyphoscoliosis

A

Plan for difficult intubation!

Bring friends to the party!

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32
Q

What is a ependymoma?

A

A tumor from the ependyma (CNS), neurofibromatosis type II

Pediatric=intercranial, common in 4th ventricle
Adult=Spinal

Syringomyelia is caused by ependymoma

33
Q

The ataxia of ______ ataxia results from the degeneration of nervous tissue in the ________, through connections with the _______, that leads to nerve cells to loose ________. (Kyphoscoliosis)

A

Friedreich’s; spinal cord, cerebellum, myelin sheath

34
Q

What are the 3 types of connective tissue d/0?

A

Osteogenesis Imperfecta (OI)
Marfan Syndrome
Ehlers- Danlos Syndrome (EDS)

35
Q

2 types of Osteogensis Imperfecta

A

Ol congenita
Ol tarda

36
Q

Description of Ol congenita

A

Fractures occur in utero, death occur during perinatal period

37
Q

Description of Ol tarda

A

Children or early adolescence with present of blur sclera, fractures from trial trauma, kyphoscoliosis, bowing of femur and tibia, otosclerosis progressing to deafness

38
Q

Osteogenesis imperfecta anesthesia implications

A

Mild hyperthermia intraop, but it not a forerunner of malignant hyperthermia

39
Q

Which connective tissue d/o has a high risk of aortic dissection?

A

Marfan Syndrome

40
Q

What should be done in the intraop period to decrease the risk of aortic dissection?

A

Avoid any sustained increased in systemic blood pressure that may occur during DL or in response to painful surgical stimulation.

41
Q

When the diameter os the ascending aorta exceeds 4.5 cm and substantial aortic regurgitation is present, what surgery is indicated?

A

Surgical replacement of the aortic valve and ascending aorta. This requires circ arrest!!!!

42
Q

MS disease affects which system, CNS or PNS?

A

CNS

43
Q

Clinical manifestations of MS are……?

A

Multifocal and always progressive

44
Q

What should you avoid with patient’s with MS?

A

Avoid hyperthermia!!!!

This may cause exacerbation of MS

45
Q

What type of block has been implicated in postoperative exacerbation of MS?

A

Spinal Anesthesia Blocks (SAB)

46
Q

What med should be avoided with ALS?

A

Succinycholine.

D/t massive release of K

47
Q

Categories of Seizure d/o

A

Focal (partial)
Generalized
Unknown
Simple
Complex

48
Q

Focal seizures description

A

Focal (partial) seizures are neural discharges originating from one part of the cerebral hemisphere

With the following features: aura, motor, autonomic, dyscognitive

W/o dyscognitive features

49
Q

Generalized seizures description

A

Arise from both hemispheres

Tonic clonic, Absence, Clonic, Tonic, Atonic, Myoclonic

50
Q

Simple seizures description

A

No loss of consciousness

51
Q

Complex seizures description

A

Altered level of consciousness

52
Q

What med should you avoid in pts having an active seizure?

A

NMB

The patient may be paralyzed, but the seizure is still happening in the brain

53
Q

Consideration for seizure meds and anesthetics

A

Anti-seizure meds have sedative properties and are liver enzyme-inducers

54
Q

T/F: AED are enzyme inducers (CYP 450)

A

True.

You have to give more anesthetics because they are being broken down quicker due to the enzyme

55
Q

Which inhalation agents provoke seizure-like activity?

A

Sevoflurane>isoflurane>desflurane

56
Q

Which drugs should you avoid for seizure patients?

A

Avoid Ketamine, Methohexital, Etomidate, Meperidine, Atracurium

These meds lower the seizure threshold!!!!!

57
Q

Which NM disease has antibodies that attack the postsynaptic ACh receptor at the NMJ

A

Myasthenia Gravis

58
Q

Myasthenia Gravis muscle description

A

Proximal muscle weakness alleviated by rest, exacerbated by activity

59
Q

Osserman Staging System classification is used in which NM d/o?

A

Myasthenia Gravis

60
Q

Bulbar muscles are affected with Myasthenia Gravis, what happens with this dysfunction?

A

Bulbar muscles of the mouth and throat responsible for speech and swallowing

61
Q

Myasthenia Anesthesia Implications

A

1) The effect of nondepolarizing NMB agents INCREASED SENSITIVITY

2) The effect of depolarizing NMB agents (SCh) is reduced, more RESISTANT, yet duration prolonged

62
Q

What is the role of sugammadex in Myasthenia Gravis pts?

A

Safe to use

63
Q

Myasthenia Risk for Post-operative Ventilation

A

Duration >6 years (12pts)
History of chronic respiratory disease (10pts)
Pyridostigmine dosage >750 mg/day (8pts)
Vital capacity < 2.9L (4pts)

Total score > 10 pts indicates increased risk for postoperative ventilation for at least 3hrs

64
Q

The Lambert-Eaton Syndrome is associated with which NM disease?

A

Myasthenic Syndrome

65
Q

What occurs during the Lamber-Eaton Syndrome?

A

Antibodies attack PRESYNAPTIC VOLTAGE-GATED CA CHANNELS ON NERVE TERMINALS

66
Q

Describe what happens to muscle weakness in Lambert-Eaton Syndrome

A

Weakness improves throughout day with repeated nerve stimulation

67
Q

List perioperative complications of Duchenne and Becker muscular dystrophies

A

Rhabdomyolysis
Hyperkalemia
MH
Cardiac arrest

68
Q

What medications should be avoided in Muscular dystrophies?

A

Avoid Succinylcholine!!!!!

Severe Hyperkalemia, dysrhythmias, rhabdomyolysis

69
Q

What is the 2nd type of medication that should be avoided with Muscular dystrophies?

A

Avoid MH triggering agents!!!!!!

Hypermetabolic syndrome with SCh and halogenated inhalation anesthetics
Severe hyperkalemia, dysrhythmias, rhabdomyolysis
Anesthetic plan???

70
Q

T/F: Unpredictable responses to anesthetic agents are common in MMD (Myotonia and Myotonic Dystrophy). Be judicious!!!

A

True

71
Q

Over ______% of perioperative strokes occur in the post-op period.

A

80%

72
Q

What should be determined in preop for a dementia patient?

A

Neurologic baseline/level of cognitive dysfunction

73
Q

Caution should be used with what types of medication for which types of patients?

A

Benzos
Antihistamines
Anti-cholinergics (Atropine and scop)

74
Q

What surgical treatment is performed for patients with Parkinson’s disease?

A

Deep brain stimulation

Targets areas w/i the basal ganglia

75
Q

T/F: Parkinson medications should continued the DOS?

A

True!!!!!

76
Q

What medications should be avoided in patient’s with Parkinson’s disease?

A

Avoid dopamine antagonists
1) Reglan
2) Inapsine
3) Phenergan

77
Q

Anesthesia implications of embolization treatment

A

1) Maintain hemodynamics and NMB!!!!!
2) Hemodynamics should be optimized to avoid rupture, re-bleeding, and cerebral ischemia
3) No movement

78
Q

Where do primary adenomas occur?

A

Adenohypophysis

AFN Assessment (7 decks)

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