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Anes& Coex > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

SLE pt presents w what on dx

A

Antinuclear antibodies, rash, low plt ct, serositis, nephritis

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2
Q

SLE: occurs mostly in who, can be induced by what

A

Young women. Drugs: hydralazine, procainamide, isonizid, methyldopa, slow acetylators at inc risk

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3
Q

What SLE inflammation and vasculitis does

A

Vessel wall thickening, weakening, narrowing, and scarring: CAD, Stroke risk etc. HTN, pulmonary HTN, Thromboembolism, Hypercoagulable state

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4
Q

SLE how skin and membranes affected

A

Butterfly rash, nasal erythema, oral and pharyngeal ulcers

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5
Q

How joints and muscle affected by SLE

A

Symmetrical arthritis, cricoarytenoid arthritis, myopathy, tendon rupture

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6
Q

How lungs affected by SLE

A

Lupus pna, restrictive, atelectasis (phrenic nerve neuropathy)

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7
Q

How kidneys and heart affected by SLE

A

Glomerulonephritis leading to nephrotic syndrome and RF. Pericarditis and valvular disease

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8
Q

How CNS and liver affected by SDLE

A

Cognitive symptoms, biliary cirrhosis, autoimmune hepatitis

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9
Q

SLE tx: mild

A

NSAIDs, low dose steroids, hydroxychloroquine for skin and arthritis

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10
Q

Severe SLE tx

A

High dose steroids (stress dose intraop), methotrexate

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11
Q

Stress dosing for small,m moderate, or major surgery

A

None. 25 mg hydrocortisone q8 then taper 1-2 days. Major 50 mg q8 then taper 2-3 days

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12
Q

Anesthesia consid w airway management SLE

A

Laryngeal erythema and edema common, CA arthritis, ulcers, laryngeal nerve Palau

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13
Q

Consid for regional SLE

A

Coagulopathy or on anticoagulants. May have nerve lesion

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14
Q

How SLE affects anesthesia drug choices

A

Which SLE drugs on, if renal imp, hepatic clearance, cardiopulm involvement.

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15
Q

SLE drugs for altered renal function

A

Propofol and etomidate good. Benzos prolonged, urine elim. Opioids- demerol and morphine metabolites, resp dep in RF. VA ideal d/t no dep on renal elim

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16
Q

Where early RA appears

A

Hands, wrists, ankles, feet

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17
Q

Where late RA appears

A

Knees, elbows, shoulders

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18
Q

RA fx on lung and heart

A

Effusions, pulm fibrosis (restrictive pattern), pericarditis, tamponade, coronary arteritis, aortic insufficiency, dysrhythmias from nodes

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19
Q

RA drugs to tx RA

A

DMARDS slow progression. Methotrexate, axothioprine, sulfasalazine, TNF inhibitors/monoclonal antibodies

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20
Q

RA document what pre op.

A

ROM limits, baseline pain, numbness, weakness

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21
Q

RA airway consid/management

A

Assess TMJ. If ltd and cervical spine immobile may do awake fiberoptic. Cricoarytenoid- hoarseness, can make glottic opening stenotic, smaller tube size, edema can lead to obstruc postop

22
Q

RA atlantoaxial subluxation: what it is, interferes w what

A

Anterior arch of atlas to odontoid process, >3 mm. Risk of SC/medulla compression, interferes w vertebral artery flow.

23
Q

RA atlantoaxial subluxation: how to handle

A

Determine awake head positions tolerated. Ask about tingling in hands, feet, pain, ROM. Avoid excessive movements w laryngoscopy

24
Q

Where OA occurs

A

Middle/lower cervical spine and lower lumbar. Weight bearing joints (hips, fingers, knees, feet)

25
Q

OA anesthesia consid

A

Positioning, support to joints. Dont need to give steroids. Bleeding potential from asa and nsaids

26
Q

Complication from joint surgery in OA

A

Bone cement can cause fat and marrow embolisms (implantation syndrome). Hypoxia, hypotension, dysrhythmias, pulm htn, dec CO

27
Q

OA complic from pneumatic tourniquets

A

Prolonged inflation can cause pain and nerve damage. Dont overdo opioids. Deflation- hemodynamic changes and washout of metabolic wastes

28
Q

MG clinical features

A

Ptosis, diploplia, bulbar involvement (aspiration), myocarditis (afib,hb), proximal muscle weakness (neck, shoulders, resp muscles)

29
Q

How MG drugs effect our drugs

A

On cholinesterase inhib. Prolonged sux, mivacurium, ester LAs

30
Q

MG. What can enhance weakness. Med consid

A

Aminoglycosides. Propofol (short acting). Maybe no NMB, lidocaine to a/w. RSI if aspiration risk, give sux but may be prolonged

31
Q

MG maintenance

A

Deep w VA, enough relaxation

32
Q

MG emergence

A

Greater risk postop RF. Awake w ETT in. Head lift 5 sec. clos obs

33
Q

Myasthenia syndrome clinical features

A

Proximal muscle weakness, bottom to top. Can affect resp muscles. Autonomic dysfunc: hemodynamic variability

34
Q

Myasthenia syndrome anesthesia consid

A

Sensitive to all NMBs. Anticholinesterase drugs may not reverse them. VA alone may provide enough relaxation. Small doses NMBs

35
Q

DMD CM

A

Hyphoscoliosis, weakness and contracture. Muscle weakness in proximal extrem. Degen of heart muscle, dec ability to cough, resp muscle weakness, delayed gastric emptying (aspiration risk)

36
Q

MD cardiac abn

A

Atrial arrythmia, prolonged PR, dec myo contractility and cardiomyopathy, mitral regurg

37
Q

MD resp fx

A

Weakness, infections, restrictive pattern, pulm htn

38
Q

MD anesthesia consid

A

Heart and lung involvement. Avoid pre op meds d/t aspir risk. Premed w GI meds, maybe glyco too for secretions. Positioning

39
Q

MD infduction: what is contraindicated

A

Sux, unpredictable. Risk of hyperkalemia, rhabdo, cv arrest, MH

40
Q

MD maintenance. What is preferable

A

Cardiopulm depression w VA, prolonged response to NMB. Regional

41
Q

Marfans CM

A

Long tubular bones, hyperextensible joints, high arched palate, crowded teeth, pectus excavating, kyphoscoliosis

42
Q

Marfans CV fx

A

Aortic aneurysm and dissection, AV valves affected, MV prolapse, BBB, aortic and aV valve calcification

43
Q

Marfans lung involvement

A

Pectus excavating/scoliosis, restrictive pattern. Dec compliance, inc PVR nad pulm htn

44
Q

Marfans tx

A

BB to reduce heart workload. Aortic repair, spinal fusion

45
Q

Marfans anesthesia consid preop and a/w

A

Cardiac abn focus on preop. Rarely hard laryngoscopy. TMJ dislocation, do assessment. Tracheomalacia (floppy- can collapse)

46
Q

Marfans: prevent what intra op, do what

A

Prevent sudden inc contractility, avoid catecholamines, tx hypertension. VAs good

47
Q

Ankylosing spondylitis airway consid

A

Difficult intub d/t cervical spine and TMJ involvement. Risk of neuro injury w neck extension. Kyphosis limits intub. Cricoarytenoid arthritis

48
Q

Akylosing spondylitis cv involv

A

Aortic regurg (avoid sudden inc SVR, keep HR <90, low normal BP), BBB, cardiomegaly

49
Q

Ankylosing spondylitis pulm abn

A

Fibrosis, apical cavity lesions, pleural thickening (like TB), dec compliance of chest, dec VC

50
Q

Ankylosing spondylitis anesthesia consid

A

Restrictive disease, a/w involvement, may do awake fiberoptic intub. Epidurals are difficult, do paramedical

51
Q

Achondroplasia anesthesia consid

A

Difficult IV and CVL placement, pulm htn common, restrictive vent, OSA common, upper a/w obstruc

52
Q

Achondroplasia airway management consid

A

May be difficult mask, larynx may be small (hard to expose glottis, base on weight rather than age). Avoid hyperextension

Anes& Coex (15 decks)

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