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Coexisting diseases > Musculoskeletal Diseases > Flashcards

Musculoskeletal Diseases Flashcards

1
Q

SLE like syndrome may also be drug induced???

A

Hydralazine
Procainamide
Methyldopa
also Phenytoin (dilantin)

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2
Q

SLE:
These autoantibodies usually affect the ___ of the cell which join with substances to form molecules called ___ - these cause ___ and ___ as they are deposited throughout the body.
*Considered the mainstay of treatment of SLE?

A 
nucleus
*immune complexes*
inflammation 
tissue injury 
*Steroids - Need to consider perioperative steroid coverage
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3
Q

SLE diagnosis confirmed with 3 of 4 typical manifestations? (5)

A
  • antinuclear antibodies
  • rash
  • thrombocytopenia
  • serositis
  • nephritis
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4
Q

SLE - Drugs for Chronic Renal Failure:

Need to AVOID these drugs? (7)

A 
Meperidine
Thiopental 
Methohexital 
Pancuronium 
d-tubocurarine
Metocurine
Gallamine
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5
Q

Chronic inflammatory disease characterized by symmetric poly-arthropathy and systemic involvement?
-Peak age of occurrence is ?

A

Rheumatoid Arthritis

-20-40 years old

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6
Q

Rheumatoid Arthritis:
Believed to be due to an ___ or ___ that leads to an immunological response in a genetically predisposed individual.

-Target is the ___.

A

antigen or microbe

-synovium

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7
Q

Hallmark is the degeneration of articular cartilage?
Disparity btw the stress applied to articular cartilage and the ability of the cartilage to withstand stress.

  • Commonly referred to as?
  • Not associated with ___ or ___.
A

Osteoarthritis

  • Degenerative Joint Disease (DJD)
  • systemic inflammation or manifestations
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8
Q

DO NOT TYPICALLY REQUIRE STEROIDS?

A

OSTEOARTHRITIS

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9
Q

Disease of the neuromuscular junction caused by a decrease in the population of the Acetylcholine receptors?

-This process is thought to originate in the ?

A

Myasthenia Gravis

-Thymus

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10
Q
  • Onset may be insidious or abrupt

- Acquired autoimmune disorder of neuromuscular transmission characterized by muscle weakness?

A

Myasthenia Gravis

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11
Q

Myasthenia Gravis: Anti-acetylcholine receptor antibodies damage the ___ secondary to a ___.

A

post-synaptic membrane

complement-mediated reaction

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12
Q

Autoimmune disorder of neuromuscular transmission? (aka?)

Develops in association with a neoplasm specifically a ___.

A

Myasthenic Syndrome
Lambert-Eaton Syndrome
small cell carcinoma of the lung

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13
Q

Myasthenic Syndrome - Auto-immune disorder in which ___ form against the voltage gate ___ ion channels on the ___ side of the NMJ.

If a tumor is present these autoantibodies are directed at the tumor but cross react with ___ in the NMJ.

A

Immunoglobulin G antibodies (IgG)
calcium
pre-synaptic
calcium channels

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14
Q

Chronic inflammatory multi-system disease characterized by anti-nuclear antibody production?

  • Antinuclear antibodies directed at antibodies to:
  • DNA
  • Histones
  • Non-histone proteins bound to RNA
  • Nuclear antigens
A

Systemic Lupus Erythematosus

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15
Q

Increased muscle strength after exercise?

A

Myasthenic Syndrome

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16
Q

Genetic abnormality due to the lack of production of dystrophin?

  • Characterized by a ___ degeneration and ___ of skeletal muscle tissue.
  • Dystrophin deficiency weakens the ___ and results in an increase in ___ into the cell.
A

Duchenne Muscular Dystrophy

  • painless
  • atrophy
  • muscle cell membrane
  • calcium
17
Q

SLE = Choose drugs that are myocardial sparing and not excreted via the kidneys:

  • Give propofol doses with incremental dosing sparingly
  • ___ if you need a MR (cleared via Hoffman elimination)
  • What kind of treatment are they on - they might need to be on a stress dose
  • Positioning huge - these patients have LOTS OF PAIN
  • Pre-anesthetic want to look at their heart, stress test, listening for friction rubs
  • These patients can also have ___ and presenting with hoarse voice - should you use a smaller tube?
A
  • Cisatracurium

- cricoarytenoid arthritis

18
Q

*Coronary atherosclerosis is the prominent cause of death in ___ - this is from chronic steroid treatment.

A

Lupus

19
Q

Affects the upper cervical spine, not the lumbar spine. Can consider regional anesthesia as long as it is in the lumbar spine. Major consideration for patients with ___ is what is going on in their upper cervical spine - will they be a difficult intubation.

  • Anesthesia = Consider ___ dose.
  • Ask them to avoid ___ and ___ preoperatively.
  • Thus these patients will be in pain. Do not give these patients ___ preoperatively - patient at risk for bleeding.
A

Rheumatoid arthritis

  • steroid stress
  • ASA and NSAIDs
  • toradol
20
Q

___ - ANESTHETIC CONSIDERATIONS
Biggest concern with RA is the airway. These patients also present with atlanto-axial instability. Very important to not do extension/flexion with these patients. CT and X-rays should be done assessing flexion and extension prior to any surgery.
*Usually first symptom is neck pain radiating to the occiput, however majority of these patients will be asymptomatic.

A

Rheumatoid Arthritis

21
Q

Myasthenia Gravis:

  • Precipitated by ___, ___, ____
  • Initial symptom may present as ____.
  • ___ that we give that can aggravate muscle weakness - ___ - at risk for developing respiratory failure
  • These patients are at high risk for ___
  • At risk for Heart Block look at preoperative EKG
A
  • electrolyte abnormalities, pregnancy, stress
  • double vision aka diplopia
  • Antibiotics, clindamycin
  • aspiration
22
Q

Myasthenia Gravis Treatment = Typically on ___ (ex-?) daily PO
Do not want patients to take this the day of surgery. Could interact with other meds.
*Too much Cholinesterase - abdominal cramping, diarrhea, excess secretions etc. These patients usually in good control of how much they should take a day.
-Want to do procedure when they patients are healthy - do not do with new onset temp, respiratory infection at risk for complications.
-Perform surgery when patient is in remission - schedule case for first procedure of the day.

A

Cholinesterase Inhibitors

Pyridostigmine

23
Q
  • –These patients are prone to cardiac depression (avoid ___) and they are prone to MH!?! THUS NO ___!!!
  • With induction probably going to be using ___.
  • For maintenance possibly use ___ (?), can use ___ and ___, put a big piece of tape over inhaled agents or take them off the machine so no one uses them accidentally
A 
Muscular Dystrophy
(inhaled agents)
-SUCC
-Etomidate 
-TIVA (propofol) 
-O2 and N2O
24
Q

Marfan’s Syndrome:

  • ___ inheritance pattern of connective tissue.
  • Connective tissue disorder related to a mutation in the ___.
  • Absence of ___ disrupts the scaffolding needed for the deposit of ___ in elastin fibers.
  • Primarily affects: ???
A
  • Autosomal dominant
  • FBN1 gene
  • fibrillin
  • elastin
  • eyes, skeletal, cardiovascular system
25
Q
  • With this patient will usually have restrictive lung disease - want small tidal volumes (4-8 ml/kg).
  • With induction concerned about blunting the response - going to use a lot of narcotics on these patients!
  • Use ___ - cardiac safe using a lot!
  • ___ is huge!!!
  • Airway - high arched palate, may need to use a ___ instead due to long palate
A

Marfan’s Syndrome

  • Fentanyl
  • Positioning
  • miller blade
26
Q

Progressive inflammatory disease of the spine and adjacent tissues?

  • Considered a ___. Cause is not known Human Leukocyte Antigen (HLA-B27).
  • ___ and ___ are NEGATIVE.
A

Ankylosing Spondylitis

  • nonrheumatic arthropathy
  • Rheumatoid factor and ANA
27
Q

Going to do AWAKE FIBEROPTIC on these patients!!!
Pre-induction going to do all 3 airway blocks or we can also do 4% nebulized lidocaine (breathe in for 10 minutes - this is the preferred method).
-Avoid sudden changes in ___ because of their cardiac involvement.
-Want to do a ___ and maintain their ___.
-If try to do an induction on these patients it is going to be an airway nightmare!

A

Ankylosing Spondylitis

  • SVR
  • controlled ventilation and maintain their SVR
28
Q

Abnormal bone growth that is responsible for several potential anesthesia related problems?
Not particularly anatomic abnormalities. Use airway appropriate for pediatrics. Anatomy is more similar to that of a child. But their an adult so be cautious of an aspiration risk - going to use a cuffed tube in adult with pituitary dwarfism.
-Oral airway is going to be very important during induction.
-Can have cervical spine instability risk for neck trauma with ___.

A

Achondroplasia

-overextension

29
Q

Achondroplasia:

  • Thermal regulation abnormalities - ___ susceptible!!!
  • No change in responses to ___ and ___.
A
  • Hyperthermia

- Anesthetics and Neuromuscular Blockers

30
Q
  • SLE = Use drugs that are myocardial sparing, not excreted by kidneys:
  • Give ___ doses with incremental dosing sparingly
  • ___ if you need a MR (cleared via Hoffman elimination)
  • What kind of treatment are they on - they might need a ___
  • Positioning huge - these patients have LOTS OF PAIN
  • Pre-anesthetic want to look at their heart, stress test, listening for ?
  • These patients can also have ___ and presenting with hoarse voice
A
  • propofol
  • Cisatracurium
  • stress dose
  • friction rubs
  • cricoid arytenoiditis - may need to use a smaller tube
31
Q

Both of these are treated with ASA and NSAIDs??
Careful with possible bleeding!!

-With MG will have muscle weakness, anesthetic consideration caution with ?

A

Rheumatoid arthritis (first line tx for pain and inflammation)
Osteoarthritis
-muscle relaxants

32
Q

Myasthenia Gravis:
Consider aspiration risk - RSI!
With induction use a short acting ___ or ___
-___ use limited
-___ good choice for intubation and maintenance
-Likely will need?

A

short acting barbiturate or propofol

  • opioid
  • inhaled agents
  • postop ventilation
33
Q

Myasthenia Gravis:

  • Reversal obtained best with ?
  • Drug interactions seen with (3)
  • Extubation - patient needs to be responsive and generate a negative inspiratory pressure of ___.
  • If respiratory depression occurs give ___, possible reintubation with mechanical ventilation
A
  • edrophonium, give with atropine
  • antibiotics (aminoglycosides), antiarrhythmics, diuretics

greater than 20 cmH2O
-anticholinesterase IV

34
Q

All of these disease may result in kyphoscoliosis thus these patients will have restrictive lung disease (require low TV) and pulmonary hypertension (3)

A

Muscular Dystrophy
Marfan’s
Achondroplasia

35
Q
  • Presence of calcium channel antibodies with?
  • Clinical hallmark is muscle weakness pronounced in the proximal extremities?
  • Hallmark is sacroiliac joint pain?
  • Hallmark is muscle weakness?
A
  • Myasthenic syndrome (increased muscle strength after exercise)
  • Muscular dystrophy (usually die in 20s from resp/cardiac issues!)
  • Ankylosing Spondylitis (morning stiffness improves with activity)
  • Myasthenia Gravis (affects eyes, face - fatigue after activity)
36
Q

All of these disease may result in kyphoscoliosis thus these patients will have restrictive lung disease (require low TV) and pulmonary hypertension (3)

A

Muscular Dystrophy
Marfan’s
Achondroplasia

37
Q
  • Presence of calcium channel antibodies with?
  • Clinical hallmark is muscle weakness pronounced in the proximal extremities?
  • Hallmark is sacroiliac joint pain?
  • Hallmark is muscle weakness?
A
  • Myasthenic syndrome (increased muscle strength after exercise)
  • Muscular dystrophy (usually die in 20s from resp/cardiac issues!)
  • Ankylosing Spondylitis (morning stiffness improves with activity)
  • Myasthenia Gravis (affects eyes, face - fatigue after activity)

Coexisting diseases (8 decks)

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