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24 Physical & Health Assessment > Musculoskeletal Diseases (Exam II) > Flashcards

Musculoskeletal Diseases (Exam II) Flashcards

1
Q

What is the pathophysiology of scleroderma?

A
  • Inflammation and Autoimmune disease w/ progressive tissue fibrosis/sclerosis and vascular injury.
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2
Q

What mnemonic guides the main symptoms associated with scleroderma?
Expound on the mnemonic.

A
  • Calcinosis
  • Raynaud’s
  • Esophageal reflux
  • Sclerodactyly
  • Telangiectasia’s
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3
Q

What skin and musculoskeletal abnormalities might be seen with scleroderma?

A
  • Taut skin
  • Contractures & myopathy
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4
Q

What can happen to nerves with scleroderma?

A

Compression

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5
Q

What does xerostomia mean?

A

Dry mouth

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6
Q

What treatments are used for scleroderma?

A
  • Symptoms alleviation
  • ACE-inhibitors
  • Digoxin
  • Steroids
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7
Q

What airway and pulmonary considerations exists for scleroderma?

A
  • Pulmonary fibrosis (↓ compliance)
  • Decreased ROM for airway
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8
Q

What CV considerations exists for scleroderma?

A
  • Possible systemic/pulm HTN
  • Dysrhythmias
  • Small artery vasospasm’s
  • CHF
  • pericarditis
  • pericardial effusion w/ or w/o tamponade
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9
Q

What GI symptoms exist for scleroderma?

A
  • Xerostomia
  • GI tract fibrosis
  • Poor dentition
  • GERD
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10
Q

What dose of metoclopramide would be utilized for GI tract fibrosis from scleroderma?

A

Trick question. Metoclopramide would not work in this scenario.

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11
Q

What scleroderma anesthesia management considerations are there?

A
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12
Q

What is Duchenne’s Muscular Dystrophy (DMD)?
What initial symptoms are present at 2-5 years of age?

A
  • X-linked dystrophin disorder resulting in muscle atrophy.
  • (Ages 2-5) = waddling gait, frequent falling, can’t climb stairs, Gower’s sign.
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13
Q

What s/s are seen with DMD?

List:
CNS
Musculoskeletal
CV
Pulm
GI

A
  • CNS - intellectual disability
  • MS - kyphosis, muscle atrophy, ↑ CK 20-100x
  • CV - ↑ HR, cardiomyopathy (age 18), short PR & tall R wave/deep Q wave
  • Pulm - weakened respiratory muscles and weak cough, OSA, pneumonia
  • GI - hypomotility & gastroparesis
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14
Q

What are the anesthetic concerns and interventions relevant to DMD patients?

  • Airway
  • Pulmonary
  • CV
  • GI
A
  • Airway - weak laryngeal reflexes & cough
  • Pulm - weakened muscles
  • CV - Get pre-op EKG & echo
  • GI - delayed gastric emptying
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15
Q

What drug should be avoided with DMD patients?

A
  • Succinylcholine (MH, Rhabdo & ↑K⁺, cardiac arrest)
  • Halogenated anesthetics “all of our gasses”

use NDMBs

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16
Q

What type of anesthesia is prefereable for a DMD patient?

A

Regional (vs GA)

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17
Q

Why might one use less volatile gasses with DMD patients?

A
  • DMD patients have ↑risk of malignant hyperthermia.

Ensure you have Dantrolene

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18
Q

What is the pathophysiology of myasthenia gravis?

A
  • ↓ function of NMJ post-synaptic ACh receptors.

αlpha sub-units of ACh receptor are bound by antibodies.

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19
Q

What organ is linked with the production of anti-ACh antibodies?

A
  • Thymus
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20
Q

Which condition is characterized by partial recovery with rest?

A

Myasthenia Gravis

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21
Q

What test is used to diagnose myasthenia gravis?

A

Edrophonium/Tensilon Test
- 1-2 mg IVP
- Myasthenia symptoms improve with injection = (+) test

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22
Q

What signs/symptoms might be seen with myasthenia gravis?

A
  • Ptosis & diplopia
  • Dysphagia & dysarthria
  • Muscle weakness
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23
Q

Differentiate Myasthenic Crisis and Cholinergic Crisis.

A
  • Myasthenic Crisis - Insufficient drug therapy and resulting respiratory failure.
  • Cholinergic Crisis - too much -stigmine drug = SLUDGE-M symptoms.
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24
Q

What drugs are the firstline treatment for Myasthenia Gravis?
What would be done if drugs were ineffective?

A
  • Pyridostigmine (AChesterase inhibitors)
  • Surgical Thymectomy
25
Q

What drugs/treatments other than pyridostigmine or surgery could be used for myasthenia gravis?

A

immunosuppression
-Corticosteroids
- Azathioprine
- Cyclosporine
- Mycophenolate

Immunotherapy
- Plasmapheresis
- Immunoglobulin

26
Q

What anesthetic considerations exist for myasthenia gravis?

A
  • Aspiration risk & weakened respiratory muscles.
  • Sensitivity to NMBs (intubate without if possible)
  • No succinylcholine (resistant to it)
  • intubate with out NMBD!
27
Q

What is osteoarthritis (OA)?
What makes the pain better?

A
  • Degeneration of articular cartilage with minimal inflammation.
  • Pain is worse with motion, relive by rest. (Morning stiffness disappears w/ movement)
28
Q

What are Heberden nodes?
What disease process do they indicate?

A
  • Bony swellings of the distal interphalangeal joints.
  • Osteoarthritis
29
Q

What spinal complications occur from osteoarthritis?

A
  • Vertebral degeneration
  • Nucleus pulposus herniation
  • Nerve root compression
30
Q

What are the treatments for osteoarthritis?

A
  • PT & exercise
  • Maintenance of muscle function
  • Pain relief
  • Joint replacement surgery
31
Q

Are osteoarthritis or rheumatoid arthritis patients prescribed corticosteroids?

A
  • RA patients (no steroids for OA)
32
Q

What anesthetic considerations exist for OA?

A
  • Airway ROM
33
Q

What is rheumatoid arthritis?
What hand condition is often seen on inspection?

A
  • Auto-immune systemic inflammatory disease
  • Swelling of the Proximal Interphalangeal, metocarpophalangeal, and elbow joints.
34
Q

What joints are usually spared by rheumatoid arthritis?

A
  • Thoracic & Lumbosacral spine
35
Q

With this condition it is common to have synovitis of the temporomandibular joint.

A

Rheumatoid Arthritis

36
Q

Why would the sniffing position and thus intubation be affected in a patient who has rheumatoid arthritis?

A
  • Atlantoaxial subluxation (pushes on spinal cord)
  • Cricoarytenoid arthritis (hoarseness, dyspnea, and upper airway obstruction may be present)
37
Q

What cardiac symptoms can be seen with RA?
Pulmonary?

A
  • Pericarditis and accelerated CAD
  • Restrictive lung changes
38
Q

What two facial symptoms are often seen with RA?

A
  • Keratoconjunctivitis sicca (dry eye)
  • Xerostomia (dry mouth)
  • synovitis of temporomandibular joint
39
Q

What drugs are used to treat rheumatoid arthritis?

A
  • NSAIDs
  • Corticosteroids
  • DMARDs
  • TNF-α inhibitors & Interleukin-1 inhibitors
40
Q

Compare and contrast DMARDs vs TNF-α inhibitors & Interleukin-1 inhibitors in how they treat rheumatoid arthritis.

A
  • DMARDs (methotrexate) slow disease progression but can take 2-6 months to see effects
  • TNF-α & IL1 inhibitors generally work better than DMARDs (IL1’s are slow than TNF)
41
Q

What anesthesia considerations exist for rheumatoid arthritis?

A
  • Airway complications by atlantoaxial subluxation or TMJ.
  • Severe RA lung disease
  • Stress dose steroids may be necessary
42
Q

What is a malar rash?
What pathology is it characteristic of?

A
  • Butterfly rash across the bridge of the nose and cheeks that is present with SLE.
43
Q

What pathology is this and what are these lesions called?

A
  • Discoid lesions characteristic of SLE.
44
Q

What type of rash is depicted below? What pathology is it characteristic of?
What often causes it?

A
  • Maculopapular rash characteristic of SLE and exposure to the sun.
45
Q

What cardiac symptoms are seen with SLE?

A
  • Pericarditis
  • CAD
  • Raynaud’s
46
Q

What type of arthritis is seen with SLE?

A
  • Symmetrical w/ no spinal involvement but frequent breakdown of femoral head.
47
Q

What pulmonary symptoms are characteristic of SLE?

A
  • Lupus pneumonia
  • Vanishing Lung syndrome
  • Restrictive lung disease
48
Q

What drugs are utilized to treat SLE?

A
  • NSAIDs or ASA
  • Antimalarials (HCQ & quinacrine)
  • Corticosteroids
  • Immunosuppressants (methotrexate, azathioprine)
49
Q

What anesthesia considerations exist for SLE patients?

A
  • Recurrent laryngeal nerve palsy
  • Cricoarytenoid arthritis
  • Stress dose steroids likely necessary
50
Q

What condition often has recurrent laryngeal nerve paralysis?

A

Lupus (SLE)

51
Q

What are the early signs of malignant hyperthermia?

A
  • ↑CO₂
  • ↑HR
  • ↑RR
  • Jaw muscle spasm
  • Peaked T waves
  • Acidosis
  • Muscle rigidity
52
Q

What are the late signs of malignant hyperthermia?

A
  • Hyperthermia
  • Rhabdo & cola-urine
  • ↑CPK
  • VTach/Vfib
  • Acute renal failure
  • DIC
  • cardiac collapse
53
Q

What is initial Dantrolene dosing?
What is the max dose?

A
  • Initial: 2.5mg/kg.
  • Max: 10mg/kg
54
Q

How is MH testing done?

A
  • Muscle biopsy and halothane + caffeine contracture test.
55
Q

Which of the following best characterizes myasthenia gravis?

A. Delayed Muscle Relaxation.
B. Fatiguability of skeletal muscle with repetitive use.
C. Rigidity after exposure to volatile anesthetics.
D. Muscle weakness that improves with repeated effort.

A

B. Fatiguability of skeletal muscle with repetitive use.

56
Q

What are treatments indicated for a patient with rheumatoid arthritis?

A. Immunoglobulin injections and DMARDS.
B. Plasmapheresis and thymectomy.
C. Corticosteroids and DMARDS.
D. Alternating heat and cold therapies.

A

C. Corticosteroids & DMARDs

57
Q

Signs and symptoms of scleroderma include: (select 2)

A. Small bowel hypomotility
B. Decreased pulmonary compliance
C. Diffuse pitting edema
D. Diarrhea

A

A. Small bowel hypomotility
B. Decreased pulmonary compliance

58
Q

Which anesthetic plan is ideal for a patient with systemic lupus erythematosus?

A. Avoid the use of volatile anesthetics
B. Prepare patient for possible post-operative ventilator use.
C. Administer metoclopramide
D. Order a pre-operative CBC & ECG.

A

D. Order a pre-operative CBC & ECG.

This is a dumb question

59
Q

Preoperative findings of Duchenne muscular dystrophy include:

A. Decreased serum creatine kinase
B. Gastrointestinal hypermotility
C. Kyphoscoliosis
D. Sinus bradycardia

A

C. Kyphoscoliosis

24 Physical & Health Assessment (33 decks)

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