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Physical & Health Assessment COPY - Grayson > Musculoskeletal Diseases (Exam II) > Flashcards

Musculoskeletal Diseases (Exam II) Flashcards

1
Q

What is the pathophysiology of scleroderma?

A

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

careful with positioning

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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 pulmHTN
  • Dysrhythmias
  • Small artery vasospasm’s
  • CHF
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9
Q

What GI symptoms exist for scleroderma?

A
  • Xerostomia
  • GI tract fibrosis
  • Poor dentition
  • GERD
  • Malabsorption

↑ risk of aspiration

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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

Scleroderma treatment
GI -
Raynaud’s -
Renal Protection -
Pulmonary HTN -
CO -
Organ Improvement -

A

GI - PPIs for reflux
Raynaud’s - CCB
Renal Protection - ACE-I
Pulmonary HTN - prostacyclins or phosphodiesterase inhibitors, oxygen, anticoagulation, diuretics
CO - digoxin
Organ Improvement - immunosupression and steroid therapy

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12
Q

What scleroderma anesthesia management considerations are there?

A
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13
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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14
Q

What s/s are seen with DMD?

List:
CNS
Musculoskeletal
CV
Pulm
GI

A
  • CNS - intellectual disability
  • MS - kyphosis, muscle atrophy, ↑ CK
  • CV - ↑ HR, cardiomyopathy, short PR & tall R-wave
  • Pulm - weakened respiratory muscles and weak cough, OSA
  • GI - hypomotility & gastroparesis

ST most common reason for death

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15
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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16
Q

What drug should be avoided with DMD patients?

A
  • Succinylcholine (Rhabdo & ↑K⁺)

use NDMBs

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17
Q

What type of anesthesia is prefereable for a DMD patient?

A

Regional (vs GA)

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18
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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19
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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20
Q

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

A
  • Thymus
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21
Q

Which condition is characterized by partial recovery with rest?

A

Myasthenia Gravis

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22
Q

What test is used to diagnose myasthenia gravis?

A

Edrophonium/Tensilon Test (1-2 mg IVP)
Myasthenia symptoms improve with injection = (+) test, makes cholinergic crisis worse

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23
Q

What signs/symptoms might be seen with myasthenia gravis?

A
  • Ptosis & diplopia
  • Dysphagia & dysarthria
  • Muscle weakness
    ptosis/diplopia most common to present with*
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24
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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25
Q

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

A
  • Pyridostigmine (AChesterase inhibitors)
  • Surgical Thymectomy
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26
Q

What antibiotics are contraindicated in Myastenia Gravis?

A

-mycins
(gentamicin, streptomycin, tobramycin)

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27
Q

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

A
  • Corticosteroids
  • Azathioprine
  • Cyclosporine
  • Mycophenolate
  • Plasmapheresis
  • Immunoglobulin
28
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)

Can use H2 antagonists and metoclopramide

29
Q

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

A
  • Degeneration of articular cartilage with minimal inflammation.
  • Pain better at rest.
  • Pain is worse with motion.
30
Q

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

A
  • Bony swellings of the distal interphalangeal joints.
  • Osteoarthritis
31
Q

What spinal complications occur from osteoarthritis?

A
  • Vertebral degeneration
  • Nucleus pulposus herniation
  • Nerve root compression
32
Q

What are the treatments for osteoarthritis?

A
  • PT & exercise
  • Maintenance of muscle function
  • Pain relief
  • Joint replacement surgery
33
Q

Are osteoarthritis or rheumatoid arthritis patients prescribed corticosteroids?

A
  • RA patients (no steroids for OA)
34
Q

What anesthetic considerations exist for OA?

A
  • Airway ROM
35
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.
36
Q

What joints are usually spared by rheumatoid arthritis?

A
  • Thoracic & Lumbosacral spine
37
Q

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

A

Rheumatoid Arthritis

38
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)
39
Q

What cardiac symptoms can be seen with RA?
Pulmonary?

A
  • Pericarditis and accelerated CAD
  • Restrictive lung changes
40
Q

What two facial symptoms are often seen with RA?

A
  • Keratoconjunctivitis sicca (dry eye)
  • Xerostomia (dry mouth)
41
Q

What drugs are used to treat rheumatoid arthritis?

A
  • NSAIDs
  • Corticosteroids - bridge
  • DMARDs (methotrexate)
  • TNF-α inhibitors & Interleukin-1 inhibitors
  • Surgery
42
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)
43
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
44
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.

45
Q

Which condition causes multisystem chronic inflammation and antinuclear antibody production?

A

SLE

46
Q

What pathology is this and what are these lesions called?

A

Discoid lesions characteristic of SLE.

47
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.

48
Q

What cardiac symptoms are seen with SLE?

A
  • Pericarditis
  • CAD
  • Raynaud’s
49
Q

What type of arthritis is seen with SLE?

A
  • Symmetrical w/ no spinal involvement but frequent breakdown of femoral head.
50
Q

What pulmonary symptoms are characteristic of SLE?

A
  • Lupus pneumonia
  • Vanishing Lung syndrome
  • Restrictive lung disease
51
Q

What drugs are utilized to treat SLE?

A
  • NSAIDs or ASA
  • Antimalarials (HCQ & quinacrine)
  • Corticosteroids
  • Immunosuppressants
52
Q

What anesthesia considerations exist for SLE patients?

A
  • Recurrent laryngeal nerve palsy
  • Cricoarytenoid arthritis
  • Stress dose steroids likely necessary
53
Q

What condition often has recurrent laryngeal nerve paralysis?

A

Lupus (SLE)

54
Q

What are the early signs of malignant hyperthermia?

A
  • ↑CO₂
  • ↑HR
  • ↑RR
  • Jaw muscle spasm
  • Peaked T waves
  • Acidosis
  • Muscle rigidity
55
Q

What are the late signs of malignant hyperthermia?

A
  • Hyperthermia
  • Rhabdo & cola-urine
  • ↑CPK
  • VTach/Vfib
  • Acute renal failure
  • DIC
56
Q

What is initial Dantrolene (Ryanodex) dosing?
What is the max dose?

A
  • Initial: 2.5mg/kg.
  • Max: 10mg/kg
57
Q

How is MH testing done?

A

Muscle biopsy and halothane/caffeine contracture test (Fh/Fc)

now testing can be done w/mouth swabs

58
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.

59
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

60
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

61
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

62
Q

Preoperative findings of Duchenne muscular dystrophy include:

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

A

C. Kyphoscoliosis

63
Q

What renal considerations exists for scleroderma?

A

↓ renal blood flow
Systemic HTN

reanal crisis w/corticosteriods, tx ACE-I

worry about NPO status, contrast

64
Q

What is the gene associated with MH?

A

RYR1 gene (ryanodoine receptor)

65
Q

Masseter spasm after succinlycholine has been administered is associated with what condition?

A

Malignant Hyperthermia

66
Q

What is the mix for Dantrolene?

A

20mg + 3 G Mannitol + 60mL sterile water

Physical & Health Assessment COPY - Grayson (24 decks)

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