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Health Assessment > Musculoskeletal (Exam 2) > Flashcards

Musculoskeletal (Exam 2) Flashcards

1
Q

What is Scleoderma?

A
  • Inflammation and autoimmunity
  • Vascular injury with vascular obliteration
  • Tissue fibrosis and organ sclerosis
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2
Q

Scleroderma: CREST Syndrome

A
  • Calcinosis: Calcium deposits in the skin
  • Raynauds Phenomenon:
  • Esopheal Dysfunction
  • Sclerodactyly : thickening and tightening of skin around fingers
  • Telangiectasias: dilation of capillaries
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3
Q

Symptoms of Scleroderma: Skin

A
  • mild thickening
  • diffuse non-pitting edema
  • taut skin
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4
Q

Symptoms of Scleroderma: MS

A
  • Limited mobility/contractures
  • skeletal muscle myopathy
  • plasma CK increased
  • mild inflammatory arthritis
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5
Q

Symptoms of Scleroderma: Nervous System

A
  • Nerve compression
  • trigeminal neuralgia
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6
Q

Symptoms of Scleroderma: CV

A
  • Systemic and Pulmonary HTN
  • dysrhythmias
  • vasospasms in small arteries of fingers
  • CHF
  • Pericarditis
  • Pericardial effussion
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7
Q

Symptoms of Scleroderma: Pulmonary

A
  • Diffuse interstitial Pulmonary Fibrosis
  • Decreased pulmonary compliance
  • arterial hypoxemia
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8
Q

Symptoms of Scleroderma: Renal

A
  • Decreased Renal Blood Flow
  • Systemic HTN
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9
Q

Symptoms of Scleroderma: GI

A
  • Xerostomia
  • poor dentition
  • fibrosis of GI tract
  • Reflux
  • dysphagia
  • malabsorption syndrome
    * Reglan does not WORK
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10
Q

Scleroderma Treatment

A
  • Alleviating Symptoms
  • ACE - Inhibitors –> Renal Protection
  • CCB –> Raynauds
  • PPIs –> Reflux
  • Pulmonary HTN –> sildanefil

Tachycardia and Bradycardia are bad

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11
Q

Scleroderma Anesthesia: Airway Concerns

A
  • Mandibular motion
  • Small mouth opening
  • Neck ROM
  • Oral bleeding
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12
Q

Scleroderma Anesthesia: CV concerns

A
  • IV/arterial line access difficulty
  • contracted intravascular volume
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13
Q

Scleroderma Anesthesia: Pulmonary Concerns

A
  • Decreased Pulmonary Compliance and Reserve
  • Avoid increased PVR (hypoxia, hypercarbia, acidosis)
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14
Q

Scleroderma Anesthesia: GI Concerns

A
  • Aspiration Risk
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15
Q

Scleroderma Anesthesia Management: Other concerns

A
  • Eyes: Corneal abrasion
  • Regional anesthesia
  • keep warm
  • VTE prophylaxis
  • Postioning
    * Pulse OX difficulties
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16
Q

What is 3x more common in Scleroderma patients than the rest of the population?

A
  • VTE (Venous Thromboembolism)
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17
Q

Pseudohypertrophy Muscular Dystrophy: Duchenne Muscular Dystrophy (DMD)

A
  • Affects the Proximal skeletal muscle groups of the pelvic girdle
  • Mutation in the dystrophin gene
  • Fatty infiltration = pseudohypertrophic
  • 2-5 y/o males
  • X chromsome link recessive trait
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18
Q

What are the initial symptoms for Pseudohypertrophy/ Duchenne Muscular Dystrophy (DMD)?

A
  • Waddling gait
  • frequent falls
  • difficulty climibing stairs
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19
Q

Pseudohypertrophy/ Duchenne Muscular Dystrophy (DMD): Timeline

A
  • Affects the Proximal skeletal muscles of the pelvic girdle
  • Wheelchair bound by 8-10
  • Deterioration in muscle strength
  • Death by 20 -25 y/r
  • Normally die from CHF and/or pneumonia
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20
Q

Pseudohypertrophy/ Duchenne Muscular Dystrophy (DMD): CNS

A
  • Intellectual disability
  • avoid NMB, low gag reflex, high asp risk
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21
Q

Pseudohypertrophy/ Duchenne Muscular Dystrophy (DMD): MS

A
  • Kyphoscoliosis
  • skeletal muscle atrophy –long bone fractures
  • serum CK 20 -100x normal
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22
Q

Pseudohypertrophy/ Duchenne Muscular Dystrophy (DMD): Pulmonary

A
  • Weakened respiratory muscle and cough
  • OSA
  • poor reserve
  • d/t weakening of the diaphragm
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23
Q

Pseudohypertrophy/ Duchenne Muscular Dystrophy (DMD): GI

A
  • Hypomotility
  • Gastroparesis — prolonged NPO times
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24
Q

Pseudohypertrophy/ Duchenne Muscular Dystrophy (DMD): CV

A
  • Sinus tachycardia
  • cardiomyopathy
  • EKG abnormlaties
  • Short PR intervals
  • tall QRS
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25
Q

Pseudohypertrophy/ Duchenne Muscular Dystrophy (DMD): Anesthesia Concerns

A
  • Airway: weak laryngeal reflexes and cough
  • Pulmonary: weakened muscles
  • CV: Pre-Op EKG and/or ECHO based on severity
  • GI: Delayed gastric emptying
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26
Q

Pseudohypertrophy/ Duchenne Muscular Dystrophy (DMD): Anesthesia Management

A

* Avoid succinylcholine
* Pharnygeal and respiratory muscle weakness
* Rhabdomyolysis w/ administration of halogenated anesthetics
* MH – increased incidence (Dantrolene)
* Regional > GA

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27
Q

Myasthenia Gravis

A
  • Chronic autoimmune disorder
  • NMJ – Decreased functional post -synaptic ACH receptor
  • Muscle weakness w/ rapid exhaustion of voluntary muscle
  • Parial recovery with rest
  • ACh receptor-binding antibodies and thymus abnormalities
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28
Q

Myasthenia Gravis: S/S

A
  • Ptosis, diplopia and dysphagia
  • Dysarthria (difficulty speaking)
  • difficulty handling saliva
  • Isolated respiratory failure
  • Arm, leg, or trunk muscle weakness
  • Myocarditis
  • Autoimmune disease associated
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29
Q

Causes and symptoms of Myasthenic Crisis

A
  • Drug resistance or insufficent drug therapy
  • s/s: severe muscle weakness and respiratory failure
    * WILL NEED INTUBATED
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30
Q

Causes and symptoms of Cholinergic Crisis

A
  • Excessive anticholinesterase treatment
  • Can be caused by Neostigmine – give Glycopylorated w/Neostigmine
  • S/S: Muscarinic side effects – profound muscle weakness, salivation, miosis, bradycardia, diarrhea, abdominal pain
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31
Q

Edrophonium/Tensilon Test

A
  • 1-2 mg IV
  • Improves = myasthenic crisis
  • Worsens = Cholinergic Crisis
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32
Q

Myasthenia Gravis Treatment: Anticholinesterase

A
  • First line treatment
  • Pyridostigmine >Neostigmine
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33
Q

Myasthenia Gravis: Thymectomy

A
  • Induces remission
  • reduces use of immunosuppresives
  • reduces ACh receptor antibody levels
  • Full benefit delayed
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34
Q

Myasthenia Gravis: Immunosuppression medications

A

* Corticosteroids – most common and most effective
* Azathioprine
* cyclosporine
* mycophenolate

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35
Q

Myasthenia Gravis: Immunotherapy

A
  • Plasmapheresis – removes antibodies from circulation
  • Immunoglobulin – temporary effect; no affect on circulating ACh
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36
Q

Myasthenia Gravis: Anesthesia Management

A
  • Aspiration Risk
  • Weakened Pulmonary effort
  • Marked sensitivity to nondepolarizing muscle relaxant
  • resistance to succinylcholine
  • intermediate - acting muscle relaxant
  • Intubated without NMBD

Give ROC if you have to RSI

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37
Q

Osteoarthritis

A
  • Degenerative process affecting articular cartilage
  • Minimal Inflammation
  • Joint trauma
  • Pain present with motion, relieve by rest
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38
Q

Joint Trauma associated wtih Osteoarthritis

A
  • Biomechanical Stresses
  • Joint injury
  • abnormal joint loading
  • neuropathy
  • ligament injury
  • muscle astrophy
  • obesity
39
Q

What is the most common joint disease, leading chronic diseases of the elderly and a major cause of disability?

A

Osteoarthritis

40
Q

Name (6) Osteoarthritis signs/symptoms?

A
  • Weight bearing and distal interphalangeal joints
  • Herberden nodes– distal interphalangeal joints
  • Degenerative Disease – vertebral bodies and intervertebral disks
  • Protusion of the nuscleus pulposus
  • Compression of nerve roots
  • Middle to lower c-spine and l-spine
41
Q

Osteoarthritis Treatment: Non medications

A
  • PT and exercise
  • Maintaining muscle function
  • Pain Relief
  • Joint Replacement surgery
42
Q

Osteroarthritis: Anesthesia Management

A
  • Airway
  • Limited ROM
43
Q

Rheumatoid Arthritis

A
  • Autoimmune- mediated, systemic inflammatory disease
  • Proximal interphalangeal and metacarpophalangeal joints
  • Rheumatoid nodules at pressure points
  • Rheumatoid factor
44
Q

Does Rheumatoid Arthritis occur more in Males or Females?

A
  • Females
  • 2-3x more
45
Q

Rheumatoid Arthritis: S/S overview

A
  • Single or multiple joints
  • painful synovial inflammation, swelling, and increased fluid
  • Morning stiffness
  • symmetrical distribution of several joints
  • Fusiform swelling
  • Synovitis of temporomandibular joint
  • Affects nearly all joints
46
Q

What joints does Rheumatoid Arthritis not affect?

A
  • Thoracic spine
  • lumbarsacral spine
47
Q

Rheumatoid Arthritis: Atlantoaxia Subluxation

A
  • Odontoid process protrudes into the foramen magnum.
  • Pressure on the spinal cord or impairs vertebral artery blood flow. —-> increase risk of stroke, bowel/bladder incontinence , paraplegia/paralysis
48
Q

Rheumatoid Arthritis: Cricoarytenoid Arthritis

A
  • Acute -hoarsness, dysnea, and stridor w/ tenderness over larynx
  • swelling and redness of arytenoids
  • Chronic – asymptomatic or variable degrees of hoarseness, dyspnea and upper airway obstruction
49
Q

Rheumatoid Arthritis: NM

A
  • Weakened Skeletal muscle– adjacent to joints w/ active synovitis and neuropathy
  • AVOID NEUROMUSCLULAR BLOCKERS
  • Peripheral neuropathies
50
Q

Rheumatoid Arthritis: CV symptoms

A
  • Pericarditis
  • accelerated coronary artherosclerosis
  • High risk for interoperative MI
51
Q

Rheumatoid Arthritis: Pulmonary symptoms

A
  • Restricitive Lung changes (decrease in VC, lung volumes)
  • pleural effussion
  • Rheumatoid nodules can develop
52
Q

Rheumatoid Arthritis: Hematology symptoms

A
  • Anemia
  • neutropenia
  • elevated platelets
53
Q

What is Keratoconjunctivitis sicca and xerostomia? What is is associated?

A
  • Sjogens Syndrome
  • Rheumatoid Arthritis
54
Q

Rheumatoid Arthritis: Treatments

A
  • PT/OT
  • NSAIDs
  • Corticosteroids
  • DMARDS
  • Tumor Necrosis Factor inhibitors (TNF) and interleukin (IL-1) inhibitors
  • Surgery
55
Q

Rheumatoid Arthritis: NSAIDS

A
  • Decrease joint swelling, relieve stiffness, provide analgesia
  • COX-1 and COX-2 inhibitors
56
Q

Rheumatoid Arthritis: Corticosteroids

A
  • Decrease joint swelling, pain and morning stiffness
57
Q

Rheumatoid Arthritis: DMARDS

A
  • Disease modifying anti-rheumatic drugs
  • Halt or slow disease progression
  • Methotrexate
58
Q

Rheumatoid Arthritis: Tumor Necrosis Factor and Interleukin Inhibitors

A
  • TNF-alpha > DMARDS
  • IL-1 inhibitors – slower onset and less effective
59
Q

Rheumatoid Arthritis: Surgery

A
  • Intractable pain, impairment of joint function, joint stabilization
  • Total replacement
  • Can help with symptoms, but not cure
60
Q

Rheumatoid Arthritis: Anesthesia Management

A
  1. Airway
    * atlantoaxial subluxation
    * TMJ limitation
    * Cricoarytenoids joints
  2. Severe Rheumatoid lung disease
  3. Protect eyes
  4. Stress Dose – corticosteroids
61
Q

Systemic Lupus Erythematosus definition

A
  • Multisystem Chronic Inflammatory
  • Antinuclear antibody production
62
Q

Systemic Lupus: Typical Manifestation

A
  • Antinuclear antibodies
  • Characteristic malar rash – butterfly rash
  • Thrombocytopenia
  • Serositis
  • Nephritis
63
Q

Who is the most at risk for Lupus?

A
  • Young women and African Americans: 15-40 y/o
  • Pregnancy w/ nephritis and HTN = risk of exacerbation and/or poor fetal outcomes
64
Q

What drugs can induce Lupus?

A
  • Hydralazine
  • Procainamide
65
Q

What is the most commonly assiciated rash with Lupus, beside the butterfly rash?

A
  • Aculopapular rash
  • Areas that are exposed to sunlight
66
Q

Systemic Lupus Erythematus: S/S

A
  • Polyarthritis and dermatitis
  • Symmetrical arthritis – no spinal involvement; Avascular nectrosis of femoral head or condyle
67
Q

Systemic Lupus Erythematus: CNS

A
  • Cognitive Dysfunction
  • psychological changes
  • anxiety, depression, migraines, fibromyalgia
68
Q

Systemic Lupus Erythematus: CV

A
  • Pericarditis
  • Coronary artherosclerosis
  • Raynaulds
69
Q

Systemic Lupus Erythematus: Pulmonary

A
  • Lupus pneumonia
  • restrictive lung disease
  • vanishing lung syndrome
70
Q

Systemic Lupus Erythematus: Renal

A
  • Glomerulonephritis
  • Decreased GFR
  • hematuria
71
Q

Systemic Lupus Erythematus: GI/Liver

A
  • ABD pain
  • pancreatitis
  • elevated liver enzymes
72
Q

Systemic Lupus Erythematus: NM

A
  • Skeletal muscle weakness
73
Q

Systemic Lupus Erythematus: Hematology

A
  • Thromboembolism
  • Thrombocytopenia
  • hemolytic anemia

ASA or plavix d/t high risk

74
Q

Systemic Lupus Erythematus: Skin symptoms

A
  • Butterfly-shaped malar rash
  • discoid lesions
  • alopecia
75
Q

Systemic Lupus Erythematus: Treatment

A
  • NSAIDs or ASA
  • Anti-malaria –> hydrocholoquine and quinacrine
  • Corticosteroids
  • Immunosuppressants (better than steroids) –> Methotrexate, azathiprine
76
Q

Systemic Lupus Erythematus: Anesthesia Management

A
  • Stress dose of Corticosteroids
  • Airway: recurrent laryngeal nerve palsy, cricoarytenoid athritis
  • Based on mainfestation and organ dysfunction
77
Q

Malignant Hyperthermia Overview

A
  • Anesthesia Specific
  • Hypermetabolic syndrome
  • Genetic Mutation – Ryanadine Receptors (RYR1) and dihydropyridine receptors
  • Exposure to Inhaled VA and succinylcholine
    * 50% mortality
  • Family history
  • Uncontrolled elevation of sarcoplasmic calcium
  • Sustained activation of muscle contractions
  • Rhabdomylosis
78
Q

Malignant Hyperthermia: Non-triggering Agents

A
79
Q

Malignant Hyperthermia: Early and Late s/s

A
80
Q

Malignant Hyperthermia: Treatment

A
  • D/C all triggering gas/drugs
  • Hyperventilation with 100% O2 @ 10L/min
  • Change breathing circuit and soda lime
  • Dantrolene
  • Treat Arrythmias
  • Monitor urine output
81
Q

What medication do you use to treat Malignant Hyperthermia? How is it prepared?

A
  • Dantrolene
  • 20 mg + 3G mannitol
  • mix w; 60 mL sterile water
  • Intial dose 2.5 mg/kg
  • Max Upper limit: 10 mg/kg
82
Q

Malignant Hyperthermia: Post-Op

A
  • Transfer to ICU 24 - 48 hours
  • Report to MH registery
  • MH testing for pt and family members – muscle biopsy
83
Q

Why do we use a Stellate Ganglion Block?

A

* Prevents SNS surges
* i.e: Recurrent chest pain, sceroderma, long COVID, chronic pain syndrome, hyperhydrosis.

84
Q

Homer’s Syndrome

A
  • Partial ptosis (drooping or falling of the upper eyelid)
  • Miosis (constricted pupil)
  • Facial anhidrosis (absence of sweating) due to a disruption in the sympathetic nerve supply
  • *** Phrenic Nerve Blockade Association
  • Caused by Stellate Ganglion Blockade
85
Q

What are the 5 parts of the Brachial Plexus?

A
  1. Root
  2. trunk
  3. divisions
  4. cords and branches
    Read That Damn Cadaver Book
86
Q

Innervation of the Hand

A
87
Q

Name the 1st sign of MH

A
  • ETCO2
88
Q

After your ETCO2 increases with MH, what other signs will you see?

A
  • HR, BP, then temp
89
Q

MH Presentation: RAT

A
  • Rigidity
  • Acidosis
  • temp
90
Q

Pathogenesis of MH

A
  • genetic predisposition d/t ryanodine receptor gene mutation —-> Excessive calcium accumalation in response to certain anesthetic trigger agents.
  • Hypermetabolic state w/ sustained cxn and muscle breakdone (rhabdomyolysis)
91
Q

Name the Clinical Features of MH

A
  • Onset – after induction
  • Hearalding signs: High ETCO2 and tachypnea and RAT (rigdity, acidosis, temp)
92
Q

(4) diffentials that can mimic MH

A

CATS
* Catecholamine tremor from phenochromocytoma
* Acute porphyria crisis
* thyrotoxicosis (thyroid storm)
* sepsis

93
Q

Management of MH

A

SHADE
* Stop d/c inhaled agent
* heat control w/ IV fluids
* Activated charcoal
* Dantrolene (Rhyanodex)
* Electrolytes

Health Assessment (7 decks)

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