Neuro, MSK

Question 1

the point of pre op assesssment

Answer 1

to decreased M&M

Question 2

should review/ask every one

Answer 2

surgical diagnosis, organ systems involved, and planned procedure
medications, drug allergies, substance abuse, review of systems, and prior anesthetic experience

Question 3

Neuro EKC when..

Answer 3

Cardiac resp advanced age

Question 4

Neuro CXR when

Answer 4

HF, pulm edema, pneumo, infx

Question 5

Guillain barre

Answer 5

Ascending peripheral demyelinating dz, 3 phase: avoid anestheisa during worsening or stable phase.
FA(G) SIP
facial paralysis-brain stem involvement, AIRWAY/CARDIAC
difficulty swallow- weak muscle AIRWAY
impaired ventilation-
pain- HA, back, muscle tenderness, What mess for control?
ANS dysfunction: sever hypotension with position changes
CONCERNS: ecg-recent arrhythmias, vasoactive drugs for Htn hotn

Question 6

MS

Answer 6

recent illness
remission/exacerbation-intervals, severity 
resp status- wob, RA sat, *CXR bs
previous triggers
steroids
*may relapse post surg

Question 7

MS document

Answer 7

motor strength
sensory disturbance
ANS disturbances: HR, BP
CN-visual changes

Question 8

Parkinson

Answer 8

when dx
current symptoms
exacerbations
ANS disturbances- orthostatic  
dysphagia/dyspnea- aspiration risk
pulm status-accessory muscles 
meds-levadopa does it help? or MAOIs
turn off brain stimulator

Question 9

intervertebral disc herniation

Answer 9

risk for massive BL-CBC, T&S
cervical spine ROM/positioning
baseline motor and sensory

Question 10

Spinal cord injury 2 types explain

Answer 10

1 Acute: Spinal shock- lose autonomic reflexes below lesion (vasodilate) if lesion higher in thoracic risk heart not responding to dilation
*Considerations: ECG (bc of lg release of epi and NE from adrenal m) CRX-resp function? CBC, Chem7, T&C–fluid status
2 Chronic: Autonomic dysreflexia-
*Considerations: what initiated it, pressurs that work? ICU chart review, resp reserve?
positioning and skin integrity

Question 11

Cerebrovascular disease

Answer 11

ask about TIA symptoms
consided carotid doppler U/S
when, where, residual symptoms
motor sensory deficits

Question 12

CVA, Head injury, Tumor

Answer 12

ICP: dec HR ince BP
pupils, N/V, mental status, LOC, HA, Sz
mech of injury, when, location, size
Neuro: Mental status, LOC, Pupils, motor and sensory
CV: head injury--tachy, HTN
Fluid: mannitol, elytes ECG
Pulm: vent settings, abg

Question 13

Sz

Answer 13

when dx, whats the cause, how long, frequency, symptoms, tx, status,
current meds-compliant,
ETOH hx

Question 14

Lupus

Answer 14

global vasculitis: HTN, Sx, arthritis, restrictive lung, glomerulonephritis
EXERCISE TOLERANCE 
Skin: butterfly 
Cardiac: CHF, value dysfunction pericarditis ECG ECHO
plum: restrictive-pft
Gi: nv 
Renal: g--BUN/cr chem
Extremities: raynaods 

Steroids
Methotrexate
looking at end organ damage
ROM, neuromuscular strength, cranial neuropathies, mentation, Cardiac status
labs: CBC, coags (dvt risk) echo, PFTs, BUN/cr
meds: may effect coag

Question 15

RA

Answer 15

ROM: atlanto-axial joint can sublex compressing vertebral art and sc—need CT
difficult airway
neuro, pulm (restrictive lung), CV, airway
in cardiac involvement hard to assess exercise tolerance so echo

Question 16

Osteoarthritis

Answer 16

natural ROM

what pain meds works

Question 17

Muscular dystrophy

Answer 17

ROM
muscle strength
resp function
delayed gastic motility- aspiration

Question 18

Myasthenia gravis

Answer 18

degree skeletal muscle weakness
resp function 
prolonged intubation, ICU admission
meds: steroids-immunosupp, cholinesterase inhibitors 
reverse all paralytics: may not need NMB

Question 19

Myasthenic syndrome

Answer 19

degree of muscle weakness

Question 20

Marfan syndrom

Answer 20

PET the marfan 
cardiapulm assessment
TMJ
echo-values
pneumo

Question 21

Ankylosing spondylitis

Answer 21

ROM-difficult airway
ECG cardiac conduction
PFT-fibrosis