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Co-Exisiting Disease 2 > Skin & Musculoskeletal Diseases > Flashcards

Skin & Musculoskeletal Diseases Flashcards

1
Q

Acanthosis nigricans and atopic dermatitis

A

Rashes

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2
Q

How are epidermolysis, pemphigus, and mastocytosis all treated?

A

Steroids

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3
Q

Profound hypotension with radiocontrast media

A

Mastocytosis

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4
Q

What is worsened by various elements of anesthetic management?

A

Weeping skin lesions and/or risk of generalized infection

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5
Q

How is mastocytosis pretreated?

A

H1 and H2 histamine receptor antagonists and a glucocorticoid before procedure involving contrast dye

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6
Q

4 main things with skin diseases?

A
  1. Avoid histamine release
  2. Warm cold drugs before injection
  3. Warm IV fluids and increase temp of OR
  4. H1 and H2 receptor antagonists and corticosteroids
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7
Q

Large blisters on the skin that are filled with clear fluid

A

Bullae

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8
Q

Bullae formation can be caused by (5)

A

Trauma from: tape, BP cuff, tourniquet, adhesive electrodes, alcohol wipes

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9
Q

Chronic scarring of the oral cavity from bullae can result in what?

A

Narrow oral aperture and immobility of the tongue

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10
Q

Which bullae has not been reported?

A

Tracheal bullae

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11
Q

Anesthesia management with bullae?

A

Anything that touches pt should be well padded

Trauma from: tape, BP cuff, tourniquet, adhesive electrodes, alcohol wipes

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12
Q

Bullae and airway?

A

Treat gently

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13
Q

Hemorrhage from ruptured oral bullae can be treated with what?

A

Epi soaked gauze

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14
Q

Intubation and bullae?

A

Tube must be carefully immobilized with soft cloth bandages

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15
Q

Inflammation and autoimmunity, vascular injury with eventual vascular obliteration, and fibrosis and accumulation of excess matrix in many organs and tissues

A

Scleroderma

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16
Q

What can trigger scleroderma (3)

A

Toxins, drugs, and some microbial pathogens

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17
Q

Age scleroderma typically onsets

A

20-40, women

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18
Q

What can you get with scleroderma?

A

CREST syndrome

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19
Q

What does CREST syndrome stand for?

A 
C: calcinosis 
R: Raynaud’s phenomenon 
E: esophageal dysfunction 
S: sclerodactyly
T: telangiectasia
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20
Q

White or cold skin on the hands and feet when you’re cold or stressed. It’s caused by BF problems.

A

Raynaud’s phenomenon

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21
Q

Tightness and thickening of finger or toe skin. Can be hard to bend fingers

A

Sclerodactyly

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22
Q

Red spots on hands, palms, forearms, face, and lips. Cause by widened blood vessels.

A

Telangiectasia

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23
Q

Scleroderma may predispose to?

A

Corneal abrasions

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24
Q

What does scleroderma affect? (7)

A

Skin and musculoskeletal system, NS, CVS, lungs, kidneys, and GI tract

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25
Q

Scleroderma and lungs?

A

Pulmonary HTN, may require higher airway pressures, and avoid increase PVR

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26
Q

Scleroderma and opioids?

A

Sensitive to respiratory depressant effects

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27
Q

Long tubular bones, giving them a tall stature and “Abe Lincoln” appearance

A

Marfan syndrome

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28
Q

Marfan syndrome and lungs (2)

A

Emphysema and pneumothorax

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29
Q

Marfan syndrome and CV? (5)

A
  1. Aortic dilation
  2. Aortic dissection
  3. Aortic rupture
  4. Prolapse of valves (mitral)
  5. BBB
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30
Q

What kind of therapy is common for Marfan syndrome?

A

Prophylactic BB

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31
Q

Marfan syndrome and pregnancy?

A

Rupture and dissection of aorta

32
Q

Why kind of minoring is needed for Marfan syndrome?

A

Invasive monitor: Transesophageal echocardiography

33
Q

Inherited connective tissue disorders caused by abnormal production of pro collagen and collagen

A

Ehlers-danlos syndrome

34
Q

Ehlers-danlos syndrome and blood vessels, bowel, uterus?

A

Can be ruptured

35
Q

S/s of ehlers- danlos syndrome? (5)

A
  1. Joint hyper mobility
  2. Skin fragility or hyper elasticity
  3. Bruising and scarring
  4. Musculoskeletal discomfort
  5. Susceptibility to osteoarthritis
36
Q

What should be avoided with anesthesia and ehlers-danlos syndrome? (2)

A
  1. IM injections/instrumentation of nose or esophagus

2. Regional

37
Q

ECG of muscular dystrophy (4)

A
  1. Tall R in V1
  2. Deep Q waves in limb leads
  3. Short PR interval
  4. Sinus tachycardia
38
Q

Muscular dystrophy’s muscle tissue eventually replaced by?

A

Fat and connective tissue; pseudo hypertrophy

39
Q

Pseudohypertrophic (enlarging) of what 2 things?

A

Tongue and calf muscles

40
Q

Can you use sux for muscular dystrophy?

A

NO bc risk of rhabdomyolysis, hyperkalemia, and/or cardiac arrest

41
Q

What has an increased incidence with muscular dystrophy?

A

MH so have dantrolene available

42
Q

7 inherited myopathies:

A
  1. Nemaline rod myopathy
  2. Myotonia congenital
  3. Paramyotonia congential
  4. Periodic paralysis
  5. Central core disease
  6. Multi core myopathy
  7. Centronuclear myopathy
43
Q

Myopathies sux and NMDR effects?

A

Unpredictable

44
Q

Group of disorders of skeletal muscle energy metabolism; defects result in abnormal fatigability with sustained exercise, skeletal muscle pain, and progressive weakness

A

Mitochondrial myopathies (kearns-sayre syndrome)

45
Q

Mitochondrial myopathies (kearns-sayre syndrome) and GA? (3)

A
  1. Drug induced myocardial depression
  2. Develop cardiac conduction defects
  3. Hypoventilation during early post op
46
Q

Alcoholic myopathy/ floppy infant syndrome effect with managing anesthesia? (3)

A
  1. NDMR increased sensitivity and sux can cause hyperkalemia
  2. Infants risk MH
  3. Ketamine does not cause significant respiratory
47
Q

What do you think of when you see myopathies?

A

Muscle relaxants and K+

48
Q

Most common disease affecting NMJ; decrease in functional ACh receptors at NMJ resulting from their destruction or inactivation by circulating antibodies

A

Myasthenia gravis

49
Q

MG and eye problem?

A

Deviation and dropping eyelid

50
Q

Limited to involvement of extraocular muscles (10% pts)

A

Type 1 MG

51
Q

Slowly progressive, mild form of skeletal muscle weakness that spares muscles of respiration (respond to anti cholinesterase drugs and corticosteroids)

A

Type 2a MG

52
Q

More rapidly progressive and more severe form of skeletal muscle weakness (respond to drug therapy is not as good, respiration muscles may be involved)

A

Type 2b MG

53
Q

Acute onset and rapid deterioration of skeletal muscle strength within 6mths (high mortality rate)

A

Type 3 MG

54
Q

Severe form of skeletal muscle weakness that results from progression of type 1 or 2

A

type 4 MG

55
Q

Chest X-ray and ct scan to evaluate their need to remove thymus and any cancerous tissue that may be present and how often is this seen in MG pts?

A

Thymomas; 10%

56
Q

If surgery is performed to remove thymoma, does it lead to remission of MG?

A

NO

57
Q

MG and intubation?

A

Can be accomplished without NMB bc of intrinsic muscle weakness and relaxant effect of volatile anesthetics on skeletal muscle

58
Q

Skeletal muscle weakness usually with small cell carcinoma of lung; this deficiency restricts Ca++ entry when terminal is depolarized

A

Myasthenic syndrome

59
Q

What other syndrome resembles MG?

A

Eaton-lambert syndrome

60
Q

Myasthenic syndrome and muscle relaxants

A

Sensitive to both NDMR and DMR; anticholintesterase drugs may be inadequate; so decrease doses of muscle relaxants

61
Q

Most common joint disease, degenerative process that affects articular cartilage; most common in knees and hips

A

Osteoarthritis

62
Q

Anterior flexion of spine

A

Kyphoscholiosis

63
Q

Pulmonary function and skeletal disease?

A

Restrictive lung disease

64
Q

Most common inflammatory arthritis; morning stiffness and metacarpophalangeal involvement

A

Rheumatoid arthritis

65
Q

Pts will be on what drugs for rheumatoid arthritis?

A

NSAIDs and/or glucocorticoids

66
Q

What joints are affected with rheumatoid arthritis?

A

Every joint except thoracic and lumbosacral spine

67
Q

Rheumatoid arthritis and neck movement?

A

Atlantoaxial subluxation may be present; minimize movement of head and neck during DL to avoid further displacement of odontoid process and damage to brainstem or spinal cord

68
Q

Spinal column can be stiff and deformed and prevent appropriate cervical spine motion for endotracheal intubation; restrictive lung disease from costochondral rigidity and flexion

A

Ankylosing spondylitis

69
Q

Best approach for spinal and epidural anesthesia?

A

Para median

70
Q

What Genetic marker in people with inflammatory arthritis of spine and joints (not osteoarthritis) and is associated with presence of one of a group of diseases called what?

A

HLA-B27; seronegative spondyloarthropathies

71
Q

HLA-B27 genetic marker can be seen in what 3 diseases?

A
  1. Ankylosing spondylitis (AS)
  2. Psoriatic arthritis
  3. Reiter’s syndrome (reactive arthritis)
72
Q

2 forms of dwarfism?

A
  1. Proportionate

2. Disproportionate

73
Q

Marked dilation of trachea and bronchi; walls are abnormally flaccid and may collapse during coughing

A

Tracheomegaly

74
Q

Osteogenesis imperfecta has the potential for what?

A

Additional fractures

75
Q

Pigeon chest

A

Pectus carinatum

76
Q

Inward concavity of sternum

A

Pectus excavatum

77
Q

Infrequent but potentially lethal postop complication;
Posterior fossa crani performed in sitting
Arterial compression
Venous compression with neck flexion
Head down position
Mechanical compression of tongue by teeth, oral airway, ETT

A

Macroglossia

Co-Exisiting Disease 2 (11 decks)

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