Skin & Musculoskeletal Dz

Question 1

The main anesthetic concerns in pts with _________ center on the serious complications that can occur if proper precautions are not taken during any form of pt manipulation or instrumentation

Answer 1

Epidermolysis bullosa

Question 2

Anesthetic concerns for epidermolysis bullosa:

Answer 2

Avoidance of trauma to the skin & mucous membrane is crucial;
Bulla formation can be caused by trauma from tape, BP cuff, tourniquets, adhesive electrodes, & rubbing of skin with alcohol wipes;
BP cuffs should be padded w/ a loose cotton dressing;
Electrodes should have the adhesive portion removed (petroleum jelly guaze to hold in place);
Anything that touches a pt should be well padded;
IV and art lines should be sutured in place or guaze wraps;
Nonadhesive pulse ox;
Place soft foam, sheepskin, or gel pad under pt

Question 3

H1 & H2 receptor antagonist should be given preop to decrease clinical response to histamine relaese in ________?

Answer 3

Mastocytosis

Question 4

What drugs should be avoided with mastocytosis? Why?

Answer 4

Morphine, benzylisoquiniloniums. B/c they stimulate histamine release

Question 5

All pts with chronic urticaria should be advised to avoid which drugs?

Answer 5

ACE inhibitors, aspirin, & NSAIDs

Question 6

Scleroderma is characterized by what 3 interrelated processes?

Answer 6

1) inflammation and autoimmunity;
2) vascular injury w/ eventual vascular obliteration;
3) fibrosis and accumulaiton of excess matrix in many organs & tissues

Question 7

CREST syndrome a/w scleroderma

Answer 7

Calcinosis, Raynaud’s phenomenon, Esophageal hypo motility, Sclerodactyly, Telangiectasia

Question 8

A connective tissue disorder d/t defects in large glycoprotein fibrillin-1 inherited as autosomal dominant . Pts have long tubular bones and an “Abe Lincoln” appearance

Answer 8

Marfan Syndrome

Question 9

What is the main cause of all premature deaths in pts with Marfan syndrome?

Answer 9

Cardiovascular abnormalities

Question 10

Management of anesthesia must consider the vulnerability of pts with polymyositis to _____

Answer 10

Pulmonary aspiration

Question 11

Are NDNMBs and sux safe with polymyositis?

Answer 11

Responses are normal, however w/ skeletal muscle weakness there is concern. Give half dose and check tiwtches before giving more

Question 12

A group of hereditary diseases characterized by PAINLESS degeneration of muslce fibers

Answer 12

Muscular dystrophy

Question 13

What age does duchenne muscular dystrophy become apparent?

Answer 13

2-5 yr old boys

Question 14

Children with duchenne muscular dystrophy are typically confined to a wheelchair by ______

Answer 14

8-10

Question 15

Intellectual disability is often present with which muscular disorder?

Answer 15

Duchenne muscular dystrophy

Question 16

_________, __________, & ________ are not able to prevent or relieve skeletal muscle contraction with myotonic dystrophy

Answer 16

General anesthesia, regional anesthesia, & nueromuscular blockade

Question 17

The inability of skeletal muscle to relax after voluntary contraction or stimulation results from _______? (Myotonic dystrophy)

Answer 17

Abnormal calcium metabolism

Question 18

Hereditary degenerativ diseases of skeletal muscle characterized by persistent contracture after voluntary contraction of a muscle or following electrical stimulation

Answer 18

Myotonic dystrophy

Question 19

A decrease in functional ACh receptors at the NMJ resulting from their destruciton or inactivation by circulating antibodies leading to marked sensitivity to non-depolarizing muscle relaxants

Answer 19

Myasthenia Gravis

Question 20

Who are most often affected by MG?

Answer 20

Women aged 20-30; men are often older than 60

Question 21

The clinical course of MG is marked by?

Answer 21

Periods of exacerbation & remission

Question 22

________, especially ________ can aggravate muscle weakness a/w MG

Answer 22

Antibiotics, aminoglycosides

Question 23

Anticholinesterase drugs effective in the treatment of MG do NOT produce improvement in which pts?

Answer 23

Eaton-Lambert Syndrome (myasthenic syndrome)

Question 24

Proximal limb weakness (legs > arms), exercise improves strength, muscle pain common, reflexes absent or decreased;
Affects males more than females;
Co-exists w/ small cell lung cancer;
Sensitive to Sux & NDNMB w/ poor response to anticholinesterase

Answer 24

Myasthenic Syndrome

Question 25

Extraocular, bulbar, & facial muscle weakness, exercise causes fatigue, muscle pain uncommon, reflexes normal;
Affects femals > males;
Co-exists w/ Thymoma;
Resistant to Sux but sensitive to NDNMB w/ good response to anticholinesterase

Answer 25

Myasthenia Gravis

Question 26

Pain usually present on motion and relieved by rest.
Stiffness tends to disappear rapidly with joint motion (physical therapy).
Pain can also be relieved w/ heat, acetaminophen, & anti-inflammatory drugs

Answer 26

Osteoarthritis

Question 27

What causes symptoms to worsen with Lumbar Spinal Stenosis? Improve?

Answer 27

Worsen with standing or walking; improve in flexed or supine position

Question 28

Hallmark of rheumatoid arthritis

Answer 28

Morning stiffness

Question 29

Management of aortic regurg in ankylosing spondylitis includes:

Answer 29

Keeping HR 90 or higher and SVR lower than normal

Question 30

Excessive osteoblastic & osteoclastic activity that results in abnormally thick but weak bones. Usually involves excess of ____ or deficiency of _____.

Answer 30

Paget’s Disease; PTH, calcitonin

Question 31

Most common symptom of Paget’s Disease

Answer 31

Bone pain

Question 32

Interscalene block may be problematic and is best avoided in which patients?

Answer 32

COPD or neuromsucular dz associated w/ weakness of the respiratory muscles

Question 33

How could succinylcholine result in fractures in pts with Osteogenesis Imperfecta?

Answer 33

The sux induced fasiculations

Question 34

Infrequent bu t potentially lethal postop complication most often a/w posterior fossa crainiotomy performed in the sitting position

Answer 34

Macroglossia