Test 3 Part 2 Flashcards
what is CREST syndrome and what dz is it affiliated with?
calcinosis
raynauds
esophogeal dysmotility
sclerodactyly
telangiectasia
limited cutaneous systemic sclerosis
which type of scleroderma is characterized as a rapidly progressive dz with generalized skin involvement and CV complications like CAD, cardiomyopathy, and HTN?
diffuse cutaneous sclerosis
__________________ sclerosis is rare and has the classic internal organ presentation without cutaneous manifestation
systemic
complications/concerns with systemic sclerosis
- chronic renal failure in > 50% of pts
- polymyositis (muscle pain)
- raynauds (>95%)
- tightening of skin around mouth/fibrosis limits neck extension (airway)
- Sjogren syndrome
- Difficult IV access
- Contractures: positioning concerns
difficult IV access is a hallmark of _______________
scleroderma
H&P for pt with scleroderma
- type/onset and sx
- airway examination
- CV and pulm : myocardial and pulm fibrosis
- GI prophylaxis r/t poor gastric emptying
- Raynauds
- evaluate other organ involvement esp kidney
- extremities for IV access
- Current meds and Side effects
pts with scleroderma may need GI prophylaxis due to…
decreased GI motility –> frequent episodes of gastric reflux which increases risk of aspiration pneumonitis
decreased Small intestine and colonic motility can –> pseudo obstruction
when would you consider CBC for pt with scleroderma?
if on immunosuppresants
when would you consider ordering a PT & albumin level for pt with scleroderma
if appear malnourished
what labs would you consider for pt with scleroderma?
CBC
PT and albumin
BUN/Cr
electrolytes
if a patient with scleroderma presents and during the H&P they state that their sx include extreme muscle pain, what lab would you consider?
Cr phosphokinase (CPK)
what preop meds should the patient with scleroderma be taking prior to surgery to treat Raynauds symptoms? and should they be continued DOS?
calcium channel blockers; yes
what preop meds should the pt with scleroderma be on prior to surgery for renal protection? should they be taken DOS?
ACEI/ARB ; NO
pts with scleroderma should be on a _______________ for reflux prior to surgery; if not you should ______________.
PPI; GI prophylax
preop pulmonary meds for pt with scleroderma d/t severe pulmonary HTN
prostacyclins or phosphodiesterase inhibitors, O2,
what preop CV meds should pt with scleroderma be on/considered ?
digoxin (improve CO)
diuretics
anticoags
when should a pt with scleroderma be on a immunosuppressant preoperatively?
for severe or worsening cutaneous sx, lung, cardiac, and muscle involvement but with limited success
pt with scleroderma what meds/tx are continued throughout the perioperative period?
antireflux
vasospasm
pulmonary HTN
anesthetic considerations for pt with scleroderma
- difficult venous access
- keep warm to prevent reynauds flare up
- consider videolaryngoscope or FOB
- aspiration prophylaxis
- regional anesthesia
- avoid depressant anesthetics
- intraoperative monitoring determined by comorbid dx of pulmonary htn or cardiac fibrosis
T/F: you should consider nasal intubation in pt with scleroderma
false; AVOID nasal intubation
T/F: A-line should be placed in pt with scleroderma undergoing surgery
false; Aline placement carries higher than usual risk d/t already poor circulation
_____________ is 3x more common in pts with scleroderma; therefore, appropriate prophylaxis necessary
VTE
__________________ is the degeneration of the articular cartilage characterized by inflammation and pain with joint motion
osteoarthritis
what is the difference between RA and OA
no systemic manifestations with OA
what joints are commonly involved with RA?
fingers, hands, wrists, knee, ankle, toes
TMJ, sternoclavicular, shoulder, elbow, and hip can also be involved (less common)
what joints are commonly involved with OA
distal fingers, thumb-wrist joint, hip, knee, big toe
proximal IPJ can also be involved (less common)
_______________ is the most common form of arthritis in the US secondary to aging population and obesity
OA
what is the leading cause of lower extremity disability
OA
on the kellgren-Lawrence grading system of OA, on a scaled of ____ - ____; definite radiographic OA is defined as KL grade of ________ or higher
0;4;2
OA is defined radiographically through the _______________________
Kellgren-Lawrence Grading severity of OA 0-4
Pathologically OA is defined/characterized by?
cartilage loss
osteophytes
subchondral bone marrow lesions and bone attrition
meniscal lesions (knees)
synovitis and effusion
clinically OA is defined/characterized by?
pain on weight bearing activity at the early stages, with progression to more persistent pain as well as fx’al limitations and disability
how do you manage OA?
- wt loss
- exercise
- physiotherapy
- bracing in certain areas
- tylenol and NSAIDs
- opoids
- Local injections +/- corticosteroids
- Viscosupplmentation (hyaluronic acid)
- surgery
for OA, joint replacement is typically performed as last option in the late stages with outcome for _____________ being better than for _____________
hip; knee
H & P for pt with OA
- what joints are involved? C-spine?
- Routine Review of Systems
- Chronic pain? if so what meds?
- neuro assessment for sensory/motor deficits
do you typically have issues with intubation (r/t C-spine) in pts with OA?
not typically; may have issues if are obese or have other comorbidities
Preop Testing for pt with OA
- no specific testing r/t OA
- may do testing related meds
- Evaluate functional capacity - activity limited by joint pain?
if pt is on herbal medications like ginko to help their OA. It should be recommended to be stopped _________ days prior to surgery
7
anesthesia consideration for pt with OA
- if have pain in C-spine with flexion –> intubate in neutral position use videolaryngoscope/FOB
- regional considerations: can you acutally perform the block and it work appropriately?
most cases of kyphoscoliosis are idopathic, with it classically presenting in ____________________
adolescent males
pt may have 2ndary kyphoscoliosis d/t underlying ___________________
neuromuscular dz
when is kyphoscoliosis consider pathologic?
if anterior curvature of any region of the spine is > 45 degrees
_______________ is lateral curvature of the spine, and is frequently found with ____________
scoliosis ; kyphosis
T/F: kyphosis is often isolated
true
dx and severity of kyphoscolosis is based on the measurement of the ______________
cobb angle
kyphoscoliosis can be associated with severe __________________________
restrictive pulmonary dz
_______________ and _______________ may induce spinal cord damage bc of the sharp angulation of the spine
kyphosis ; kyphoscoliosis
what treatment for kyphosis/kyphoscoliosis is indicated to prevent long term ventilatory compromise, restrictive lung disease, and cardiopulmonary sequelae
surgery
surgery for kyphoscoliosis is usually indicated with scoliosis curvature exceeding ____________ degrees
40
T/F: majority of cases of Kyphoscoliosis are idiopathic presenting during childhood
true
for kyphoscoliosis males are affected __________ more than females
4x
what is the minimum cobb angle to define scoliosis
10 degrees
cobb angle (scoliosis) of 15 - 20 degrees
no treatment, regular check ups to see if curve is progressing up until bone maturity. possible PT
at what cobb angle with scoliosis will a dr generally prescribe a back brace to keep the spine from developing more of a curve?
between 20 and 30
at what cobb angle (scoliosis) may surgery (spinal fusion) be required to correct the curve?
40-50
H & P for kyphoscoliosis
- age of onset and curvature
- can pt lie flat for intubation?
- detailed plan for difficult intubation
- look for increased WOB, cyanosis, hypoventilation, asymmetric chest expansion, pectus excavatum
- fx’al status, level of exercise
what are disease states associated with kyphoscoliosis?
- neurofibromatosis
- ependymoma, astrocytoma
- cerebral palsy
- poliomyelitis
- muscular dystrophy
- freidrich ataxia
- marfan syndrome
- collagen vascular disorders
________________ is a disease state associated with kyphoscoliosis, it is a tumor that arises from a tissue of the central nervous system
ependymoma
in peds the location of an ependymoma is ______________, while in adults it is ______________
intracranial; spinal
what is the most common location of an intracranial ependymoma
fourth ventricle
