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Apex Review > Musculoskeletal diseases 3 > Flashcards

Musculoskeletal diseases 3 Flashcards

1
Q

Preoperative findings in the patient with Duchenne muscular dystrophy include: (select 2)
a. mitral stenosis
b. pulmonary fibrosis
c. increased creatine kinase
d. deep Q waves in the limb leads

A

c. increased creatine kinase
d. deep Q waves in the limb leads

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2
Q

The most common skeletal muscle myopathy is

A

Duchenne Muscular Dystrophy (DMD)

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3
Q

Duchenne muscular dystrophy results from the absence of

A

dystrophin protein

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4
Q

Patients with DMD are at risk for

A

an MH-like syndrome characterized by hyperkalemia & rhabdomyolysis (not true MH though)

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5
Q

Best practices for drugs to give and avoid with DMD include

A

do: TIVA
avoid: succinylcholine & volatile anesthetics

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6
Q

With DMD, there’s a progressive deterioration of

A

skeletal muscle strength in the first decade of life, culminating in profound weakness

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7
Q

Describe associated issues with DMD.

A

kyphoscoliosis (restrictive lung disease)
congestive heart failure
risk of aspiration

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8
Q

Describe the pathophysiology of Duchenne muscular dystrophy.

A

the absence of dystrophin destabilizes the sarcolemma during muscle contraction
the breakdown of the sarcolemma allows creatine kinase and myoglobin to enter the systemic circulation
calcium freely enters the cell, which activates proteases that destroy the contractile elements and cause inflammation, fibrosis, and cell death

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9
Q

Other types of muscular dystrophy include

A

Becker
Emery-Dreifuss
facioscapulohumeral
limb-girdle muscular dystrophy

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10
Q

Describe the respiratory considerations for patients with DMD.

A

respiratory muscle weakness
kyphoscoliosis (restrictive lung disease)–> decreased pulmonary reserve–> increased secretions and risk of pneumonia

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11
Q

Describe the cardiac considerations for patients with DMD.

A

degeneration of cardiac muscle–> reduced contractility, papillary muscle dysfunction, mitral regurgitation, cardiomyopathy, and CHF
s/s of Cardiomyopathy include resting tachycardia, JVD, S3/S4 gallop, and displacement of the point of maximal impulse

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12
Q

Patients with DMD should receive _____ prior to surgery

A

a cardiac workup

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13
Q

Describe the GI considerations for patients with DMD.

A

Impaired airway reflexes and GI hypomotility–> increased risk of pulmonary aspiration

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14
Q

Describe the EKG changes for patients with DMD.

A

impaired cardiac conduction–> sinus tachycardia and short PR interval
scarring of the posterobasal aspect (back/bottom) of the left ventricle manifests as increased R wave amplitude in lead I and deep Q waves in the limb leads

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15
Q

The Cobb angle describes

A

the magnitude of spinal curvature in a patient with scoliosis

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16
Q

Describe scoliosis.

A

A lateral and rotational curvature of the spine and ribcage

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17
Q

Describe kyphoscoliosis

A

a posterior curvature of the spinal column that produces a restrictive ventilatory defect

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18
Q

A Cobb angle > _________ is an indication for surgery

A

40-50 degrees

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19
Q

Cervicalscoliosis can cause

A

difficult intubation

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20
Q

A vital capacity of <40% predicted with scoliosis correlates with

A

requirement for post-op ventilation

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21
Q

Risks for scoliosis surgery include

A

prepare for significant blood loss
venous air embolism is a risk
monitor end-organ perfusion with serial ABG (risk of metabolic acidosis) and urine output

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22
Q

Thoracic correction of scoliosis higher than _____ may require one-lung ventilation

A

T8

23
Q

Describe the etiology of scoliosis.

A

idiopathic (incidence= 80%)
congenital
myopathic (muscular dystrophy & amyotonia congenita)
neuropathic (cerebral palsy, syringomyelia, Friedreich’s ataxia)
traumatic

24
Q

Pulmonary symptoms are present at a Cobb angle of

A

70 degrees

25
Q

At a Cobb Angle of 100 degrees,

A

gas exchange is significantly impaired
higher risk of postop pulmonary complications

26
Q

Cardiac complications, such as __________, are the result of ______________

A

RV hypertrophy; increased pulmonary vascular resistance

27
Q

An EKG may reveal ____________ & _____________ for patients with scoliosis

A

RV strain & right atrial enlargement

28
Q

Co-existing cardiac conditions for patients with scoliosis include

A

mitral valve prolapse (most common)
mitral regurgitation
coarctation of the aorta

29
Q

Deliberate hypotension to maintain MAP 60 mmHg for spinal rod insertion surgery carries the risk of

A

cerebral hypoperfusion and ischemic optic neuropathy

30
Q

If a patient can move their hands but not their feed on a wake up test, then

A

the surgeon should reduce distraction on the spinal rods

31
Q

Risks of the wakeup test include

A

pain
awareness
tracheal extubation
removal of lines
air embolism
damage to surgical instrumentation

32
Q

What three places does rheumatoid arthritis impact the airway in?

A

temporomandibular joint
cricoarytenoid joint
cervical spine

33
Q

The most common airway complication of rheumatoid arthritis is

A

atlantoaxial subluxation and separation of the atlanto-odontoid articulation
** risk for quadriparesis or paralysis

34
Q

RA decreases _____________ and the size of __________

A

mouth opening and the size of the glottic opening

35
Q

In terms of the airway setup for patients with RA, it is important to use

A

a smaller ETT to minimize laryngeal trauma d/t decreased size of glottic opening

36
Q

Patients with RA are at high risk of ___________post-extubation

A

airway obstruction

37
Q

Patients with arthritis to the cricoarytenoid joints will present with

A

hoarseness, stridor, dyspnea, and may result in airway obstruction

38
Q

Anesthetic considerations for the patient with rheumatoid arthritis include (select 3):
a. aortic regurgitation
b. obstructive ventilatory pattern
c. hypercoagulability
d. hypoglycemia
e. anemia
f. pulmonary effusion

A

e. anemia
f. pulmonary effusion
a. aortic regurgitation

39
Q

Rheumatoid arthritis is an

A

autoimmune disease that targets the synovial joints

40
Q

The hallmark symptoms of RA include

A

morning stiffness that improves with activity
painful, swollen, and warm joints
weakness, fatigue, and anorexia

41
Q

RA affects ________ where as OA typically affects ________

A

interphalangeal and metacarpophalangeal joints in the hands and feet; weight bearing joints

42
Q

Medical management of RA includes

A

reducing inflammation with antirheumatics, glucocorticoids, and NSAIDs

43
Q

Concerns with antirheumatic drugs include

A

they suppress the immune system and increase the risk of infection and cancer

44
Q

Examples of antirheumatics include

A

methotrexate, cyclosporine, and etanercept

45
Q

Systemic involvement of rheumatoid arthritis includes

A

vasculitis to the small and medium arteries

46
Q

Hematologic complications of RA include

A

anemia
platelet dysfunction secondary to NSAIDs

47
Q

Eye complications of RA include

A

Sjogren’s syndrome–> risk of corneal abrasian

48
Q

Nervous system complications of RA include

A

peripheral neuropathy due to nerve entrapment

49
Q

Renal system complications of RA include

A

renal insufficiency due to vasculitis and NSAID use

50
Q

Endocrine system complications of RA include

A

adrenal insufficiency and infections due to chronic steroid therapy

51
Q

Pulmonary complications of RA include

A

restrictive ventilatory pattern (limits chest wall expansion)
pleural effusion

52
Q

Cardiac complications of RA include

A

aortic regurgitation
valvular fibrosis
pericardial effusion or tamponade
restrictive pericarditis
coronary artery arteritis

53
Q

Lab testing for RA includes

A

rheumatoid factor which is an anti-immunoglobulin antibody that is increased in 90% of patients with RA
increased C-reactive protein
increased erythrocyte sedimentation rate

Apex Review (224 decks)

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